Volume 18, Issue 2 pp. 185-189
Original Article

Low plasma levels of antithrombin III in the early post-operative period following pediatric liver transplantation: Should they be replaced? A single-center pilot study

Jesús Quintero

Corresponding Author

Jesús Quintero

Pediatric Liver Transplant Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

Jesús Quintero, Avinguda de la Vall d'Hebron 119-129; 08035 Barcelona, Spain

Tel.: 0034 93 489 31 40

Fax: 0034 93 489 44 60

E-mail: [email protected]

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Juan Ortega

Juan Ortega

Pediatric Intensive Care Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

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Mar Miserachs

Mar Miserachs

Pediatric Liver Transplant Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

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Javier Bueno

Javier Bueno

Digestive and Transplantation Pediatric Surgery, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

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Itxarone Bilbao

Itxarone Bilbao

Liver Transplant Unit, HBP Surgery and Transplant Department, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

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Ramón Charco

Ramón Charco

Liver Transplant Unit, HBP Surgery and Transplant Department, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

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First published: 20 January 2014
Citations: 20

Abstract

eHAT after LT remains a life-threatening complication. In the majority of anticoagulation protocols, heparin is used to prevent thromboses. Our study aimed to monitor AT-III levels in the early post-LT period to assess the need for the administration of AT-III concentrate to ensure the effectiveness of heparin. We monitored coagulation daily by measuring INR, APTT, fibrinogen, platelets, and AT-III. Anticoagulation therapy consisted of LMWH, AT-III, and dipyridamole. AT-III concentrate was administered when AT-III activity was ≤60%. DUS was performed daily for the first five post-operative days or whenever vascular thrombosis was suspected. Between October 2007 and October 2011, 39 LT were performed in our center. The median age was 26 months (6–196) with a median weight of 9 kg (5.5–49). AT-III activity was ≤60% in 27 patients. Lower levels were particularly observed in partial grafts and recipients weighing less than 10 kg. Patent arterial flow was present in all 39 LT during the first five post-operative days. AT-III levels were low in 70% of pediatric patients following LT, thereby risking heparin ineffectiveness. These results may implicate low AT-III levels in the etiology of eHAT post-LT. However, this is a small single-center pilot study and further larger prospective trials are required to confirm these results.

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