Management of Patients with Vascular Reconstruction during Liver Transplantation

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Liver transplantation occasionally requires vascular reconstruction, such as arterial jump grafts or portal vein thrombectomy, to ensure adequate blood flow. Aspirin (ASA) and anticoagulation (AC) therapies are used to reduce thrombotic risk but may increase bleeding. Limited data exist on their impact in this context. This study evaluates the effect of ASA AC use on survival, thrombotic events, bleeding, and retransplant rates, aiming to optimize care for this high-risk group. Methods: We performed a retrospective chart review of 400 patients who underwent liver transplant between 2019 and 2023. 66 patients received an arterial jump graft, a portal vein thrombectomy, or both. Demographic factors (age, gender, race), ASA AC prescription at discharge, MELD scores at transplant, and clinical outcomes, including 1-year survival, ischemia clots, bleeding events, and retransplant or death, were collected. Patients were stratified by ASA AC prescription. Descriptive analysis was performed to identify trends in outcomes. Results: The study analyzed a cohort of 66 post-transplant patients with a median age of 62 years (range: 58-72). The majority were male (62%, n=41) and White (85%, n=56), with smaller proportions of Black (4%, n=3) and other racial backgrounds (11%, n=7). MELD scores at the time of transplant were higher in patients not on ASA AC (median: 30, range: 23-40) compared to ASA AC users (median: 24, range: 15-39). ASA AC was prescribed at discharge to 87.87% of patients, while 12.12% did not receive ASA AC. Clinical outcomes differed between groups: the 1-year survival rate was 96.5% in ASA AC users compared to 75% in non-users. The incidence of ischemia clots was comparable (27.6% vs. 25%), while bleeding events were more frequent in ASA AC users (17.2% vs. 0%). Retransplant rates were 1.72% in ASA AC users versus 12.5% in non-users. Among patients with clots, 16.7% experienced graft loss, with death occurring in 5.5% and retransplantation in 11.1% of these patients. In contrast, patients without clots had a 4.3% graft loss (death) rate and 0% retransplantation. Conclusions: ASA AC use post-transplant is associated with improved 1-year survival rates, lower retransplant and death rates, and minimal impact on ischemia clot incidence. Among patients with clots, graft loss, death, and retransplantation rates were notably higher than in patients without clots. These findings suggest ASA AC may confer protective benefits in the post-transplant population, warranting further research to optimize its role in this context. CITATION INFORMATION: Alomari A., Althunibat I., Saleem A., Abusuliman M., Omari Y., Jomaa D., Dababneh Y., Jafri S. Management of Patients with Vascular Reconstruction during Liver Transplantation AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES:

Volume

25

Issue

8

First Page

S455

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