Pre-transplant Portal Vein Thrombosis is an Independent Risk Factor for Postoperative Thrombotic Complications in Pediatric Liver Transplantation. - ICISA 2017 – The 24th International Conference of the Israeli Society of Anesthesiologists held jointly with the Israeli Society of Critical Care Medicine

Dmitri Bezinover ¹ Patrick McQuillan ¹ Molly Deacutis ¹ Priti Dalal ¹ Fuat Saner ² Ethan Reeder ¹ Robert Moore ³ Piotr Janicki ¹

¹Departments of Anesthesiology and Perioperative Medicine, Penn State University, Penn State Milton S. Hershey Medical Center, USA
²Department of General, Visceral and Transplant Surgery, Essen University Medical Center, Essen, Germany
³Department of Anesthesiology, School of Medicine, Washington University in St Louis, St Louis, USA

An association between preoperative portal vein thrombosis (PVT) and postoperative thrombotic complications has been previously demonstrated in adults but has not been evaluated in children. Postoperative thromboses can lead to graft failure and affect survival. The most frequent postoperative thrombotic complication in children is hepatic artery thrombosis (HAT).

We performed a retrospective UNOS database evaluation to determine the incidence of preoperative portal vein thromboses (PVT) and postoperative thromboses leading to graft failure in different age groups. Group assignments were based on trends in the frequency of pre- and postoperative thromboses specific for each age: Group I (0-5 years), Group II (6-11 years), and Group III (12-18 years). We also analyzed the data for a variety of other factors potentially related to perioperative thrombotic complications.

Between 2000 and 2015, 8133 pediatric liver transplantations (LT) were performed in the US. Among these, 361 patients (4.4%) had PVT at the time of transplantation, and 382 patients (4.7%) had postoperative thromboses. Multivariate regression analysis demonstrated that PVT at the time of LT was independently associated with postoperative thromboses leading to graft failure (OR=2.1, CI (1.2-3.4), p=0.005). This trend was especially prominent in younger children. The cause of this association is likely a combination of the re-balancing of coagulation seen in end stage liver disease, the predisposition of younger children to be hypercoagulable, and the technical challenges in performing vascular anastomoses in younger children.

In conclusion, among children presenting for LT, younger children were more likely to develop both preoperative and postoperative thrombotic complications. To avoid these thrombotic complications, perioperative antithrombotic therapy should be considered in younger children undergoing LT.