PhD ceremony: N. Warnaar, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen
Thesis: Trombotic complications in liver transplantation
Promotor(s): prof. R.J. Porte, prof. J.A. Lisman
Faculty: Medical Sciences
Orthotopic liver transplantation (OLT) is a successful treatment for patients with end-stage acute or chronic liver disease. Historically OLT was a major surgical procedure, often complicated by massive blood loss. The traditional concept on contributors to this bleeding included coagulation abnormalities secondary to the preexisting liver disease. Anti-hemostatic agents were thought to be contraindicated.
Recent studies though show that overall hemostatic function in patients with cirrhosis may not be as abnormal as traditionally believed. The alterations concern both pro- and anti-hemostatic pathways, resulting in a rebalanced system, albeit with more narrow margins. These patients are therefore not only at risk for bleeding, but also for thromboembolic complications.
Multiple cases of central venous thromboembolic events during or after OLT have been described. Also the development of hepatic artery thrombosis (HAT) is a dreaded complication. In this thesis the literature on this subject is reviewed and two studies are described regarding the incidence of and risk factors for the development of central venous thromboembolic events in OLT. Another study describes the long-term results of urgent intervention for HAT after pediatric OLT. The impact of intraoperative use of antifibrinolytic drugs in OLT on the development of thromboembolic complications and renal dysfunction was studied; and no association was found. In conclusion: a) patients with liver failure are not exempt from thromboembolic complications, which are not uncommon. b) the use of antifibrinolytic drugs in OLT is safe and does not increase the number of thromboembolic complications. c) anti-hemostatic drugs shouln’t be contraindicated in patients undergoing OLT and more research is warranted on this subject.
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