Low plasma levels of antithrombin III in the early post-operative period following pediatric liver transplantation: should they be replaced? A single-center pilot study.
eHAT after LT remains a life-threatening complication. In the majority of anticoagulation protocols, heparin is used to prevent thromboses. Our study aimed to monitor AT-III levels in the early post-LT period to assess the need for the administration of AT-III concentrate to ensure the effectiveness of heparin. We monitored coagulation daily by measuring INR, APTT, fibrinogen, platelets, and AT-III. Anticoagulation therapy consisted of LMWH, AT-III, and dipyridamole. AT-III concentrate was administered when AT-III activity was ≤60%. DUS was performed daily for the first five post-operative days or whenever vascular thrombosis was suspected. Between October 2007 and October 2011, 39 LT were performed in our center. The median age was 26 months (6-196) with a median weight of 9 kg (5.5-49). AT-III activity was ≤60% in 27 patients. Lower levels were particularly observed in partial grafts and recipients weighing less than 10 kg. Patent arterial flow was present in all 39 LT during the first five post-operative days. AT-III levels were low in 70% of pediatric patients following LT, thereby risking heparin ineffectiveness. These results may implicate low AT-III levels in the etiology of eHAT post-LT. However, this is a small single-center pilot study and further larger prospective trials are required to confirm these results.
Pediatric Liver Transplant Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
Jesús
J
Quintero
Juan
J
Ortega
Mar
M
Miserachs
Javier
J
Bueno
Itxarone
I
Bilbao
Ramón
R
Charco
D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D000990:Antithrombin III / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D017093:Liver Failure / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D010865:Pilot Projects; D011184:Postoperative Period; D013927:Thrombosis / Q000473:pathology
D000925:Anticoagulants; D007166:Immunosuppressive Agents; D000990:Antithrombin III; D006493:Heparin
anticoagulation; children; early hepatic artery thrombosis; low-molecular-weight heparin