Volume 14, Issue 6 pp. 968-977
ORIGINAL ARTICLE

Transfusion-related acute hepatic injury following postoperative platelets administration in pediatric patients undergoing the Fontan procedure

Uri Pollak MD

Corresponding Author

Uri Pollak MD

Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Jerusalem, Israel

Pediatric Cardiology, Hadassah University Medical Center, Jerusalem, Israel

Pediatric Extracorporeal Support Program, Hadassah University Medical Center, Jerusalem, Israel

The Hebrew University Hadassah Medical School, Jerusalem, Israel

Uri Pollak and Tatyana Ruderman contributed equally to the performance of this research.

Correspondence

Uri Pollak, Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Ein Kerem, POB 12000, Jerusalem 9112001, Israel.

Email: [email protected], [email protected]

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Tatyana Ruderman BMedSc

Tatyana Ruderman BMedSc

The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Uri Pollak and Tatyana Ruderman contributed equally to the performance of this research.Search for more papers by this author
Sharon Borik-Chiger MD

Sharon Borik-Chiger MD

The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Pediatric Cardiology, Edmond J Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel

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David Mishaly MD

David Mishaly MD

The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Pediatric and Congenital Cardiac Surgery, Edmond J Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel

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Alain Serraf MD

Alain Serraf MD

The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Pediatric and Congenital Cardiac Surgery, Edmond J Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel

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Amir Vardi MD

Amir Vardi MD

The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Pediatric Cardiac Intensive Care Unit, Edmond J Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel

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First published: 25 July 2019
Citations: 4

Abstract

Objective

The final common pathway of single ventricle patients is the Fontan procedure. Among the immediate postoperative complications is acute hepatic injury presented by marked elevation of liver enzymes (alanine transaminase [ALT] and aspartate transaminase [AST]). We aimed to determine the contribution of blood products transfusion to acute hepatic injury.

Design

Single center retrospective cohort study.

Setting

Pediatric Cardiac Intensive Care Unit at a tertiary medical center.

Patients

Ninety-nine pediatric patients undergoing the Fontan procedure between January 2009 and December 2016.

Interventions

None.

Measurements and Main Results

Out of the four types of blood products, transfusion of platelets was found to significantly affect postoperative levels of ALT and AST. Additional factors included postoperative administration of sodium bicarbonate, decreased flow through the Fontan canal and decreased urine output. Preoperative pulmonary artery pressure and pulmonary vascular resistance, cardiopulmonary bypass time, aortic cross-clamp time, amount of postoperative bleeding, and vasoactive-inotropic score did not influence liver enzymes levels

Conclusions

In pediatric Fontan patients, platelets transfusions contribute to an acute hepatic injury. The relation between platelets and transfusion-related acute lung injury (TRALI) has been well described, but this is the first time it is being described in regard to acute hepatic injury (TRAHI). Changing platelet transfusion strategy could decrease morbidity in Fontan patients but further research is needed.

CONFLICT OF INTEREST

The authors declare that they do not have any conflicts of interest or ethical adherence regarding this manuscript and no financial support was obtained for its preparation.

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