Intracardiac thrombosis and pulmonary thromboembolism during liver transplantation: A systematic review and meta-analysis.

Abstract

Intracardiac thrombosis and/or pulmonary thromboembolism (ICT/PE) is a rare but devastating complication during liver transplantation. Its pathophysiology remains poorly understood, and successful treatment remains a challenge. This systematic review summarizes the available published clinical data regarding ICT/PE during liver transplantation. Databases were searched for all publications reporting on ICT/PE during liver transplantation. Data collected included its incidence, patient characteristics, the timing of diagnosis, treatment strategies, and patient outcomes. This review included 59 full-text citations. The point prevalence of ICT/PE was 1.42%. Thrombi were most often diagnosed during the neohepatic phase, particularly at allograft reperfusion. Intravenous heparin was effective in preventing early-stage thrombus from progressing further and restoring hemodynamics in 76.32% of patients it was utilized for; however, the addition of tissue plasminogen activator or sole use of tissue plasminogen activator offered diminishing returns. Despite all resuscitation efforts, the in-hospital mortality rate of an intraoperative ICT/PE was 40.42%, with nearly half of these patients dying intraoperatively. The results of our systematic review are an initial step for providing clinicians with data that can help identify higher-risk patients. The clinical implications of our results warrant the development of identification and management strategies for the timely and effective treatment of these tragic occurrences during liver transplantation.

• Authors: Nicolas Kumar, Antolin S Flores, Justin Mitchell, Nasir Hussain, Julia E Kumar, Jack Wang, Michael Fitzsimons, Adam A Dalia, Michael Essandoh, Sylvester M Black, Austin D Schenk, Erica Stein, Katja Turner, Tamara R Sawyer, Manoj H Iyer
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 23 Issue 8 Pg. 1227-1240 (08 2023) ISSN: 1600-6143 [Electronic] United States
• PMID: 37156300 (Publication Type: Meta-Analysis, Systematic Review, Journal Article)
• Copyright: Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.

Chemical References

• Tissue Plasminogen Activator

Topics

• Humans
• Tissue Plasminogen Activator
• Liver Transplantation (adverse effects, methods)
• Thrombosis (etiology, diagnosis)
• Pulmonary Embolism (diagnosis, drug therapy, etiology)
• Heart Diseases