Perioperative thrombotic complications in liver transplantation

Table 1 Perioperative thromboembolic events in liver transplantation

Arterial complications

Intraoperative hepatic artery thrombosis

Early postoperative hepatic artery thrombosis

Coronary artery thrombosis

Peripheral arterial occlusion

Intracardiac thrombosis

Pulmonary emboli

Paradoxical air/thromboembolism

Early portal vein thrombosis/re-thrombosis

Post-orthotopic liver transplantion deep vein thrombosis and inferior vena cava thrombosis

Table 2 Major risk factors for perioperative thromboembolic events in liver transplant

Abnormal thrombin generation

Defective profibrinolitic system due to elevated plasminogen activator inhibitor 1 endothelial type levels

Platelet activation from venous stasis or inflammation

Intestinal ischaemia and liberation of infectious mediators

Tissue thromboplastin release

Vascular clamping/unclamping

Platelet aggregates and microthrombosis around catheters

Severe ischaemia-reperfusion phenomena

Veno-venous by-pass

High pulmonary artery pressure

Anatomical and/or technical causes

Table 3 Major indications for post-orthotopic liver transplantion thromboprophylaxis

Thrombophylic states
Excessive intraoperative administration of procoagulant factors
Split and living donor transplant
Small arteries or reconstructed arteries
Pre-transplant portal vein thrombosis
Complicated vascular anastomosis
Decreased portal vein blood flow
Hypoplastic portal vein
Caval transposition and “non-anatomical” procedures
Poor arterial flow
Multiple recipient arteries
Infrarenal aortohepatic grafting