Thrombosis prophylaxis in pediatric liver transplantation: A systematic review.
Thrombosis prophylaxis in pediatric liver transplantation: A systematic review.
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DOI：
10.4254/wjh.v10.i10.752
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发表时间：
2018-10-27
影响因子：
2.4
通讯作者：
Lussana F
中科院分区：
文献类型：
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作者：
Nacoti M;Ruggeri GM;Colombo G;Bonanomi E;Lussana F
回顾目前预防小儿肝移植(PLT)血栓形成的文献，因为血栓形成仍然是一个严重的并发症。研究通过电子搜索MEDLINE、EMBASE和Cochrane图书馆(中央)数据库确定，直到2018年3月。通过人工查阅纳入研究的参考文献和已发表的关于血栓形成和PLT的主要系统性综述的参考文献来补充搜索。我们排除了这篇综述病例报告、小病例系列、评论、会议摘要、描述10例/年以下儿童肝移植的论文和1990年前发表的文章。两名评价者独立进行研究选择，分歧通过讨论解决，必要时由第三评价者的意见解决。本综述包括9项回顾性研究。研究的整体质量较差。由于纳入研究的回溯性设计和异质性，研究结果的汇集分析是不可能的。门静脉血栓形成(PVT)在儿童活体供肝移植(LDLT)中的发生率为2%~10%，在儿童已故供体肝移植(DDLT)中的发生率为4%~33%。肝动脉血栓形成(HAT)多见于混合LDLT和DDLT儿童人群，发生率为0%~29%。在大多数研究中，多普勒超声被用作血栓形成的第一线诊断筛查。报告了四种不同的门静脉吻合术，在降低门静脉血栓方面具有相似的效果。体积缩小的肝移植与低风险PVT(发生率4%)和HAT(发生率0%，P<；0.05)相关。同样，无移植物介入的主动脉吻合术和显微外科肝动脉重建术显著降低HAT发生率(分别为6%和0%)。根据我们的纳入和排除标准，我们没有找到评估药物预防血栓形成的合格研究。低质量的回顾研究表明，使用量身定制的手术策略可能有助于减少PLT后的HAT和PVT；迫切需要前瞻性研究。
To review current literature of thrombosis prophylaxis in pediatric liver transplantation (PLT) as thrombosis remains a critical complication. Studies were identified by electronic search of MEDLINE, EMBASE and Cochrane Library (CENTRAL) databases until March 2018. The search was supplemented by manually reviewing the references of included studies and the references of the main published systematic reviews on thrombosis and PLT. We excluded from this review case report, small case series, commentaries, conference abstracts, papers which describing less than 10 pediatric liver transplants/year and articles published before 1990. Two reviewers performed study selection independently, with disagreements solved through discussion and by the opinion of a third reviewer when necessary. Nine retrospective studies were included in this review. The overall quality of studies was poor. A pooled analysis of results from studies was not possible due to the retrospective design and heterogeneity of included studies. We found an incidence of portal vein thrombosis (PVT) ranging from 2% to 10% in pediatric living donor liver transplantation (LDLT) and from 4% to 33% in pediatric deceased donor liver transplantation (DDLT). Hepatic artery thrombosis (HAT) was observed mostly in mixed LDLT and DDLT pediatric population with an incidence ranging from 0% to 29%. In most of the studies Doppler ultrasonography was used as a first line diagnostic screening for thrombosis. Four different surgical techniques for portal vein anastomosis were reported with similar efficacy in terms of PVT reduction. Reduced size liver transplant was associated with a low risk of both PVT (incidence 4%) and HAT (incidence 0%, P < 0.05). Similarly, aortic arterial anastomosis without graft interposition and microsurgical hepatic arterial reconstruction were associated with a significant reduced HAT incidence (6% and 0%, respectively). According to our inclusion and exclusion criteria, we did not find eligible studies that evaluated pharmacological prevention of thrombosis. Poor quality retrospective studies show the use of tailored surgical strategies might be useful to reduce HAT and PVT after PLT; prospective studies are urgently needed.