TY - JOUR
T1 - Evidence for a rebalanced hemostatic system in pediatric liver transplantation
T2 - A prospective cohort study
AU - Werner, Maureen J M
AU - de Meijer, Vincent E
AU - Adelmeijer, Jelle
AU - de Kleine, Ruben H J
AU - Scheenstra, René
AU - Bontemps, Sander T H
AU - M E M Reyntjens, Koen
AU - Hulscher, Jan B F
AU - Lisman, Ton
AU - Porte, Robert J
N1 - © 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2020/1/8
Y1 - 2020/1/8
N2 - In adults with end-stage liver disease concurrent changes in pro- and antihemostatic pathways result in a rebalanced hemostasis. Children though, have a developing hemostatic system, different disease etiologies, and increased risk of thrombosis. This study aimed to assess the hemostatic state of children during and after liver transplantation. Serial blood samples were obtained from 20 children (≤16 years) undergoing primary liver transplantation (September 2017-October 2018). Routine hemostasis tests, thrombomodulin-modified thrombin generation, clot lysis times, and hemostatic proteins were measured. Reference values were established using an age-matched control group of 30 children. Thrombocytopenia was present in study patients. Von Willebrand factors were doubled and ADAMTS13 levels decreased during and after transplantation up until day 30, when platelet count had normalized. Whereas prothrombin time and activated partial thromboplastin time were prolonged during transplantation, thrombin generation was within normal ranges, except during perioperative heparin administration. Fibrinogen, factor VIII levels, and clot lysis time were elevated up until day 30. In conclusion, children with end-stage liver disease are in tight hemostatic balance. During transplantation a temporary heparin-dependent hypocoagulable state is present, which rapidly converts to a hemostatic balance with distinct hypercoagulable features that persist until at least day 30. This hypercoagulable state may contribute to the risk of posttransplant thrombosis.
AB - In adults with end-stage liver disease concurrent changes in pro- and antihemostatic pathways result in a rebalanced hemostasis. Children though, have a developing hemostatic system, different disease etiologies, and increased risk of thrombosis. This study aimed to assess the hemostatic state of children during and after liver transplantation. Serial blood samples were obtained from 20 children (≤16 years) undergoing primary liver transplantation (September 2017-October 2018). Routine hemostasis tests, thrombomodulin-modified thrombin generation, clot lysis times, and hemostatic proteins were measured. Reference values were established using an age-matched control group of 30 children. Thrombocytopenia was present in study patients. Von Willebrand factors were doubled and ADAMTS13 levels decreased during and after transplantation up until day 30, when platelet count had normalized. Whereas prothrombin time and activated partial thromboplastin time were prolonged during transplantation, thrombin generation was within normal ranges, except during perioperative heparin administration. Fibrinogen, factor VIII levels, and clot lysis time were elevated up until day 30. In conclusion, children with end-stage liver disease are in tight hemostatic balance. During transplantation a temporary heparin-dependent hypocoagulable state is present, which rapidly converts to a hemostatic balance with distinct hypercoagulable features that persist until at least day 30. This hypercoagulable state may contribute to the risk of posttransplant thrombosis.
KW - clinical research
KW - practice
KW - liver allograft function
KW - dysfunction
KW - liver transplantation
KW - hepatology
KW - pediatrics
KW - thrombosis and thromboembolism
KW - VON-WILLEBRAND-FACTOR
KW - HEPATIC-ARTERY THROMBOSIS
KW - PLASMA
KW - GENERATION
KW - CIRRHOSIS
KW - ADAMTS13
KW - DISEASE
KW - COAGULATION
KW - COMPLICATIONS
KW - FIBRINOLYSIS
U2 - 10.1111/ajt.15748
DO - 10.1111/ajt.15748
M3 - Article
C2 - 31841272
SN - 1600-6135
VL - 20
SP - 1384
EP - 1392
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 5
ER -