Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: Effect of microvascular techniques and a customized anticoagulation protocol
William A. Ziaziaris
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
Search for more papers by this authorAlexandre Darani
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorAndrew J. A. Holland
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
Search for more papers by this authorAngus Alexander
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorJonathan Karpelowsky
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
Search for more papers by this authorPasquale Barbaro
Department of Haematology, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorMichael Stormon
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
Department of Gastroenterology, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorEdward O'Loughlin
Department of Gastroenterology, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorAlbert 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
Search for more papers by this authorCorresponding Author
Gordon Thomas
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
Correspondence
Gordon Thomas, Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Email: [email protected]
Search for more papers by this authorWilliam A. Ziaziaris
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
Search for more papers by this authorAlexandre Darani
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorAndrew J. A. Holland
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
Search for more papers by this authorAngus Alexander
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorJonathan Karpelowsky
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
Search for more papers by this authorPasquale Barbaro
Department of Haematology, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorMichael Stormon
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
Department of Gastroenterology, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorEdward O'Loughlin
Department of Gastroenterology, The Children's Hospital at Westmead, Westmead, NSW, Australia
Search for more papers by this authorAlbert 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
Search for more papers by this authorCorresponding Author
Gordon Thomas
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
Correspondence
Gordon Thomas, Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Email: [email protected]
Search for more papers by this authorAbstract
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.
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