Autoimmune conditions are associated with perioperative thrombotic complications in liver transplant recipients: A UNOS database analysis

BMC Anesthesiology

Research Article

Dmitri Bezinover¹  Piotr K. Janicki¹  Patrick McQuillan¹  Thomas R. Riley²  Fuat Saner³  Vernon Chinchilli⁴  Khaled Iskandarani⁴  Zakiyah Kadry⁵ 

[1] Department of Anesthesiology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, 17033, Hershey, PA, USA;Department of Gastroenterology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, 17033, Hershey, PA, USA;Department of General, Visceral- and Transplant Surgery/Essen University Medical Center, Hufelandstr. 55, 45147, Essen, Germany;Department of Public Health Sciences, Penn State College of Medicine/Penn State Hershey Medical Center, 90 Hope Drive, 17033, Hershey, PA, USA;Department of Surgery, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Dr, 17033, Hershey, PA, USA;

关键词: Liver transplantation;    Portal vein thrombosis;    Hepatic artery thrombosis;    Autoimmune and oncologic conditions;    Antithrombotic prophylaxis;   

DOI  :  10.1186/s12871-016-0192-3

 received in 2016-02-03, accepted in 2016-05-04,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundEnd stage liver disease (ESLD) is associated with significant thrombotic complications. In this study, we attempted to determine if patients with ESLD, due to oncologic or autoimmune diseases, are susceptible to thrombosis to a greater extent than patients with ESLD due to other causes.MethodsIn this retrospective study, we analyzed the UNOS database to determine the incidence of thrombotic complications in orthotopic liver transplant (OLT) recipients with autoimmune and oncologic conditions.Between 2000 and 2012, 65,646 OLTs were performed. We found 4,247 cases of preoperative portal vein thrombosis (PVT) and 1,233 cases of postoperative vascular thrombosis (VT) leading to graft failure.ResultsStatistical evaluation demonstrated that patients with either hepatocellular carcinoma (HCC) or autoimmune hepatitis (AIC) had a higher incidence of PVT (p = 0.05 and 0.03 respectively). Patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and AIC had a higher incidence of postoperative VT associated with graft failure (p < 0.0001, p < 0.0001, p = 0.05 respectively). Patients with preoperative PVT had a higher incidence of postoperative VT (p < 0.0001). Multivariable logistic regression demonstrated that patients with AIC, and BMI ≥40, having had a transjugular intrahepatic portosystemic shunt, and those with diabetes mellitus were more likely to have preoperative PVT: odds ratio (OR)(1.36, 1.19, 1.78, 1.22 respectively). Patients with PSC, PBC, AIC, BMI ≤18, or with a preoperative PVT were more likely to have a postoperative VT: OR (1.93, 2.09, 1.64, 1.60, and 2.01, respectively).ConclusionDespite the limited number of variables available in the UNOS database potentially related to thrombotic complications, this analysis demonstrates a clear association between autoimmune causes of ESLD and perioperative thrombotic complications. Perioperative management of patients at risk should include strategies to reduce the potential for these complications.

【 授权许可】

CC BY   
© Bezinover et al. 2016