Cargando…

Thrombosis prophylaxis in pediatric liver transplantation: A systematic review

AIM: To review current literature of thrombosis prophylaxis in pediatric liver transplantation (PLT) as thrombosis remains a critical complication. METHODS: Studies were identified by electronic search of MEDLINE, EMBASE and Cochrane Library (CENTRAL) databases until March 2018. The search was suppl...

Descripción completa

Detalles Bibliográficos
Autores principales: Nacoti, Mirco, Ruggeri, Giulia Maria, Colombo, Giovanna, Bonanomi, Ezio, Lussana, Federico
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206147/
https://www.ncbi.nlm.nih.gov/pubmed/30386468
http://dx.doi.org/10.4254/wjh.v10.i10.752
_version_ 1783366311908212736
author Nacoti, Mirco
Ruggeri, Giulia Maria
Colombo, Giovanna
Bonanomi, Ezio
Lussana, Federico
author_facet Nacoti, Mirco
Ruggeri, Giulia Maria
Colombo, Giovanna
Bonanomi, Ezio
Lussana, Federico
author_sort Nacoti, Mirco
collection PubMed
description AIM: To review current literature of thrombosis prophylaxis in pediatric liver transplantation (PLT) as thrombosis remains a critical complication. METHODS: Studies were identified by electronic search of MEDLINE, EMBASE and Cochrane Library (CENTRAL) databases until March 2018. The search was supplemented by manually reviewing the references of included studies and the references of the main published systematic reviews on thrombosis and PLT. We excluded from this review case report, small case series, commentaries, conference abstracts, papers which describing less than 10 pediatric liver transplants/year and articles published before 1990. Two reviewers performed study selection independently, with disagreements solved through discussion and by the opinion of a third reviewer when necessary. RESULTS: Nine retrospective studies were included in this review. The overall quality of studies was poor. A pooled analysis of results from studies was not possible due to the retrospective design and heterogeneity of included studies. We found an incidence of portal vein thrombosis (PVT) ranging from 2% to 10% in pediatric living donor liver transplantation (LDLT) and from 4% to 33% in pediatric deceased donor liver transplantation (DDLT). Hepatic artery thrombosis (HAT) was observed mostly in mixed LDLT and DDLT pediatric population with an incidence ranging from 0% to 29%. In most of the studies Doppler ultrasonography was used as a first line diagnostic screening for thrombosis. Four different surgical techniques for portal vein anastomosis were reported with similar efficacy in terms of PVT reduction. Reduced size liver transplant was associated with a low risk of both PVT (incidence 4%) and HAT (incidence 0%, P < 0.05). Similarly, aortic arterial anastomosis without graft interposition and microsurgical hepatic arterial reconstruction were associated with a significant reduced HAT incidence (6% and 0%, respectively). According to our inclusion and exclusion criteria, we did not find eligible studies that evaluated pharmacological prevention of thrombosis. CONCLUSION: Poor quality retrospective studies show the use of tailored surgical strategies might be useful to reduce HAT and PVT after PLT; prospective studies are urgently needed.
format Online
Article
Text
id pubmed-6206147
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Baishideng Publishing Group Inc
record_format MEDLINE/PubMed
spelling pubmed-62061472018-10-31 Thrombosis prophylaxis in pediatric liver transplantation: A systematic review Nacoti, Mirco Ruggeri, Giulia Maria Colombo, Giovanna Bonanomi, Ezio Lussana, Federico World J Hepatol Systematic Review AIM: To review current literature of thrombosis prophylaxis in pediatric liver transplantation (PLT) as thrombosis remains a critical complication. METHODS: Studies were identified by electronic search of MEDLINE, EMBASE and Cochrane Library (CENTRAL) databases until March 2018. The search was supplemented by manually reviewing the references of included studies and the references of the main published systematic reviews on thrombosis and PLT. We excluded from this review case report, small case series, commentaries, conference abstracts, papers which describing less than 10 pediatric liver transplants/year and articles published before 1990. Two reviewers performed study selection independently, with disagreements solved through discussion and by the opinion of a third reviewer when necessary. RESULTS: Nine retrospective studies were included in this review. The overall quality of studies was poor. A pooled analysis of results from studies was not possible due to the retrospective design and heterogeneity of included studies. We found an incidence of portal vein thrombosis (PVT) ranging from 2% to 10% in pediatric living donor liver transplantation (LDLT) and from 4% to 33% in pediatric deceased donor liver transplantation (DDLT). Hepatic artery thrombosis (HAT) was observed mostly in mixed LDLT and DDLT pediatric population with an incidence ranging from 0% to 29%. In most of the studies Doppler ultrasonography was used as a first line diagnostic screening for thrombosis. Four different surgical techniques for portal vein anastomosis were reported with similar efficacy in terms of PVT reduction. Reduced size liver transplant was associated with a low risk of both PVT (incidence 4%) and HAT (incidence 0%, P < 0.05). Similarly, aortic arterial anastomosis without graft interposition and microsurgical hepatic arterial reconstruction were associated with a significant reduced HAT incidence (6% and 0%, respectively). According to our inclusion and exclusion criteria, we did not find eligible studies that evaluated pharmacological prevention of thrombosis. CONCLUSION: Poor quality retrospective studies show the use of tailored surgical strategies might be useful to reduce HAT and PVT after PLT; prospective studies are urgently needed. Baishideng Publishing Group Inc 2018-10-27 2018-10-27 /pmc/articles/PMC6206147/ /pubmed/30386468 http://dx.doi.org/10.4254/wjh.v10.i10.752 Text en ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Systematic Review
Nacoti, Mirco
Ruggeri, Giulia Maria
Colombo, Giovanna
Bonanomi, Ezio
Lussana, Federico
Thrombosis prophylaxis in pediatric liver transplantation: A systematic review
title Thrombosis prophylaxis in pediatric liver transplantation: A systematic review
title_full Thrombosis prophylaxis in pediatric liver transplantation: A systematic review
title_fullStr Thrombosis prophylaxis in pediatric liver transplantation: A systematic review
title_full_unstemmed Thrombosis prophylaxis in pediatric liver transplantation: A systematic review
title_short Thrombosis prophylaxis in pediatric liver transplantation: A systematic review
title_sort thrombosis prophylaxis in pediatric liver transplantation: a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206147/
https://www.ncbi.nlm.nih.gov/pubmed/30386468
http://dx.doi.org/10.4254/wjh.v10.i10.752
work_keys_str_mv AT nacotimirco thrombosisprophylaxisinpediatriclivertransplantationasystematicreview
AT ruggerigiuliamaria thrombosisprophylaxisinpediatriclivertransplantationasystematicreview
AT colombogiovanna thrombosisprophylaxisinpediatriclivertransplantationasystematicreview
AT bonanomiezio thrombosisprophylaxisinpediatriclivertransplantationasystematicreview
AT lussanafederico thrombosisprophylaxisinpediatriclivertransplantationasystematicreview