Background: Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) are serious causes of morbidity and mortality after pediatric orthotopic liver transplantation (OLT). To minimize the risk of thrombosis we introduced routine anticoagulant therapy in our pediatric liver transplant program in 2003, consisting of 1 week iv heparin followed by 3 months oral acetylsalicylic acid postoperatively. This study aims to evaluate the efficacy, effects and hemorrhagic side-effects of this protocol.

Methods: This retrospective study analyzes all 200 pediatric primary OLTs performed between 2003-2016. Recipients with and without postoperative bleeding complications, defined as a bleeding requiring blood transfusion or reintervention within 3 months after transplantation, were compared.

Results: Median recipient age was 2.7 (0.8-9.5) years, 52% were male. Fifty-six full size and 144 partial grafts were derived from 162 deceased and 38 living donors. Four recipients (2%) developed HAT and 10 (5%) PVT. Seventy-two (36%) recipients developed a bleeding complication postoperatively at a median time of 3 (1-4) days. Thirty-seven of them (51%) stabilized with blood transfusion and 35 (49%) required relaparotomy. Five-year survival was lower in recipients with postoperative bleeding complications (72 vs. 86%; p=0.015). Recipients with bleeding complications more often had a hepatorenal syndrome (24 vs. 12%; p=0.031), higher Child Pugh scores (10 vs. 8; p=0.002) and longer cold ischemia times (CIT; 507 vs. 438 min; p=0.004). Intraoperative bleeding complications (43 vs. 22%; p=0.002) and blood loss (89 vs. 62 ml/kg; p=0.014) were significantly higher in recipients with postoperative bleeding complications.

Conclusion: Routine anticoagulation therapy after pediatric OLT contributed to very low rates of HAT and PVT at the expense of an increased bleeding complication risk, especially in patients with hepatorenal syndrome, high Child Pugh score, long CIT and intraoperative bleeding complications. Since bleeding complications have a negative impact on outcomes of pediatric OLT, anticoagulation should be used with caution in patients with these risk factors.

CITATION INFORMATION: Werner M., de Kleine R., de Boer M., de Meijer V., Scheenstra R., Verkade H-.J., Bodewes F., Bontemps S., Lisman T., Porte R. Anticoagulation in Pediatric Liver Transplantation; the Pros and Cons Am J Transplant. 2017;17 (suppl 3).

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