Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: Effect of microvascular techniques and a customized anticoagulation protocol.
We aimed to assess the incidence of HAT over three eras following implementation of microvascular techniques and a customized anticoagulation protocol in a predominantly cadaveric split liver transplant program. We retrospectively reviewed pediatric liver transplants performed between April 1986 and 2016 and analyzed the incidence HAT over three eras. In E1, 1986-2008, each patient received a standard dose of 5 U/kg/h of heparin and coagulation profiles normalized passively. In E2, 2008-2012, microvascular techniques were introduced. In E3, 2012-2016, in addition, a customized anticoagulation protocol was introduced which included replacement of antithrombin 3, protein C and S, and early heparinization. A total of 317 liver transplants were completed during the study period, with a median age of 31.7 months. In E1, 22% of grafts were cadaveric in situ split grafts, while the second and third eras used split grafts in 59.0% and 64.9% of cases, respectively. HAT occurred in 9.5% in the first era, 11.5% (P=.661) in the second, and dropped to 1.8% in the third era (P=.043). A routine anticoagulation protocol has significantly reduced the incidence of HAT post-liver transplantation in children in a predominantly cadaveric in situ split liver transplant program.
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.|Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
William A
http://orcid.org/0000-0001-6804-8041
WA
Ziaziaris
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Alexandre
A
Darani
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.|Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Andrew J A
AJA
Holland
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Angus
A
Alexander
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.|Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Jonathan
J
Karpelowsky
Department of Haematology, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Pasquale
P
Barbaro
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.|Department of Gastroenterology, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Michael
M
Stormon
Department of Gastroenterology, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Edward
E
O'Loughlin
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.|Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Albert
A
Shun
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.|Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Gordon
G
Thomas
D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
D000925:Anticoagulants
anticoagulation protocol; hepatic artery thrombosis; liver transplantation; microsurgery; pediatric; split liver graft