Intracardiac thrombus formation and pulmonary thromboembolism immediately after graft reperfusion in 7 patients undergoing liver transplantation

Intravascular and/or intracardiac thrombus formation followed by pulmonary thromboembolism with right ventricular dysfunction immediately after graft reperfusion during orthotopic liver transplantation (OLT) is described in 7 patients. This complication may have been related to excessive activation of the coagulation system by graft reperfusion, which overwhelmed anticoagu lation mechanisms and was disproportionate to fibrinolysis. Activation of t he coagulation system may be more pronounced in patients who receive less t han optimal grafts, require massive transfusion, or have septic complicatio ns at the time of OLT. It is unclear whether antifibrinolytic therapy durin g the anhepatic stage had a role. Transesophageal echocardiography was usef ul in diagnosing and managing intracardiac thrombus and pulmonary thromboem bolism.