Thrombotic complications post liver transplantation: Etiology and management

Abstract

Liver transplantation (LT) is the life saving therapeutic option for patients with acute and chronic end stage liver disease. This is a routine procedure with excellent outcomes in terms of patient survival and quality of life post LT. Orthotopic LT (OLT) patients require a critical care as they are prone to variety of post-operative vascular, cardiovascular, biliary, pulmonary and abdominal complications. Thrombotic complications (both arterial and venous) are not uncommon post liver transplant surgery. Such vascular problems lead to increased morbidity and mortality in both donor and graft recipient. Although thromboprophylaxis is recommended in general surgery patients, no such standards exist for liver transplant patients. Drastic advancements of surgical and anesthetic procedures have improvised survival rates of patients post OLT. Despite these, haemostatic imbalance leading to thrombotic events post OLT cause significant graft loss and morbidity and even lead to patient’s death. Thus it is extremely important to understand pathophysiology of thrombosis in LT patients and shorten the timing of its diagnosis to avoid morbidity and mortality in both donor and graft recipient. Present review summarizes the current knowledge of vascular complications associated with LT to highlight their impact on short and long-term morbidity and mortality post LT. Also, present report discusses the lacunae existing in the literature regarding the risk factors leading to arterial and venous thrombosis in LT patients.

Keywords: Liver transplantation; Thrombotic risk; Arterial thrombosis; Venous thrombosis; Genetic risk

Core Tip: Liver transplantation (LT) is the most widely accepted standard for treatment of end stage liver disease. Despite surgical advancements and improvements in post-operative therapeutic regime, there exists high morbidity and mortality rate due to biliary complications, renal or abdominal malfunction, pulmonary dysfunction as well as thrombotic events. Though vascular complications are seldom post orthotopic LT (OLT), they result in high incidences of morbidity and mortality. Vascular dysfunction post OLT leading to thrombotic event could be either arterial or venous. Its clinical feature depends on its type, presentation (early or late) and time taken for diagnosis. Thrombotic complications are one of the leading causes of the failure of LT. There is very scanty data available on the possible risk factors amongst individuals who develop thrombotic complications post LT. It is extremely important to monitor vascular graft supply and to ensure effective screening of every patient undergoing LT.