Aprotinin and the risk of thrombotic complications after liver transplantation: a retrospective analysis of 1492 patients.
Aprotinin is an antifibrinolytic drug that reduces blood loss during orthotopic liver transplantation (OLT). Case reports have suggested that aprotinin may be associated with an increased risk of thromboembolic complications. Recent studies in cardiac surgery also have suggested a higher risk of renal failure and postoperative mortality. Despite these concerns, no large-scale safety assessment has been performed in OLT. In a retrospective observational study involving 1492 liver transplants, we studied the occurrence of postoperative thromboembolic or thrombotic events and mortality in patients who received aprotinin (n = 907) and patients who did not (n = 585). The overall incidence of hepatic artery thrombosis and central venous complications (pulmonary embolism or inferior vena cava thrombosis) was 3.2% and 0.9%, respectively. In propensity score-adjusted analyses (C-index = 0.79), aprotinin was not associated with an increased risk of hepatic artery thrombosis [odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.50-2.01, P = 0.86]. Although central venous complications were found more frequently in patients receiving aprotinin, the difference was not statistically significant (OR = 2.95, 95% CI = 0.54-16.23, P = 0.32). In addition, no significant differences were found in 1-year mortality (OR = 1.21, 95% CI = 0.86-1.71, P = 0.32). In conclusion, this study did not demonstrate an increased risk of thrombotic complications or mortality when aprotinin is used during OLT.
Warnaar
Nienke
N
Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Mallett
Susan V
SV
Klinck
John R
JR
de Boer
Marieke T
MT
Rolando
Nancy
N
Burroughs
Andrew K
AK
Jamieson
Neville V
NV
Rolles
Keith
K
Porte
Robert J
RJ
D000328:Adult; D007611:Aprotinin / Q000494:pharmacology*; D005260:Female; D006490:Hemostatics / Q000494:pharmacology; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012306:Risk; D013927:Thrombosis / Q000150:complications / Q000209:etiology*; D016896:Treatment Outcome
D006490:Hemostatics; D007611:Aprotinin