Prothrombotic Gene Polymorphisms: Possible Contributors to Hepatic Artery Thrombosis After Orthotopic Liver Transplantation

Background. Gene polymorphisms involved in hemostasis have been associated with an increased risk of thromboembolic events. The aim of this study was to assess whether prothrombotic gene polymorphism is a risk factor for hepatic vascular thrombosis after orthotopic liver transplantation (OLT).

Methods. In a series of 421 transplant procedures, genomic DNA was available for genotyping in 381 donors (91%) and 382 recipients (91%). In donors and recipients, the presence of factor V Leiden mutation, the prothrombin G20210A, and the factor XIII G100T polymorphisms were identified. In recipients, the C677T methylenetetrahydrofolate reductase (MTHFR), the platelet glycoprotein integrin alpha 2 C807T, the integrin beta 3 C1565T, and the thrombospondin 4 A387P polymorphisms were identified. Clinical data were obtained from a prospectively maintained database and medical records. All recipients underwent screening for hepatic vascular thrombosis using Doppler ultrasonography, followed by catheter or computed tomography angiography if indicated.

Results. In an overall analysis, none of the polymorphisms were associated with hepatic vascular thrombosis. When thrombosis in the first 7 days after OLT was excluded, we found a 3- to 7-fold increased risk for hepatic artery thrombosis (HAT) in association with factor V Leiden or factor XIII G100T (donor), and MTHFR C677T (recipient).

Conclusions. The presence of factor V Leiden or factor XIII G100T in the donor liver or MTHFR C677T in the recipient is associated with an increased risk of HAT after OLT. However, because the prevalence of these polymorphisms is low and the overall impact on the incidence of HAT is minimal, routine screening for these genotypes seems not justified.