S007: INCIDENCE OF VENOUS THROMBOEMBOLIC COMPLICATIONS FIRST MONTH POST LIVER TRANSPLANTATION: SINGLE CENTER RETROSPECTIVE STUDY
Daniel Erwin Schmidt; Nicolas P Caram, MD; Mariana Acosta, MD; Marianfeli Landino, MD; Vadim Shatz, MD; Behrouz Ashrafi, MD; Ramona Nicolau-Raducu, MD, PhD; Fouad Souki, MD, MS
Jackson Memorial Hospital / University of Miami
Introduction: The incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in liver transplant patients is estimated to be between 5% to 10%. The incidence is much higher than that reported for emergency general surgery (1.9%), and much higher than the incidence in elective general surgery (0.8%).
Method: Retrospectively we review 1079 LT cases done in 1060 patients during 2016 to 2024. We extracted the demographics and characteristics of patients with extrahepatic and hepatic venous thromboembolic complications (VTE) which occurred during the first month post-transplant. We define extrahepatic VTE all DVT of upper and lower extremity and PE; while hepatic VTE was any event of portal venous thrombosis (PVT), inferior vena cava thrombosis (IVC) or hepatic ischemia. This study aims to investigate the incidence of VTE within the first month post-LT. Early VTE prophylaxis at our center consists of intermittent pneumatic compression, and aspirin 75mg starting on postoperative day two.
Results: The overall incidence of hepatic and extrahepatic VTE in our series was 9%, with a median time of 9 (5-17) days. The incidence was significantly higher in LK patients when compare with patients which received isolated LT (15% vs 8% respectively, p=0.0076*; OR 2; CI 1.233- 3.448). LK patients were significantly older, had higher MELD score and on renal replacement therapy pre-transplant, when compared with LT patients with VTE. No hepatic VTE events occurred on LK patients. However, in LT patients, extrahepatic VTE lead in 86% of cases followed by hepatic VTE (9%) and mixed extrahepatic and hepatic VTE events (5%), see Figure 1.
Conclusions: The higher incidence of VTE in LK patients is likely explained by this groups being significantly older and also having higher MELD scores. They also have additional risk factors for VTE, like central venous catheters. Interestingly, LT patients had a higher rate of hepatic VTE. They usually experience a significant drop in platelet counts post-transplant, with the lowest count between postoperative day 3-5, followed by recovery typically within two weeks, thus contributing to shift from the risk of bleeding to VTE complications.
