Split-liver activity in an Italian transplant program: An update

12nonenoneDe Feo Tullia M.; Colledan Michele; Andorno Enzo; De Carlis Luciano G.; Cillo Umberto; Rossi Giorgio; Baccarani U; Regalia Enrico; Donataccio Matteo; Risaliti Andrea; Di Silvestre Adriana; Scalamogna MarioDe Feo Tullia, M.; Colledan, Michele; Andorno, Enzo; De Carlis Luciano, G.; Cillo, Umberto; Rossi, Giorgio; Baccarani, Umberto; Regalia, Enrico; Donataccio, Matteo; Risaliti, Andrea; Di Silvestre, Adriana; Scalamogna, Mari

Thrombosis after liver transplantation for hepatocellular carcinoma.

The influence of thrombosis on the prognosis of patients with hepatocellular carcinoma (HCC) after liver transplantation (LT) and the role of the commonest inherited thrombophilia abnormalities factor V Leiden and prothrombin G20210A in the development of thrombosis are unknown. We investigated a cohort of patients who underwent LT for HCC with the aim to estimate the incidence rate (IR) of thrombosis, its influence on mortality and re-transplantation rates and, in the frame of a nested case-control study, the role of thrombophilia in donors and recipients for the development of thrombosis. Four-hundred and thirty patients underwent LT and were followed for a median of 7.2 years. Twenty-six recipients (6%) developed thrombosis (IR 1.06 [95%CI: 0.71-1.53] per 100 pts-yr). Mortality rate after LT was 3.95 (95%CI: 3.22-4.79) per 100 pts-yr and was not influenced by thrombosis. Re-transplantation was planned for 33 patients and was more common in patients with thrombosis than in those without (HR 2.50 [95%CI: 0.87-7.17]). The risk of thrombosis was 4 times higher in recipients with thrombophilia than in those without (OR 4.23 [95%CI: 0.99-18.04]) and 6 times higher when the analysis was restricted to venous thrombosis (OR 6.26 [95%CI: 1.19-32.85]). The presence of inherited thrombophilia in the donors did not increase the risk of thrombosis of the recipient. In conclusion, thrombosis is a complication of 6% of patients transplanted for HCC and increases the risk of re-transplantation but not of mortality. The risk of thrombosis, particularly venous, is increased in the presence of thrombophilia abnormalities in the recipients

Incidence rates of mortality and need of re-transplantation in patients with or without thrombosis.

<p>Incidence rates of mortality and need of re-transplantation in patients with or without thrombosis.</p

Characteristics of patients included in the nested case-control study.

<p>Characteristics of patients included in the nested case-control study.</p

Flow-chart of the study population of patients with hepatocellular carcinoma.

<p>Flow-chart of the study population of patients with hepatocellular carcinoma.</p

Characteristics of patients who underwent liver transplantation.

<p>Characteristics of patients who underwent liver transplantation.</p

Kaplan Meier curve for cumulative incidence of thrombosis after liver transplantation.

<p>Kaplan Meier curve for cumulative incidence of thrombosis after liver transplantation.</p