title: Increased risk of vascular thrombosis in pediatric liver transplant recipients with thrombophilia.
abstract: BACKGROUND
  Pediatric patients who undergo liver transplantation are at higher risk of developing vascular complications when compared to adult liver transplant recipients. The consequences of hepatic artery thrombosis (HAT) or portal vein thrombosis (PVT) can cause significant morbidity and mortality. We examined pediatric liver transplant recipients who developed vascular thrombosis and the presence of thrombophilia.
  
  
  METHODS
  We examined outcome in all pediatric patients who underwent liver transplantation. Recipient, donor demographic data, and outcome data were examined. Categorical differences were compared using the unpaired Student t-test and nominal variables using either the chi-square or the Fischer exact test. A P value of <0.05 was considered significant.
  
  
  RESULTS
  Forty-six pediatric patients underwent liver transplantation. Twenty-one recipients were found to have thrombophilia, including 5 with HAT and 2 with PVT. When comparing recipients with or without any vascular thrombosis, those with thrombophilia had a significantly higher incidence of developing a vascular thrombosis (7/21 versus 0/25, P = 0.0017). Five of 42 recipients with artery-to-artery reconstruction developed HAT versus 0 of 4 with a conduit. Recipients who developed any thrombosis were significantly lower in weight than those who did not develop any thrombosis (9.0 ± 1.6 kg versus 22.2 ± 16.0 kg, P = 0.0366).
  
  
  CONCLUSIONS
  All pediatric liver transplant recipients who developed any vascular thrombosis were also found to have thrombophilia. Recipients who were smaller in size were at significantly higher risk of developing vascular thrombosis. Lower weight recipients with thrombophilia may benefit from arterial reconstruction with a conduit to decrease the risk of vascular thrombosis.
authors.affiliation: Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cha
authors.affiliation: Department of Surgery, Marin General Hospital, Greenbrae, California; Department of Surgery, Stanford University Medical Center, Stanford, California.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Alfrey
authors.affiliation: Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Pediatric Transplantation, Department of Surgery, Children's Medical Center, Dallas, Texas.
authors.forename: Dev M
authors.initials: DM
authors.lastname: Desai
authors.affiliation: Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Pediatric Transplantation, Department of Surgery, Children's Medical Center, Dallas, Texas.
authors.forename: Malcolm
authors.initials: M
authors.lastname: MacConmara
authors.affiliation: Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Pediatric Transplantation, Department of Surgery, Children's Medical Center, Dallas, Texas. Electronic address: christine.hwang@utsouthwestern.edu.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Hwang
mesh_terms: D002648:Child; D002675:Child, Preschool; D006499:Hepatic Artery; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D011169:Portal Vein; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D019851:Thrombophilia / Q000150:complications*; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*
keywords: Liver transplant; Pediatric; Rejection; Thrombophilia; Thrombosis