Systematic Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2018; 10(10): 752-760
Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.752
Thrombosis prophylaxis in pediatric liver transplantation: A systematic review
Mirco Nacoti, Giulia Maria Ruggeri, Giovanna Colombo, Ezio Bonanomi, Federico Lussana
Mirco Nacoti, Giulia Maria Ruggeri, Giovanna Colombo, Ezio Bonanomi, Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
Federico Lussana, Hematology and Bone Marrow Transplant Unit, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
Author contributions: Nacoti M was responsible for the concept, design, analysis of data and drafting; Ruggeri GM and Colombo G were responsible for selection of the papers and variables and drafting; Bonanomi E was responsible for concept and critical revision; Lussana F was responsible for the concept, design, searching strategy, drafting and critical revision.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mirco Nacoti, MD, Staff Physician, Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Via Piazza OMS 1, Bergamo 24127, Italy.
Telephone: +39-35-2675150 Fax: +39-35-2674989
Received: May 2, 2018
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
Research background

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.

Research motivation

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.

Research objective

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspective

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.