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Risk Factors For Intracardiac Thrombus During Liver Transplantation

Molly K Groose, Breanna N Aldred, Joshua D Mezrich, Laura L Hammel
Liver Transplantation 2019 May 22

BACKGROUND: Intracardiac thrombus (ICT) is an intraoperative complication during orthotopic liver transplantation (OLT) with high mortality. Patients with end stage liver disease have compromised coagulation pathways and when combined with stressors of surgery, thrombi can form. However, it is unknown which patients are most likely to develop ICT.

METHODS: We performed a retrospective cohort study of all OLT patients at our hospital from 2010 to 2017 to identify risk factors for ICT. Analysis was performed with conventional bivariate tests and logistic regression.

RESULTS: The incidence of ICT during OLT was 4.2% (22/528) with a 45.5% (10/22) mortality. Patients who developed ICT had higher physiologic MELD scores at the time of transplant (25.1 vs 32.4, p=.004), received grafts from donors with higher BMIs (28.1 vs 32.2, p=.01), and had longer intraoperative warm ischemia times (53.1 vs 67.5 minutes, p=.001). The odds of developing ICT were significantly lower after administration of intravenous heparin prior to inferior vena cava (IVC) clamping compared to no administration of heparin (odds ratio, 0.25; 95% confidence interval, 0.08-0.75; p=.01).

CONCLUSION: The incidence of ICT at our institution is higher than previously reported which may be explained by our routine use of transesophageal echocardiography. While many factors associated with ICT in this study are non-modifiable, administration of IV heparin prior to IVC cross-clamping is modifiable and was found to be protective. Further studies will be needed to confirm findings and ultimately aid in preventing these lethal events. This article is protected by copyright. All rights reserved.


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