PREVENTION OF HEPATIC-ARTERY THROMBOSIS IN PEDIATRIC LIVER-TRANSPLANTATION

Hepatic artery thrombosis after orthotopic liver transplantation is a serious complication, especially in children, We report our experience with intensive anticoagulant therapy during and after living-related liver transplantation in pediatric recipients, Twenty-four patients be tween 5 months and 15 years of age were studied. The mean diameter of the anastomosed hepatic arteries was 2.7 mm, The anticoagulant therapy consisted of low-molecular-weight heparin, antithrombin III concentra tes, prostaglandin E(1), fresh frozen plasma, and a protease inhibitor , The profiles of the coagulation and fibrinolytic systems were monito red by measuring several parameters, including plasma levels of thromb in-antithrombin III complex, antithrombin III, plasmin-alpha 2 plasmin inhibitor complex, fibrin degradation product D-dimer, tissue type-pl asminogen activator, and plasminogen activator inhibitor-1. Accelerati on of the coagulation system and delayed recovery of the fibrinolytic system were observed during the early postoperative days, The plasma l evel of antithrombin III activity was maintained within the normal ran ge by the administration of antithrombin III concentrates, None of the recipients developed hepatic artery thrombosis, Children have been re ported to be at a greater risk of developing hepatic artery thrombosis than adults due to the small diameters of their hepatic arteries and the postoperative hypercoagulable state. We believe that the intensive anticoagulation therapy described in this study, the main concept of which is the early correction of imbalance between the coagulant and a nticoagulant systems, could become a model for the prevention of hepat ic artery thrombosis in pediatric Liver transplantation patients.