Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study

Yehuda Raveh, Yiliam Rodriguez, Ernesto Pretto, Fouad Souki, Vadim Shatz, Behrouz Ashrafi, Vinaya Manmohansigh, Michael Demos, Joshua Livingstone, Georges Nasrallah, David Andrews, Thiago Beduschi, Rodrigo Vianna, Ramona Nicolau-Raducu

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

This study describes the risk of thrombotic and hemorrhagic complications, both intraoperatively, and up to 1 month following visceral transplantation. Data from 48 adult visceral transplants performed between 2010 and 2017 were retrospectively studied [32 multivisceral (MVTx); 10 isolated intestine; six modified-MVTx]. Intraoperatively, intracardiac thrombosis (ICT)/pulmonary embolism (PE) occurred in 25%, 0% and 0% of MVTx, isolated intestine and modified MVTx, respectively, and was associated with 50% (4/8) mortality. Preoperative portal vein thrombosis (PVT) was a significant risk factor for ICT/PE (P = 0.0073). Thromboelastography resembling disseminated intravascular coagulation (DIC) (r time <4 mm combined with fibrinolysis or flat-line) was statistically associated with occurrence of ICT/PE (P < 0.0001). Compared to subgroup without ICT/PE, occurrence of ICT/PE was associated with an increased demand for all blood product components both overall, and each surgical stage. Hyperfibrinolysis (56%) was identified as cause of bleeding in MVTx. Incidence of postoperative thrombotic event at 1 month was 25%, 30% and 17% for MVTx, isolated intestine and modified MVTx, respectively. Incidence of postoperative bleeding complications at 1 month was 11%, 20% and 17% for MVTx, isolated intestine and modified MVTx. In conclusion, MVTx recipients with preoperative PVT are at an increased risk of developing intraoperative life-threatening ICT/PE events associated with DIC-like coagulopathy.

Original languageEnglish (US)
Pages (from-to)1125-1134
Number of pages10
JournalTransplant International
Volume31
Issue number10
DOIs
StatePublished - Oct 1 2018

Keywords

  • bleeding
  • disseminated intravascular coagulation
  • intracardiac thrombosis
  • multivisceral transplant
  • pulmonary embolism
  • thromboelastography

ASJC Scopus subject areas

  • Transplantation

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