Background: In 2017, we published an anticoagulation protocol that successfully reduced the rate of hepatic artery thrombosis (HAT). This study aimed to evaluate the effect of this protocol on postoperative anticoagulant factors, fresh frozen plasma (FFP) use, and the impact on fluid balance.
Methods: Paediatric liver transplants performed at a single centre between 2008 and 2018 were identified. In Epoch 1 (January 2008–April 2014), postoperative coagulation profiles normalised passively. In Epoch 2 (May 2014–December 2018), our anticoagulation protocol was implemented, introducing regular intra- and postoperative antithrombin III (AT3) concentrate and postoperative FFP. Linear mixed effects models were used to test the total effect of multiple predictors and account for repeated measures.
Results: A total of 181 transplant events involving 173 patients were included. Compared to Epoch 1, patients in Epoch 2 had higher AT3 (mean difference = 23.6%, p = .003), protein C (mean difference = 21.4%, p < .001), and protein S (mean difference = 15.3%, p < .001). PELD at transplant (p < .001), operation time (p < .001), and graft type (p = .029; p < .001; p < .001) also had significant effects on AT3, protein C and S. Patients in Epoch 2 received more FFP (mean difference = 9.4 mL/kg, p < .001) but had less positive fluid balance (mean difference = -9.7 mL/kg, p < .001). HAT rate reduced from 8.86% in Epoch 1 to 1.96% in Epoch 2 (p = .043), whereas bleeding rate did not differ by epoch.
Conclusions: Our postoperative anticoagulation protocol effectively increases postoperative AT3, protein C and S. We believe this outcome to be instrumental in reducing HAT rate at our centre without increasing complications such as bleeding and fluid overload.