Abstract
Aims & Objectives: The final common pathway of single ventricle patients is the Fontan procedure. One of the immediate postoperative complications is acute hepatic injury presented by marked elevation of liver enzymes (alanine transaminase (ALT) and aspartate transaminase (AST)). Aims: We aimed to determine the contribution of blood products transfusion to acute hepatic injury. Methods We retrospectively reviewed demographic, pre-, intra- and post-operative parameters including blood products transfusions and liver enzymes (Table 1). ALT and AST levels were transformed into log scale for the regression analysis. We used the Spearman correlation while adjusting for possible confounders. Propensity score was used in order to perform a stepwise weighted linear regression. Results 99 pediatric patients after the Fontan procedure were identified between 01/2009 and 12/2016. Out of the four types of blood products, transfusion of platelets was found to significantly impact post-operative levels of ALT and AST (Figure 1). Additional factors include post-operative administration of sodium bicarbonate, decreased flow through the Fontan canal and decreased urine output. Cardiopulmonary bypass time, aortic cross-clamp time, amount of post-operative bleeding and vasoactive-inotropic score did not influence liver enzymes levels (Table 2). Conclusions In pediatric patients undergoing the Fontan procedure, platelets transfusions significantly contribute to acute hepatic injury. The relation between platelets and transfusion related acute lung injury (TRALI) has been well described, but this is the first time it is being described in regards to acute hepatic injury (TRAHI). Changing platelet transfusion strategy could decrease morbidity in Fontan patients but further research is needed.
Published Version
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