Pediatric Liver Transplantation Clinical Trial
Official title:
Perioperative Thromboelastometry as a Predictor of Thrombotic Complications During Pediatric Recipient Liver Transplantation
The study aims to correlate the perioperative results of a device called thromboelastogram, which is used to detect coagulation abnormalities, with thrombotic complications during pediatric recipient liver transplantation.
Pediatric patients undergoing liver transplant are at risk for significant bleeding and
thrombotic complications. Studies in both pediatric and adult cohorts estimate an incidence
of thrombotic events in up to 26% of cases. Hepatic artery and portal vein thrombosis (PVT)
are reported at rates of 5-15% in pediatric cohorts, which is three to four times the
incidence in adults. Bleeding estimates are harder to quantify given variability in the
definition of major bleeding, but range from approximately 5 to 9%.The contribution of
bleeding to morbidity is difficult to quantify, but thrombotic complications are known to
reduce graft survival and contribute significantly to adverse outcomes, with mortality rates
approaching 50% in those with hepatic artery thrombosis.
Thromboelastometry offers rapid, comprehensive, and global clinical assessment of the
patients' coagulation status, as demonstrated by several studies.
Little data exists in the use of thromboelastography (TEG) in pediatric liver
transplantation. In 2011, Curiel et al implemented pre-transplant TEGs for patients listed
for liver transplantation. The invistigators sought to examine if there were any correlations
with preoperative hypercoagulable indices on the TEG and postoperative thrombotic
complications.The invistigators have identified that a preoperative hypercoagulable TEG
portends to thrombotic complications in pediatric liver transplant patients. Further studies
are needed to explore perioperative management strategies for high risk patients to prevent
the development of postoperative thrombotic complications based upon preoperative TEG
studies. That's why the invistigators will study the perioperative thromboelastometry as a
predictor of thrombotic complications during pediatric recipient liver transplantation.
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