Liver Transpl. 2022 Apr 21. doi: 10.1002/lt.26489. Online ahead of print.
ABSTRACT
BACKGROUND: This study characterizes incidence and outcomes surrounding intracardiac thrombosis (ICT) during liver transplant over nine years at a single center, pre/post routine use of transesophageal echocardiography (TEE).
METHODS: Adult liver transplant patients from 2011 to 2020 were divided into eras based on routine TEE use. ICTs were identified by querying anesthetic records for search terms. Descriptive statistics included counts and proportions for baseline recipient, donor, intraoperative, and postoperative characteristics. Outcome data were based upon date of hospital discharge and date of death.
RESULTS: The incidence of ICT increased in the TEE-Era (2016-2020) compared to the Pre-TEE Era (2011-2015) (3.7% (25/685) vs. 1.9% (9/491); p<0.001). ICT patients had significantly higher MELD-Na, pretransplant hospitalization, malignancy, drug induced liver injury, hypertension, DVT, reperfusion syndrome, transfused platelets and cryoprecipitate and use of hemostatic medications. A higher proportion of patients in the ICT group underwent simultaneous liver kidney transplant. The ICT patients were similar except the pre-TEE era had higher MELD-Na score and incidence of hepatitis C virus and lower incidence of encephalopathy. In the Pre-TEE Era, all ICTs presented as intraoperative cardiac arrest and the 30-day mortality in the setting of ICT was 66.7% (6/9). During the TEE Era, 80% of ICT were diagnosed incidentally or due to hemodynamic instability (p=0.002). The 30-day mortality was 36% (9/25) in the TEE-era (p=0.25).
CONCLUSION: ICT incidence increased in the TEE-Era, yet the mortality was lower, suggesting that routine intraoperative TEE may lead to early detection of ICT prior to hemodynamic collapse.
PMID:35447005 | DOI:10.1002/lt.26489
