TY - JOUR
T1 - Donor tobacco smoking is associated with postoperative thrombosis after primary liver transplantation
AU - Li, Yanni
AU - Nieuwenhuis, Lianne M
AU - Werner, Maureen J M
AU - Voskuil, Michiel D
AU - Gacesa, Ranko
AU - Blokzijl, Hans
AU - Lisman, Ton
AU - Weersma, Rinse K
AU - Porte, Robert J
AU - Festen, Eleonora A M
AU - de Meijer, Vincent E
N1 - This article is protected by copyright. All rights reserved.
PY - 2020/7/25
Y1 - 2020/7/25
N2 - Background: Thrombosis after liver transplantation is a leading cause of graft loss, morbidity, and mortality. Several known recipient- and surgery-related characteristics have been associated with increased risk of thrombosis after transplantation. Potential donor-related risk factors, however, remain largely undefined. Objectives: We aimed to identify risk factors for early post-transplantation thrombosis ('90 days) and to determine the impact of early postoperative thrombosis on long-term graft and patient survival. Patients/Methods: A post hoc analysis was performed of an observational cohort study including all primary, adult liver transplantations performed between 1993 and 2018. Donor-, recipient-, and surgery-related characteristics were collected. Competing risk model analyses and multivariable regression analyses were performed to identify risk factors for developing early post-transplant thrombosis and graft failure. Results: From a total of 748 adult liver transplantations, 58 recipients (7.8%) developed a thrombosis after a median of 7 days. Post-transplantation thrombotic events included 25 hepatic artery thromboses, 13 portal vein thromboses, and 22 other thrombotic complications. Donor history of smoking was independently associated with early postoperative thrombosis (odds ratio [OR] 2.42; 95% confidence interval [CI], 1.29-4.52). Development of early post-transplant thrombosis was independently associated with patient mortality (hazard ratio [HR] 3.61; 95% CI 1.54-8.46) and graft failure (HR 5.80, 95% CI 3.26-10.33), respectively. Conclusion: Donor history of smoking conveys a more than two-fold increased risk of thrombosis after liver transplantation, independent of other factors. Post-transplant thrombosis was independently associated with decreased patient and graft survival.
AB - Background: Thrombosis after liver transplantation is a leading cause of graft loss, morbidity, and mortality. Several known recipient- and surgery-related characteristics have been associated with increased risk of thrombosis after transplantation. Potential donor-related risk factors, however, remain largely undefined. Objectives: We aimed to identify risk factors for early post-transplantation thrombosis ('90 days) and to determine the impact of early postoperative thrombosis on long-term graft and patient survival. Patients/Methods: A post hoc analysis was performed of an observational cohort study including all primary, adult liver transplantations performed between 1993 and 2018. Donor-, recipient-, and surgery-related characteristics were collected. Competing risk model analyses and multivariable regression analyses were performed to identify risk factors for developing early post-transplant thrombosis and graft failure. Results: From a total of 748 adult liver transplantations, 58 recipients (7.8%) developed a thrombosis after a median of 7 days. Post-transplantation thrombotic events included 25 hepatic artery thromboses, 13 portal vein thromboses, and 22 other thrombotic complications. Donor history of smoking was independently associated with early postoperative thrombosis (odds ratio [OR] 2.42; 95% confidence interval [CI], 1.29-4.52). Development of early post-transplant thrombosis was independently associated with patient mortality (hazard ratio [HR] 3.61; 95% CI 1.54-8.46) and graft failure (HR 5.80, 95% CI 3.26-10.33), respectively. Conclusion: Donor history of smoking conveys a more than two-fold increased risk of thrombosis after liver transplantation, independent of other factors. Post-transplant thrombosis was independently associated with decreased patient and graft survival.
KW - graft survival
KW - hepatic artery thrombosis
KW - liver transplantation
KW - portal vein thrombosis
KW - risk factors
KW - HEPATIC-ARTERY THROMBOSIS
KW - PORTAL-VEIN THROMBOSIS
KW - COMPLICATIONS
KW - MANAGEMENT
KW - CYTOMEGALOVIRUS
KW - EXPERIENCE
U2 - 10.1111/jth.14983
DO - 10.1111/jth.14983
M3 - Article
C2 - 32614986
VL - 18
SP - 2590
EP - 2600
JO - JOURNAL OF THROMBOSIS AND HAEMOSTASIS
JF - JOURNAL OF THROMBOSIS AND HAEMOSTASIS
SN - 1538-7933
IS - 10
ER -