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. 2022 Dec 9;36(10):e14629. doi: 10.1111/ctr.14629

TABLE 2.

Study outcomes

Prevention of bleeding HAT PVT
1. Shay R et al 2013

Significant Bleeding (requiring ≥2 units RBC)

9% on Aspirin vs 19% without Aspirin, NS

 HAT

  • Overall HAT

3% on Aspirin vs 4.9% without Aspirin, NS

  • Early HAT (<30 days post OLTx)

1.8% on Aspirin vs 3.9% without Aspirin, NS

  • Early HAT (<30 days with graft loss)

0% on Aspirin vs 3.6% without Aspirin, p < .05Late HAT (>30 days post OLTx)1.2% on Aspirin vs 1% without Aspirin, NS

PVT

.6% on Aspirin vs 2% without Aspirin, NS
2. Lin et al. 28 NA No imaging comparison, more intraoperative flow as predictor of HAT

  • Overall incidence of HAT 6.6% (13/198)

  • Mean and median flow rates of the hepatic artery in HAT group 262mL/min and 220 ml/min vs. 436 ml/min and 400ml/min in non‐HAT groups (p < .0036).

Median portal vein flow rate was 2115 ml/min (range 900–3200) for the HAT group vs. 2171 ml/min (range: 300–6000) in the non‐HAT group (p < .84).		 NA
3. Bärthel et al. 37 Fresh Frozen Plasma requirement (units) 5.5 control vs 4 iloprost. 0 (‐4,1) p = .264. Composite HAT/PVT AE rare and not different between groups Composite HAT/PVT AE rare and not different between groups
4. Wolf et al. 17 Biopsy bleeding:

  • 1.1% ASA vs

.6% non‐ASA (p = .29)GI bleeding:18.9% ASA vs 12.8% non‐Asa (p = .08)		 Overall HAT

  • 3.7% ASA vs

4% non‐ASA (p = .85)NS for all pts, 2–12 yo and <2 yo		 NA
5. Nguyen‐Buckley C et al, 2021 NA Overall HAT

  • 2.3% no ROTEM vs 5.2% ROTEM

(≥18 yo) (p < .01)Overall MTC (major thrombotic complications)

  • 4.2% no ROTEM vs 9.5% ROTEM

(p < .001)Use of cryoprecipitate

  • 1.1 ± 1.1 no ROTEM vs 2.9 ± 2.3 units ROTEM (p < .001)

Use of cryoprecipitate as independent risk factor for MTCOR 1.1, 95% CI: 1.04–1.24 (p < .003)		 NA
6. Roullet S et al, 2014 Perioperative bleeding:

  • 3 L (1.7‐4 L) no ROTEM vs 3 L (2.1‐4.9 L) ROTEM (NS)

Autologous transfusion:

  • 545 ml (288–752 ml) no ROTEM vs 490 ml (268–1122 ml) ROTEM (NS)

Received perioperative FFP units:

  • 4 (4‐5) no ROTEM vs. 8 (7‐8) ROTEM (p < .05)

But fewer ROTEM pts got FFPReceived Perioperative Fibrinogen (%pts):

  • 30% no ROTEM vs

57% ROTEM (p < .05)No difference in fibrinogen volume between groupsHyperfibrinolysis detection with ROTEM

  • Specificity 100%

  • Sensitivity 11–13%

Postoperative ICU within 24hrs:Platelet units:

  • 1.2 ± .5 no ROTEM vs 1 ± 0 ROTEM (p < .01)

Total transfusions RBC, FFP, PLT, Fibrinogen (g), Tranexamic acid (g):No significance in number of pts and amount between no ROTEM and ROTEM		 NA NA
7. Oberkofler C et al, 2021 (manuscript is available on request) NA 1‐year arterial patency:

  • 99% ASA vs 96% no ASA

HR .23; 95% CI:.13‐.4; (p < .001)Overall HAT:2.9% ASA vs 1.9% no ASA, p = .136		 NA
8. Widen A, 2009 Number of patients who bled

  • Anticoagulated group 9 (15%) vs. 16 (23%) control group (P.0.37)

Number of bleeding episodes

  • Anticoagulation group10 (17%) vs. 19 (24%) control group (P.0.45)

Conclusion:(Warfarin) Anticoagulation in LT recipients does not increase the risk of bleeding complications.		 NA NA
9. Vivarelli et al. 31 N/A The effect of aspirin on early HAT was not assessable due to median presentation 5 days post‐op and ASA was started at median time 8 days.

  • Overall late HAT was .4% in ASA group and 2.2% in non‐ASA group (p = .037)

The incidence of late HAT in high risk recipients (DCD or arterial conduits) was significantly higher among those patients who did not receive aspirin (12/338; 3.6%), as compared to those who received the prophylaxis (1/160; .6%) (p = .037). A multivariate analysis was not performed.		 N/A
10. Alexander et al. 32

  • Multivariate logistic regression revealed no association between the use of chemoprophylaxis with heparin (adjusted odds ratio [OR] 1.5 [.45‐4.7], p = .53) and VTE. Only revealed that blood product administration was significantly associated with VTE and death.

  • A significant positive association was observed between the use of chemoprophylaxis (adjusted OR 3.2 [1.3–8.0], p = .01) and death.

  • Use of chemoprophylaxis and increasing amounts of blood products following orthotropic liver transplant was associated with increased mortality.

 N/A N/A
11. Bos et al. 35 Bleeding events:

  • 23% anticoagulation vs 4.1% no anticoagulation, p < .02

Length of stay:

  • 21 days anticoagulation vs 17.5 days no anticoagulation, p < .01

* Initial heparin with transition to warfarin, INR target of 2–3

HAT:

4.3% anticoagulation vs. 4.5% no anticoagulation, NS

 Overall for Yerdel I and II PVT recurrence within 1 yr post‐LT:

  • 5.3% anticoagulation vs

2.5% no anticoagulation, p = .32For Yerdel II PVT:

  • 5.7% anticoagulation vs

5.5% no anticoagulation, p = 1
12. Rizzari M, 2020 NA NA Recurrent post‐op PVT:

  • high PVT grade group 22.6% versus

  • low PVT grade group 9.6%,

p = .07low‐flow group 29.0%versushigh‐flow group 10.5%,p = .02All pts were on SQ 5,000 TID heparin and 325 mg ASA
13. Sanchez‐Ocaña et al. 33

  • No bleeding episodes in warfarin group

 NA

Intra‐op:

Short (Grades I‐II) 26/37 (70%) Long (Grades III‐IV) 11/37 (30%) Cavernous Transformation 5/37 (13.5%)

Post‐op PVT recurrence:

0% recurrence of PVT

(all patients received low molecular‐weight heparin (1 mg/kg twice a day) in the immediate postoperative period and were discharged with OAC (warfarin) for 6 months)
14. Kaneko et al. 39 Incidence of bleeding:

  • 15% bleeding/take‐back for bleeding

 Early HAT

  • N = 3, 2.3% (on POD#1, 4, 11)

 PVT

  • N = 2,1.6% (POD#4, 5)
15. Gad et al. 40 Incidence of bleeding:

  • N = 4, 1.8%

 Incidence of HAT

  • N = 9 (4 early and 5 late), 4.2% Risk of HAT and/or PVT Recipient age > 18 years 3/27 (11.1%) (yes) versus 39/186 (no) (21%) p > .05

 Incidence of PVT

  • N = 5, 2.3%
16. Stange et al.16 Incidence of bleeding:

  • N = 3 (.2%)

 Incidence of early HAT

  • N = 14 (1.17%)

Incidence of late HAT

  • N = 16 (1.33%)

 NA