Hemostasis in Pediatric Liver Transplantation

Recipient outcomes after pediatric liver transplantation improved significantly over the years. Two of the main challenges remain thrombotic and bleeding complications, which both contribute to morbidity and mortality. Outcomes after pediatric liver transplantation in the Netherlands were analyzed in this thesis. Actuarial 5-year patient survival rates of 83% are reported after post mortal liver transplantation, and 95% after living donor liver transplantation. Posttransplant thrombosis occurred in 9.5% of pediatric liver transplant recipients, clinically relevant bleeding complications occurred in 37%. Risk factors for both thrombotic and bleeding complications were examined, and in the future, a more personalized approach in antithrombotic therapy may have merit.
Since hemostasis plays a key role in the pathogenesis of thrombotic and bleeding complications, especially in patients with end-stage liver disease, hemostasis was examined in pediatric patients undergoing liver transplantation. It appeared that, in contrast to the current view that children with end-stage liver disease have a high bleeding tendency, a normal to hypercoagulable hemostatic state was present in these patients. The hypercoagulable features might contribute to the increased risk of posttransplant thrombosis in children.
Prevention and treatment of thrombosis is performed with pro- and anticoagulant drugs. One of the studies in this thesis study revealed important differences in efficacy of commonly used pro- and anticoagulant drugs in children undergoing liver transplantation. Therefore, dose adjustments of these drugs may be required.
The new insights in this thesis may be helpful for strategies to prevent and treat bleeding and thrombotic complications in pediatric liver transplantation.