Browsing by Author "Monde, Alexandra"

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    Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?
    (Elsevier, 2023) Martinez, Mercedes; Kang, Elise; Beltramo, Fernando; Nares, Michael; Jeyapalan, Asumthia; Alcamo, Alicia; Monde, Alexandra; Ridall, Leslie; Kamath, Sameer; Betters, Kristina; Rowan, Courtney; Mangus, Richard Shane; Kaushik, Shubhi; Zinter, Matt; Resch, Joseph; Maue, Danielle; Pediatrics, School of Medicine
    Background: 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.