Evidence for a rebalanced hemostatic system in pediatric liver transplantation: A prospective cohort study. Issue 5 (8th January 2020)

• Record Type: Journal Article
• Authors: Werner, Maureen J. M.; de Meijer, Vincent E.; Adelmeijer, Jelle; de Kleine, Ruben H. J.; Scheenstra, René; Bontemps, Sander T. H.; Reyntjens, Koen M. E. M.; Hulscher, Jan B. F.; Lisman, Ton; Porte, Robert J.
• Is Part Of: American journal of transplantation. Volume 20:Issue 5(2020)
• Page Start: 1384
• Page End: 1392
• Publication Date: 2020-01-08
• Subjects: clinical research/practice -- liver allograft function/dysfunction -- liver transplantation/hepatology -- pediatrics -- thrombosis and thromboembolism; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15748
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : 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. Abstract : This prospective exploratory study shows that children with end‐stage liver disease undergoing liver transplantation are in a fragile hemostatic balance, with a temporary heparin‐induced hypocoagulable state during transplantation, which rapidly converts to a rebalanced hemostatic state with distinct hypercoagulable features posttransplantation.