Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.752
Peer-review started: May 4, 2018
First decision: May 23, 2018
Revised: July 13, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: October 27, 2018
Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) commonly occur after pediatric liver transplantation (PLT) that may cause graft loss and patient death. Different surgical techniques and pharmacological prophylaxis have been purposed in several studies; nevertheless, there is not a standardized approach for thrombosis prevention in PLT.
Prevention of HAT and PVT remains very important for PLT outcome and it should be a matter of primary interest for clinicians and researchers, considering the ongoing scarcity of hepatic allografts.
We performed a systematic review of current literature about surgical and pharmacological prophylaxis for prevention of thrombosis after PLT to evaluate the current evidence available.
Studies were identified by electronic search of MEDLINE, EMBASE and Cochrane Library (CENTRAL) databases until March 2018. We excluded from this review case report, small case series, commentaries, conference abstracts, papers which describe less than 10 pediatric liver transplants/year and articles published before 1990. Two reviewers performed an independent study selection, solving any disagreements through discussion and the opinion of a third reviewer.
Nine retrospective studies were included in this review. They showed the use of tailored surgical strategies might be useful to reduce thrombosis. We did not find eligible studies evaluating pharmacological prevention strategies. The overall quality of studies was poor. A pooled analysis of results from studies was not possible due to the retrospective design and heterogeneity of included studies.
This systematic review in which different prophylaxis strategies were tested for the prevention of HAT and PVT failed to provide enough evidence for a definitive conclusion due to the poor quality of studies found.
This systematic review showed there is no evidence based strategy for thrombosis prevention in PLT. Prospective studies are urgently needed. The recent “single ventricle trial” showed that randomized clinical trials are possible also in the pediatric surgery area.