Donor tobacco smoking is associated with postoperative thrombosis after primary liver transplantation

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Abstract

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.

Original languageEnglish
Pages (from-to)2590-2600
Number of pages11
JournalJOURNAL OF THROMBOSIS AND HAEMOSTASIS
Volume18
Issue number10
Early online date2-Jul-2020
DOIs
Publication statusPublished - 25-Jul-2020

Keywords

  • graft survival
  • hepatic artery thrombosis
  • liver transplantation
  • portal vein thrombosis
  • risk factors
  • HEPATIC-ARTERY THROMBOSIS
  • PORTAL-VEIN THROMBOSIS
  • COMPLICATIONS
  • MANAGEMENT
  • CYTOMEGALOVIRUS
  • EXPERIENCE

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