B0505 - The Selection of Donors in Living Donors of Liver Transplantation Based on Results of Thrombophilia Screening Tests and Prophylactic Strategy for Venous Thromboembolic Events (VTE)

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Azhar Hussain, MBBS

Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences
Gambat, Sindh, Pakistan

Abdul Wahab Dogar, MBBS, FCPS¹, Azhar Hussain, MBBS¹, Kaleem Ullah, MBBS, FCPS¹, Shams Ud-din, MBBS, FCPS¹, Zubair Khan, MD², Hafiz M. Khan, MD³
¹Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Sindh, Pakistan; ²UTHealth Houston, Houston, TX; ³AdventHealth Orlando, Orlando, FL

Introduction: Vascular events after living donor liver transplantation (LDLT) are one of the most feared complications that usually lead to graft and donor loss. The main aim of this study was to determine the frequency of hereditary thrombophilia in the Pakistani population and share our centers’ safety and venous thromboembolic events (VTE) prophylaxis protocols in the borderline and high-risk groups in live liver donors.

Methods: This prospective, observational study included thrombophilia testing, which was done on 567 living donor candidates between July 2018 and April 2021. Donors were divided into the normal, border-line, and high-risk groups according to the Caprini scoring system. Usual prophylaxis with enoxaparin along with elastic stockings and intermittent pneumatic compression (IPC) was given postoperatively to donors in the borderline and high-risk groups. The safety endpoints were VTE occurrence, bleeding complications, or mortality.

Results: Among 567 donors, 21 (3.7%) donors were deficient in protein C, 14(2.5%) were deficient in anti-thrombin-III and 45(7.9%) were having Leiden factor-V mutation. 31/416 (7.45%) were deficient in factor-II. IgM & IgG Anti-phospholipids antibodies were positive in 2/567(0.4%) and 2/567(0.4%) respectively. Donor operation was performed on 44 candidates in the borderline group and 7 in the high-risk group. Complications after surgery were comparable between the 2 groups (p >0.05). One donor in the normal donor group developed pulmonary embolism, but none of the donors in either borderline or high-risk group developed VTE.

Discussion: Early hepatic artery thrombosis (eHAT), deep venous thrombosis, and pulmonary embolism are one of the most common vascular events after liver transplantation.The majority of LDLT centers exclude donors from high-risk groups (according to the Caprini scoring system) and are used to give low molecular weight heparin in borderline donor groups. But we are the only LDLT center where not only did we perform right lobe hepatectomy on high-risk donor group on thrombophilia screening tests, but we also gave usual prophylaxis with enoxaparin (rather than low molecular weight heparin) along with elastic stockings, and intermittent pneumatic compression (IPC) postoperatively to donors in the borderline and high-risk groups (Fifty-one donors ) to decrease the risk of VTE.

Variables	Normal Group (n=516)	Borderline Group (n=44)	High-Risk Group (n=7)	P-value
Mean age (Years)	23.43 ± 5.53	23.91± 5.25	26.86 ± 6.54	0.17
Mean BMI (Kg/m²)	21.40 ± 7.99	20.5 ± 2.71	21.53 ± 3.29	0.69
Gender Male Female	290(56.2%) 226(43.7%)	24(54.5%) 20(45.4%)	4(57.1%) 3(42.8%)	0.97
Marital status Unmarried Married	351(68.1%) 165 (31.9%)	25(56.9%) 19 (43.1%)	5(71.4%) 2(28.5%)	0.06
Donor's relation to recipients Son Brother Nephew Daughter Sister Father Swap Others Type of Graft Modified right lobe graft Modified extended right lobe graft Left lobe graft Left lateral segment graft GRWR Mean warm ischemia time (minutes) Mean operation time (hours) Mean blood loss (ml) Blood transfusions (no of patients/ %)	63 (12.2%) 99 (19.1%) 25 (4.8%) 35 (6.7%) 32 (6.2%) 88 (17.1%) 10 (1.9%) 157(30.4%) 437 (84.6%) 62 (12.0%) 4 (0.7%) 11 (2.1%) 6(1.1%) 1.26 ± 0.63 10.99 ± 6.09 407.94 ± 64.86 516	6 (13.6%) 5 (11.3%) 5(11.3%) 5 (11.3%) 5 (11.3%) 3 (6.8%) 0 11 (25.0%) 36 (81.8%) 8 (18.1%) 7 (15.9%) 0 0 1.4 ± 0.68 10.68 ± 4.08 412.27 ± 89.11 44	1(14.2%) 2(28.5%) 1(14.2%) 0 0 0 0 3(42.8%) 6(85.7%) 1(14.2%) 0 0 1.2 ± 0.63 13.86 ± 7.26 422.86 ± 62.37 7	0.008 NS NS NS 0.76
Personal History of Thrombosis	0	0	0	_
Total number of complications	62 (12.0%)	15 (34.1%)	2(28.5%)	0.43
Grade 1 & 2 -Wound infections -Wound hematoma -UTI -Fever -Paralytic ileus	20 (3.8%) 2 (0.3%) 4 (0.7%) 3 (0.5%) 2 (0.3%)	3 (6.8%) 1 (2.2%) 2 (4.5%) 2 (4.5%) 1 (2.2%)	2(28.5%) 0 0 0 0	0.12
Grade 3A -Bile leakage -Bile duct stricture -Post-op bleeding -Pleural effusion/Aspiration -ERCP & Stenting	6 (1.1%) 3(0.5%) 3 (0.5%) 9 (1.7%) 3 (0.5%)	1 (2.2%) 0 1 (2.2%) 1 (2.2%) 1 (2.2%)	0 0 0 0 0	0.15
Grade 3B - Re-open	6(1.1%)	1 (2.2%)	0	0.45
Grade 4A - Need ICU care/ ventilator Grade 4B -Multi-organ failure	1 (0.1%) 0	1 (2.2%) 0	0 0	0.95 --
Grade 5	0	0	0	--
Mean ICU stay (Days)	3 ± 1	2.53 ± 1	3 ± 1	0.15
Mean hospital stay (Days)	6 ± 2	5 ± 2	6 ± 2	0.17
Mortality	0	0	0	--

Abbreviations: BMI: body mass index; GRWR= graft to recipient weight ratio; ICU: Intensive care unit; UTI: Urinary tract infection

Table: Comparison of demographics, surgical features, and postoperative complications of LLDs in donor groups

Disclosures:

Abdul Wahab Dogar indicated no relevant financial relationships.

Azhar Hussain indicated no relevant financial relationships.

Kaleem Ullah indicated no relevant financial relationships.

Shams Ud-din indicated no relevant financial relationships.

Zubair Khan indicated no relevant financial relationships.

Hafiz Khan indicated no relevant financial relationships.

Abdul Wahab Dogar, MBBS, FCPS¹, Azhar Hussain, MBBS¹, Kaleem Ullah, MBBS, FCPS¹, Shams Ud-din, MBBS, FCPS¹, Zubair Khan, MD², Hafiz M. Khan, MD³. B0505 - The Selection of Donors in Living Donors of Liver Transplantation Based on Results of Thrombophilia Screening Tests and Prophylactic Strategy for Venous Thromboembolic Events (VTE), ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.