Perioperative thrombotic complications associated with pediatric liver transplantation: a UNOS database evaluation.
Journal
HPB : the official journal of the International Hepato Pancreato Biliary Association
ISSN: 1477-2574
Titre abrégé: HPB (Oxford)
Pays: England
ID NLM: 100900921
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
01
06
2018
accepted:
31
08
2018
pubmed:
30
9
2018
medline:
4
4
2020
entrez:
30
9
2018
Statut:
ppublish
Résumé
This retrospective UNOS database evaluation analyzes the prevalence of preoperative portal vein thromboses (PVT), and postoperative thromboses leading to graft failure in pediatric patients undergoing liver transplantation (LT). The evaluation was performed in three age groups: I (0-5), II (6-11), III (12-18) years old. Factors predictive of pre- and postoperative thromboses were analyzed. Between 2000 and 2015, 8982 pediatric LT were performed in the US. Of those, 390 patients had preoperative PVT (4.3%), and 396 (4.4%) had postoperative thromboses. The prevalence of both types of thromboses was less in Group III than in the other two groups (3.20% vs 4.65%, p = 0.007 and 1.73% vs. 5.13%, p < 0.001, respectively). The prevalence of postoperative thromboses was significantly higher in Group I than in the other two groups (5.49% vs. 2.51%, p < 0.001). Preoperative PVT was independently associated with postoperative thromboses (OR = 1.7, p = 0.02). Children less than 5 years of age were more likely to develop postoperative thromboses leading to graft failure (OR = 2.9, p < 0.001). Younger children undergoing LT are prone to pre-and postoperative thrombotic complications. Preoperative PVT at the time of transplantation was independently associated with postoperative thromboses. Perioperative antithrombotic therapy should be considered in pediatric patients undergoing LT.
Sections du résumé
BACKGROUND
This retrospective UNOS database evaluation analyzes the prevalence of preoperative portal vein thromboses (PVT), and postoperative thromboses leading to graft failure in pediatric patients undergoing liver transplantation (LT).
METHODS
The evaluation was performed in three age groups: I (0-5), II (6-11), III (12-18) years old. Factors predictive of pre- and postoperative thromboses were analyzed.
RESULTS
Between 2000 and 2015, 8982 pediatric LT were performed in the US. Of those, 390 patients had preoperative PVT (4.3%), and 396 (4.4%) had postoperative thromboses. The prevalence of both types of thromboses was less in Group III than in the other two groups (3.20% vs 4.65%, p = 0.007 and 1.73% vs. 5.13%, p < 0.001, respectively). The prevalence of postoperative thromboses was significantly higher in Group I than in the other two groups (5.49% vs. 2.51%, p < 0.001). Preoperative PVT was independently associated with postoperative thromboses (OR = 1.7, p = 0.02). Children less than 5 years of age were more likely to develop postoperative thromboses leading to graft failure (OR = 2.9, p < 0.001).
CONCLUSION
Younger children undergoing LT are prone to pre-and postoperative thrombotic complications. Preoperative PVT at the time of transplantation was independently associated with postoperative thromboses. Perioperative antithrombotic therapy should be considered in pediatric patients undergoing LT.
Identifiants
pubmed: 30266497
pii: S1365-182X(18)33946-7
doi: 10.1016/j.hpb.2018.08.014
pmc: PMC7480188
mid: NIHMS1626821
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
370-378Subventions
Organisme : NIDDK NIH HHS
ID : L30 DK118601
Pays : United States
Informations de copyright
Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
Références
Liver Int. 2013 Jul;33(6):820-7
pubmed: 23490221
World J Gastroenterol. 2001 Apr;7(2):208-15
pubmed: 11819762
J Pediatr Surg. 1988 Oct;23(10):927-30
pubmed: 3069996
Thromb Haemost. 2016 Jul 4;116(1):9-16
pubmed: 26988943
World J Gastroenterol. 2016 Feb 14;22(6):2005-23
pubmed: 26877606
Thromb Haemost. 2011 Dec;106(6):1046-52
pubmed: 22012181
Cardiovasc Intervent Radiol. 2018 Jan;41(1):96-103
pubmed: 28913651
Liver Transpl Surg. 1997 Jul;3(4):351-8
pubmed: 9346763
Am J Transplant. 2009 Apr;9(4):746-57
pubmed: 19298450
Liver Transpl. 2015 Aug;21(8):1016-21
pubmed: 25845711
World J Gastroenterol. 2015 Jul 14;21(26):8004-13
pubmed: 26185371
Transplant Proc. 2010 Oct;42(8):2970-2
pubmed: 20970585
Transplant Proc. 2003 Jun;35(4):1447-8
pubmed: 12826187
Clinics (Sao Paulo). 2014;69 Suppl 1:42-6
pubmed: 24860858
Digestion. 2013;88(3):135-44
pubmed: 24008288
Ann Surg. 2007 Aug;246(2):301-10
pubmed: 17667510
Thromb Haemost. 2004 Feb;91(2):267-75
pubmed: 14961153
BMC Anesthesiol. 2016 May 21;16(1):26
pubmed: 27207434
Clin Transplant. 2004 Aug;18(4):390-4
pubmed: 15233815
J Pediatr Surg. 1995 Aug;30(8):1122-6
pubmed: 7472963
HPB (Oxford). 2017 Jul;19(7):620-628
pubmed: 28495438
J Pediatr Surg. 2012 Jun;47(6):1255-60
pubmed: 22703802
Ann Surg. 2002 Jan;235(1):125-32
pubmed: 11753051
HPB (Oxford). 2016 Mar;18(3):279-86
pubmed: 27017168
Clin Cancer Res. 2003 Nov 1;9(14):5339-45
pubmed: 14614019
Liver Transpl. 2013 Nov;19 Suppl 2:S14-6
pubmed: 24019107
Semin Fetal Neonatal Med. 2011 Dec;16(6):301-4
pubmed: 21810548
J Hepatol. 2004 May;40(5):736-41
pubmed: 15094219
J Hepatol. 2014 Jul;61(1):148-54
pubmed: 24657400
J Am Coll Surg. 2009 May;208(5):896-903; discussion 903-5
pubmed: 19476857
Transplant Proc. 2012 Jun;44(5):1373-8
pubmed: 22664018
Liver Transpl. 2013 Mar;19(3):315-21
pubmed: 23495080
Gastroenterology. 1991 Nov;101(5):1382-90
pubmed: 1718809
Am J Gastroenterol. 2006 Jul;101(7):1524-8; quiz 1680
pubmed: 16863556
Transplantation. 1992 Feb;53(2):396-9
pubmed: 1738935
Transplantation. 1997 Jul 27;64(2):242-8
pubmed: 9256181
Transplantation. 1989 Jun;47(6):971-7
pubmed: 2472028
Liver Transpl. 2011 Sep;17(9):1066-72
pubmed: 21744467
Thromb Res. 2008;122(3):299-306
pubmed: 18045666
Transplantation. 1998 May 15;65(9):1172-8
pubmed: 9603163
Blood. 1987 Jul;70(1):165-72
pubmed: 3593964
Transpl Int. 2006 Jan;19(1):27-37
pubmed: 16359374
Pediatr Transplant. 2005 Aug;9(4):486-90
pubmed: 16048601
J Pediatr. 1987 Apr;110(4):545-8
pubmed: 3550022
Am J Transplant. 2012 Jun;12(6):1496-503
pubmed: 22390346