title: Oral surgery in liver transplant candidates: a retrospective study on delayed bleeding and other complications.
abstract: OBJECTIVE
  Untreated dental infections pose a threat for immunocompromised liver transplant (LT) recipients. Therefore, pretransplant dental evaluations are recommended. However, risk of bleeding should be considered among patients with end-stage liver disease, and prophylactic blood transfusions may be used to prevent bleeding. We performed a retrospective study of the incidence of and risk factors for oral surgery-related bleeding in candidates for LT and hypothesized that complications may occur despite preoperative and perioperative hemostatic actions.
  
  
  METHODS
  One hundred thirty-four patients who had tooth extractions performed by oral and maxillofacial surgeons before LT were studied. The primary endpoint was bleeding between 24 hours and 2 weeks after extraction. Bleeding risk was analyzed by preoperative platelet (PLT) count and international normalized ratio (INR). Invasiveness of procedures, severity of liver disease, PLT, INR, prophylactic transfusions of PLT, fresh frozen plasma, and tranexamic acid (TA) were included in univariate and multivariate logistic regression analyses to further assess risk.
  
  
  RESULTS
  Twelve patients exhibited minor bleeding; four despite PLT >100 × 10(9)/L and INR <1.5. Increased bleeding associated with INR and prophylactic transfusions by univariate analysis; by multivariate analyses, prophylactic TA (odds ratio [OR] = 8.0; 95% confidence interval [CI] 1.7-37.0), and PLT (OR = 8.3; 95% CI 1.1-62.7) remained significant.
  
  
  CONCLUSIONS
  Most extractions were safe, but prophylactic transfusions did not ensure adequate hemostasis. Local hemostatic measures and close follow-up are warranted.
authors.affiliation: Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: Jaana.s.helenius@helsinki.fi.
authors.forename: Jaana
authors.initials: J
authors.lastname: Helenius-Hietala
authors.affiliation: Department of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Åberg
authors.affiliation: Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Jukka H
authors.initials: JH
authors.lastname: Meurman
authors.affiliation: Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Arno
authors.initials: A
authors.lastname: Nordin
authors.affiliation: Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Isoniemi
mesh_terms: D001803:Blood Transfusion; D005260:Female; D005387:Finland; D006488:Hemostasis, Surgical; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D019647:Oral Surgical Procedures; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014081:Tooth Extraction
chemical_list: D006490:Hemostatics