Risk Factors and Outcomes of Intracardiac Thrombosis During Orthotopic Liver Transplantation

Authors

Waleed Al-Darzi, Henry Ford HealthFollow
Yusuf Alalwan, Henry Ford HealthFollow
Firas Askar, Henry Ford HealthFollow
Omar Sadiq, Henry Ford HealthFollow
Deepak Venkat, Henry Ford HealthFollow
Humberto C. Gonzalez, Henry Ford HealthFollow
Dragos Galusca, Henry Ford HealthFollow
Atsushi Yoshida, Henry Ford HealthFollow
Syed Mohammed Jafri, Henry Ford HealthFollow

Recommended Citation

Al-Darzi W, Alalwan Y, Askar F, Sadiq O, Venkat D, Gonzalez HC, Galusca D, Yoshida A, Jafri S. Risk Factors and Outcomes of Intracardiac Thrombosis During Orthotopic Liver Transplantation. Transplantation Proceedings 2021; 53(1):250-254.

Document Type

Article

Publication Date

1-1-2021

Publication Title

Transplantation Proceedings

Abstract

Background: Intracardiac thrombosis incidence during orthotopic liver transplantation is estimated at 0.36% to 6.2% with mortality up to 68%. We aimed to evaluate risk factors and outcomes related to intracardiac thrombosis during orthotopic liver transplantation.

Materials and Methods: A comprehensive retrospective data review of 388 patients who underwent orthotopic liver transplantation at an urban transplant center from January 2013 to October 2016 was obtained.

Results: Six patients were found to have documented intracardiac thrombosis; 4 cases were recognized during the reperfusion stage and 1 during pre-anhepatic stage. All allografts were procured from decreased donors with a median donor age of 44 years (interquartile range, 35.25-49.75) and the cause of death was listed as cerebrovascular accident in 5 donors. Preoperative demographic, clinical, laboratory, and historical risk factors did not differ in patients with thrombosis. None had a prior history of trans-jugular intrahepatic portosystemic shunt or gastrointestinal bleeding. Three patients had renal injury, but no intraoperative hemodialysis was performed. Transesophageal echocardiographic findings included elevated pulmonary artery pressure (1/6), right ventricular strain (1/6), and pulmonary artery thrombus (1/6). Three patients died intraoperatively. Tissue plasminogen activator alone was given to 1 patient who did not survive, intravenous heparin only to 1 patient with resolution, and a combination of both was used in 2 patients with clot resolution achieved.

Conclusion: Cardiac thrombosis should be considered in patients having hemodynamic compromise during liver transplantation. Transesophageal echocardiography is a useful diagnostic tool. Intracardiac thrombosis treatment remains challenging; however, using both thrombolytics and heparin could achieve better results.

PubMed ID

33246584

Volume

53

Issue

1

First Page

250

Last Page

254