Thrombotic complications remain a significant source of morbidity and mortality in pediatric liver transplantation. Derangements in the hemostatic system are quite common, but the incidence of hypercoagulability remains unknown. From 2011 to 2012 all patients at our center considered for pediatric liver transplantation were evaluated with a detailed hypercoagulability work up. Herein we report our experience with hypercoagulability evaluations of the patients that underwent liver transplantation in the last two years.

Prior to transplant, patients were checked for: Lupus Anticoagulant screen, Factor V Liden, Protein C activity and antigen, Protein S activity and antigen, Anti thrombin III activity and antigen, Lipoprotein A levels, and the factor V and VIII assays. Antibody panels included the phosphatidylserene antibody panel, anti cardiolipin antibody panel, and the Beta 2 Glycoprotein antibody panel. Finally, genetic analysis included the PAI-1 gene analysis, Factor II Prothrombin gene mutation, and the MTHFR mutations together with the homosystene levels. Charts were reviewed for laboratory data and patient demographics and outcomes.

From January 2011 to December 2012 we performed liver transplants on 22 pediatric patients. The age range was 5 months to 16 years. During this time there were 6 LLS from living donors, 2 LLS from cadaveric splits, and 3 liver kidney transplants. The remaining transplants were cadaveric whole organ liver transplants. Three patients were undergoing a second liver transplant. All 22 patients had one or more positive findings in their hypercoagulability evaluation (Mean 2.5, Range 1-8). Abnormal Lupus antibodies were the most common finding (55%) followed by elevated factor VIII levels (36%). During this time period there were 4 thrombotic complications, three of which resulted in a graft loss, with one mortality. The patient with the mortality had 5 positive findings and developed simultaneous HAT and PVT. An abnormal phosphatidyserine antibody was associated with all three graft losses.

Laboratory alterations suggestive of hypercoagulability are common in patients undergoing pediatric liver transplant, and routine screening can be used to identify patients at risk for adverse outcomes.

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