Martinez, MercedesKang, EliseBeltramo, FernandoNares, MichaelJeyapalan, AsumthiaAlcamo, AliciaMonde, AlexandraRidall, LeslieKamath, SameerBetters, KristinaRowan, CourtneyMangus, Richard ShaneKaushik, ShubhiZinter, MattResch, JosephMaue, Danielle2024-04-172024-04-172023Martinez M, Kang E, Beltramo F, et al. Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?. J Liver Transpl. 2023;12:100185. doi:10.1016/j.liver.2023.100185https://hdl.handle.net/1805/40080Background: Vascular thromboses (VT) are life-threatening events after pediatric liver transplantation (LT). Single-center studies have identified risk factors for intra-abdominal VT, but large-scale pediatric studies are lacking. Methods: This multicenter retrospective cohort study of isolated pediatric LT recipients assessed pre- and perioperative variables to determine VT risk factors and anticoagulation-associated bleeding complications. Results: Within seven postoperative days, 31/331 (9.37%) patients developed intra-abdominal VT. Open fascia occurred more commonly in patients with VT (51.61 vs 23.33%) and remained the only independent risk factor in multivariable analysis (OR = 2.84, p = 0.012). Patients with VT received more blood products (83.87 vs 50.00%), had significantly higher rates of graft loss (22.58 vs 1.33%), infection (50.00 vs 20.60%), and unplanned return to the operating room (70.97 vs 16.44%) compared to those without VT. The risk of bleeding was similar (p = 0.2) between patients on and off anticoagulation. Conclusions: Prophylactic anticoagulation did not increase bleeding complications in this cohort. The only independent factor associated with VT was open fascia, likely a graft/recipient size mismatch surrogate, supporting the need to improve surgical techniques to prevent VT that may not be modifiable with anticoagulation.en-USPublisher PolicyPediatric liver transplantationVascular complicationsHepatic artery thrombosisPortal vein thrombosisArticle