title: Autoimmune conditions are associated with perioperative thrombotic complications in liver transplant recipients: A UNOS database analysis.
abstract: End stage liver disease (ESLD) is associated with significant thrombotic complications. In this study, we attempted to determine if patients with ESLD, due to oncologic or autoimmune diseases, are susceptible to thrombosis to a greater extent than patients with ESLD due to other causes.
  
  
  
  In this retrospective study, we analyzed the UNOS database to determine the incidence of thrombotic complications in orthotopic liver transplant (OLT) recipients with autoimmune and oncologic conditions. Between 2000 and 2012, 65,646 OLTs were performed. We found 4,247 cases of preoperative portal vein thrombosis (PVT) and 1,233 cases of postoperative vascular thrombosis (VT) leading to graft failure.
  
  
  
  Statistical evaluation demonstrated that patients with either hepatocellular carcinoma (HCC) or autoimmune hepatitis (AIC) had a higher incidence of PVT (p = 0.05 and 0.03 respectively). Patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and AIC had a higher incidence of postoperative VT associated with graft failure (p < 0.0001, p < 0.0001, p = 0.05 respectively). Patients with preoperative PVT had a higher incidence of postoperative VT (p < 0.0001). Multivariable logistic regression demonstrated that patients with AIC, and BMI ≥40, having had a transjugular intrahepatic portosystemic shunt, and those with diabetes mellitus were more likely to have preoperative PVT: odds ratio (OR)(1.36, 1.19, 1.78, 1.22 respectively). Patients with PSC, PBC, AIC, BMI ≤18, or with a preoperative PVT were more likely to have a postoperative VT: OR (1.93, 2.09, 1.64, 1.60, and 2.01, respectively).
  
  
  
  Despite the limited number of variables available in the UNOS database potentially related to thrombotic complications, this analysis demonstrates a clear association between autoimmune causes of ESLD and perioperative thrombotic complications. Perioperative management of patients at risk should include strategies to reduce the potential for these complications.
authors.affiliation: Department of Anesthesiology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. dbezinover@hmc.psu.edu.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Bezinover
authors.affiliation: Department of Public Health Sciences, Penn State College of Medicine/Penn State Hershey Medical Center, 90 Hope Drive, Hershey, PA, 17033, USA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Iskandarani
authors.affiliation: Department of Public Health Sciences, Penn State College of Medicine/Penn State Hershey Medical Center, 90 Hope Drive, Hershey, PA, 17033, USA.
authors.forename: Vernon
authors.initials: V
authors.lastname: Chinchilli
authors.affiliation: Department of Anesthesiology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: McQuillan
authors.affiliation: Department of General, Visceral- and Transplant Surgery/Essen University Medical Center, Hufelandstr. 55, Essen, 45147, Germany.
authors.forename: Fuat
authors.initials: F
authors.lastname: Saner
authors.affiliation: Department of Surgery, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, USA.
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Kadry
authors.affiliation: Department of Gastroenterology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Riley
authors.affiliation: Department of Anesthesiology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Piotr K
authors.initials: PK
authors.lastname: Janicki
mesh_terms: D001327:Autoimmune Diseases / Q000150:complications / Q000453:epidemiology*; D016208:Databases, Factual / Q000706:statistics & numerical data; D058625:End Stage Liver Disease / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: Antithrombotic prophylaxis; Autoimmune and oncologic conditions; Hepatic artery thrombosis; Liver transplantation; Portal vein thrombosis