Preoperative thromboelastography as a sensitive tool predicting those at risk of developing early hepatic artery thrombosis after adult liver transplantation

Firas Zahr Eldeen; Garrett R Roll; Carlos Derosas; Rajashankar Rao; Muhammad S Khan; Bridget K Gunson; James Hodson; Hynek Mergental; Ben-Hur Ferraz-Neto; John Isaac; Paolo Muiesan; Darius F Mirza; Asim Iqbal; M Thamara P R Perera

doi:10.1097/TP.0000000000001395

Preoperative thromboelastography as a sensitive tool predicting those at risk of developing early hepatic artery thrombosis after adult liver transplantation

Firas Zahr Eldeen, Garrett R Roll, Carlos Derosas, Rajashankar Rao, Muhammad S Khan, Bridget K Gunson, James Hodson, Hynek Mergental, Ben-Hur Ferraz-Neto, John Isaac, Paolo Muiesan, Darius F Mirza, Asim Iqbal, M Thamara P R Perera

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29 Citations (Scopus)

Abstract

BACKGROUND: Whilst causes of hepatic artery thrombosis (HAT) after liver transplantation (LT) are multifactorial, early HAT (E-HAT) remains pertinent complication impacting on graft and patient survival. Currently there is no screening tool that would identify patients with increased risk of developing E-HAT.

METHODS: We analyzed the native procoagulant state of LT recipients, identified through pretransplant thromboelastographic (TEG) data among other known risk factors, to identify risk factors for E-HAT.

RESULTS: The outcomes of 828 adult patients undergoing LT between 2008 and 2013 were analyzed. Overall, 79 (9.5%) patients experienced HAT, E-HAT was diagnosed in 23, and in the remainder this was "late" HAT. The maximum amplitude (MA) on preoperative TEG was significantly higher in patients diagnosed with E-HAT compared with those who did not (71.2 mm vs 57.9 mm; P < 0.0001). Receiver operating characteristic analysis with the cutoff value for MA of 65 mm or greater returned area under the curve of 0.750 (P < 0.001) predicting E-HAT with a sensitivity of 70%. A total of 7% of patients with an MA of 65 mm or greater went on to develop E-HAT (hazard ratio, 5.28; 95% confidence interval, 2.10-12.29; P < 0.001), whereas only 1.2% patients with an MA less than 65 mm experienced E-HAT.

CONCLUSIONS: Preoperative TEG may reliably identify group of recipients at greater risk of developing E-HAT, and intense surveillance and anticoagulation prophylaxis may avoid this serious complication after LT.

Original language	English
Pages (from-to)	2382-2390
Number of pages	9
Journal	Transplantation
Volume	100
Issue number	11
DOIs	https://doi.org/10.1097/TP.0000000000001395
Publication status	Published - 30 Nov 2016

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Zahr Eldeen, F., Roll, G. R., Derosas, C., Rao, R., Khan, M. S., Gunson, B. K., Hodson, J., Mergental, H., Ferraz-Neto, B-H., Isaac, J., Muiesan, P., Mirza, D. F., Iqbal, A., & Perera, M. T. P. R. (2016). Preoperative thromboelastography as a sensitive tool predicting those at risk of developing early hepatic artery thrombosis after adult liver transplantation. Transplantation, 100(11), 2382-2390. https://doi.org/10.1097/TP.0000000000001395

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title = "Preoperative thromboelastography as a sensitive tool predicting those at risk of developing early hepatic artery thrombosis after adult liver transplantation",

abstract = "BACKGROUND: Whilst causes of hepatic artery thrombosis (HAT) after liver transplantation (LT) are multifactorial, early HAT (E-HAT) remains pertinent complication impacting on graft and patient survival. Currently there is no screening tool that would identify patients with increased risk of developing E-HAT.METHODS: We analyzed the native procoagulant state of LT recipients, identified through pretransplant thromboelastographic (TEG) data among other known risk factors, to identify risk factors for E-HAT.RESULTS: The outcomes of 828 adult patients undergoing LT between 2008 and 2013 were analyzed. Overall, 79 (9.5%) patients experienced HAT, E-HAT was diagnosed in 23, and in the remainder this was {"}late{"} HAT. The maximum amplitude (MA) on preoperative TEG was significantly higher in patients diagnosed with E-HAT compared with those who did not (71.2 mm vs 57.9 mm; P < 0.0001). Receiver operating characteristic analysis with the cutoff value for MA of 65 mm or greater returned area under the curve of 0.750 (P < 0.001) predicting E-HAT with a sensitivity of 70%. A total of 7% of patients with an MA of 65 mm or greater went on to develop E-HAT (hazard ratio, 5.28; 95% confidence interval, 2.10-12.29; P < 0.001), whereas only 1.2% patients with an MA less than 65 mm experienced E-HAT.CONCLUSIONS: Preoperative TEG may reliably identify group of recipients at greater risk of developing E-HAT, and intense surveillance and anticoagulation prophylaxis may avoid this serious complication after LT.",

author = "{Zahr Eldeen}, Firas and Roll, {Garrett R} and Carlos Derosas and Rajashankar Rao and Khan, {Muhammad S} and Gunson, {Bridget K} and James Hodson and Hynek Mergental and Ben-Hur Ferraz-Neto and John Isaac and Paolo Muiesan and Mirza, {Darius F} and Asim Iqbal and Perera, {M Thamara P R}",

year = "2016",

month = nov,

day = "30",

doi = "10.1097/TP.0000000000001395",

language = "English",

volume = "100",

pages = "2382--2390",

journal = "Transplantation",

issn = "0041-1337",

publisher = "Lippincott Williams and Wilkins",

number = "11",

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Zahr Eldeen, F, Roll, GR, Derosas, C, Rao, R, Khan, MS, Gunson, BK, Hodson, J, Mergental, H, Ferraz-Neto, B-H, Isaac, J, Muiesan, P, Mirza, DF, Iqbal, A & Perera, MTPR 2016, 'Preoperative thromboelastography as a sensitive tool predicting those at risk of developing early hepatic artery thrombosis after adult liver transplantation', Transplantation, vol. 100, no. 11, pp. 2382-2390. https://doi.org/10.1097/TP.0000000000001395

TY - JOUR

T1 - Preoperative thromboelastography as a sensitive tool predicting those at risk of developing early hepatic artery thrombosis after adult liver transplantation

AU - Zahr Eldeen, Firas

AU - Roll, Garrett R

AU - Derosas, Carlos

AU - Rao, Rajashankar

AU - Khan, Muhammad S

AU - Gunson, Bridget K

AU - Hodson, James

AU - Mergental, Hynek

AU - Ferraz-Neto, Ben-Hur

AU - Isaac, John

AU - Muiesan, Paolo

AU - Mirza, Darius F

AU - Iqbal, Asim

AU - Perera, M Thamara P R

PY - 2016/11/30

Y1 - 2016/11/30

N2 - BACKGROUND: Whilst causes of hepatic artery thrombosis (HAT) after liver transplantation (LT) are multifactorial, early HAT (E-HAT) remains pertinent complication impacting on graft and patient survival. Currently there is no screening tool that would identify patients with increased risk of developing E-HAT.METHODS: We analyzed the native procoagulant state of LT recipients, identified through pretransplant thromboelastographic (TEG) data among other known risk factors, to identify risk factors for E-HAT.RESULTS: The outcomes of 828 adult patients undergoing LT between 2008 and 2013 were analyzed. Overall, 79 (9.5%) patients experienced HAT, E-HAT was diagnosed in 23, and in the remainder this was "late" HAT. The maximum amplitude (MA) on preoperative TEG was significantly higher in patients diagnosed with E-HAT compared with those who did not (71.2 mm vs 57.9 mm; P < 0.0001). Receiver operating characteristic analysis with the cutoff value for MA of 65 mm or greater returned area under the curve of 0.750 (P < 0.001) predicting E-HAT with a sensitivity of 70%. A total of 7% of patients with an MA of 65 mm or greater went on to develop E-HAT (hazard ratio, 5.28; 95% confidence interval, 2.10-12.29; P < 0.001), whereas only 1.2% patients with an MA less than 65 mm experienced E-HAT.CONCLUSIONS: Preoperative TEG may reliably identify group of recipients at greater risk of developing E-HAT, and intense surveillance and anticoagulation prophylaxis may avoid this serious complication after LT.

AB - BACKGROUND: Whilst causes of hepatic artery thrombosis (HAT) after liver transplantation (LT) are multifactorial, early HAT (E-HAT) remains pertinent complication impacting on graft and patient survival. Currently there is no screening tool that would identify patients with increased risk of developing E-HAT.METHODS: We analyzed the native procoagulant state of LT recipients, identified through pretransplant thromboelastographic (TEG) data among other known risk factors, to identify risk factors for E-HAT.RESULTS: The outcomes of 828 adult patients undergoing LT between 2008 and 2013 were analyzed. Overall, 79 (9.5%) patients experienced HAT, E-HAT was diagnosed in 23, and in the remainder this was "late" HAT. The maximum amplitude (MA) on preoperative TEG was significantly higher in patients diagnosed with E-HAT compared with those who did not (71.2 mm vs 57.9 mm; P < 0.0001). Receiver operating characteristic analysis with the cutoff value for MA of 65 mm or greater returned area under the curve of 0.750 (P < 0.001) predicting E-HAT with a sensitivity of 70%. A total of 7% of patients with an MA of 65 mm or greater went on to develop E-HAT (hazard ratio, 5.28; 95% confidence interval, 2.10-12.29; P < 0.001), whereas only 1.2% patients with an MA less than 65 mm experienced E-HAT.CONCLUSIONS: Preoperative TEG may reliably identify group of recipients at greater risk of developing E-HAT, and intense surveillance and anticoagulation prophylaxis may avoid this serious complication after LT.

U2 - 10.1097/TP.0000000000001395

DO - 10.1097/TP.0000000000001395

M3 - Article

C2 - 27780186

SN - 0041-1337

VL - 100

SP - 2382

EP - 2390

JO - Transplantation

JF - Transplantation

IS - 11

ER -

Preoperative thromboelastography as a sensitive tool predicting those at risk of developing early hepatic artery thrombosis after adult liver transplantation

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