Early Thrombosis Research Articles

Influence of donor and recipient sex on outcomes following simultaneous pancreas-kidney transplantation in the new millennium: Single-center experience and review of the literature.

The influence of sex on outcomes following simultaneous pancreas-kidney transplantation (SPKT) in the modern era is uncertain. We retrospectively studied 255 patients undergoing SPKT from 11/2001 to 8/2020. Cases were stratified according to donor (D) sex, recipient (R) sex, 4 D/R sex categories, and D/R sex-matched versus mismatched. D-male was associated with slightly higher patient (p=.08) and kidney (p=.002) but not pancreas (p=.23) graft survival rates (GSR) compared to D-female. There were no differences in recipient outcomes other than slightly higher pancreas thrombosis (8% R-female vs. 4.2% R-male, p=.28) and early relaparotomy rates in female recipients (38% R-female vs. 29% R-male, p=.14). When analyzing the 4 D/R sex categories, the two D-male groups had higher kidney GSRs compared to the two D-female groups (p=.01) whereas early relaparotomy and pancreas thrombosis rates were numerically higher in the D-female/R-female group compared to the other three groups. Finally, there were no significant differences in outcomes between sex-matched and sex-mismatched groups although overall survival outcomes were lower with female donors irrespective of recipient sex. The influence of D/R sex following SPKT is subject to multiple confounding issues but survival rates appear to be higher in D-male/R-male and lower in D-female/R-male categories.

Intra-arterial thrombolysis for early hepatic artery thrombosis following liver transplantation: a case report

Intra-arterial thrombolysis for early hepatic artery thrombosis following liver transplantation: a case report

Children with Acute Lymphoblastic Leukemia and Early Thrombosis Have Dysregulated Coagulation-Related Genes and Pathways

Introduction Thrombo-embolic events (TE) are a frequent complication of childhood acute lymphoblastic leukemia (ALL). Disease-specific mechanistic insights governing the development of TE in this disease remain unclear. Overexpression of coagulation-related genes (coagulome) and pathways have been identified in cancer-induced TE. We investigate whether coagulome dysregulation in newly-diagnosed children with ALL is associated with TE development. Methods We included patients aged 1-21 years old with newly-diagnosed ALL from September 3, 2015, to June 30, 2021, with available RNA-sequencing (RNAseq) data at diagnosis, either enrolled on the Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocol 16-001 or treated following the DFCI 11-001 protocol. RNAseq was performed through an optional study performed as part of the DFCI 16-001 clinical trial for patients who consented to it, or through the research oncogenomic program of the province of Quebec. The primary outcome was the occurrence of TE during ALL therapy requiring medical intervention (grade ≥2 as per the CTCAE version 5). TE were classified as early thrombosis (ET) if they occurred within 6 weeks from treatment start. Patients' characteristics were compared using Chi-Square or Fisher's exact test. Differential gene expression (DE) was performed to compare children with and without TE, adjusted for ALL phenotype (B- or T-cell lineage). The dysregulated genes were compared to a customized panel of 174 genes known to be implicated in cancer-related TE (coagulome and podoplanin) and in coagulation pathways. A secondary analysis, determined a priori, stratified children between ET and no TE, based on the hypothesis that the leukemia environment might predominantly affect early complications. Gene set enrichment analyses (GSEA) were performed on KEGG and gene ontology (GO) databases from the molecular signatures database (MSigDB). DE was considered for absolute fold change (FC) ≥2, and benjamini-Hochberg adjusted p-values (adj p) <0.05. Results We included 274 ALL patients (median age: 6.7 years [interquartile range, IQR: 3.7-12.0 years], 54% male, 81% B-ALL) of whom 49 (17.9%) experienced a TE (including 21 ET) at a median of 76 days (IQR: 27-155 days) following ALL diagnosis. Patients with TE were more likely to be ≥10 years old (57.1% vs. 31.6%, p<0.001) compared to those without TE. Sex, immunophenotype, mediastinal mass, central nervous system disease (CNS) involvement at diagnosis and risk status were otherwise not significantly different among the two groups. Three coagulation pathway-related genes were dysregulated in children with TE compared to those without TE. Glycoprotein 9 (GP9) and platelet factor 4 (PF4), implicated in von Willebrand-dependent platelet adhesion and platelet aggregation, were upregulated (log2FC = 2.1 and 1.5, respectively). Metalloproteinase-2 (MMP2), involved in collagenolysis and thrombus degradation, was downregulated (log2FC = -1.9). The KEGG olfactory transduction pathway was downregulated in the group with TE (normalized enrichment score (NES) = 1.55, adj p<0.001). In the secondary analysis stratified by timing of TE, patients with early TE were more likely to be ≥10 years (80.9% vs. 31.6%, p<0.001), have T-ALL (38.1% vs. 16.9%, p=0.002) and be CNS-positive at diagnosis (52.4% vs. 22.7%, p=0.004). Patients with ET showed overexpression of the GP9, PF4, integrin subunit beta 3 (ITGB3) and clusterin (CLU) genes involved in platelet aggregation and adhesion (log2FC = 3.3, 3.7, 2.7 and 1.6, respectively). The following GO pathways were significantly upregulated: blood coagulation (NES=1.73, adj p<0.001), platelet activation (NES=2.21, adj p<0.01), and platelet alpha granules (NES=2.48, adj p<0.001) while the KEGG olfactory transduction pathway was downregulated (NES=-1.70, adj p<0.001). Dysregulation of the olfactory transduction pathway has previously been described in cancer-associated TE in adults. Conclusion Our study identified coagulation-related genes and pathways that might be drivers of leukemia-induced thrombosis. Early TEs in childhood ALL were associated with significant upregulation of coagulation and platelet activation pathways, suggesting a role of the leukemia microenvironment in TE development. Additional studies are required to validate these observations that could be incorporated in future algorithms to predict TE risk in children with ALL. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Outcomes in small children on Berlin Heart EXCOR support: age and body surface area as clinical predictive factors.

The Berlin Heart EXCOR (BHE) offers circulatory support across all paediatric ages. Clinically, the necessary care and the outcomes differ in various age groups. The EUROMACS database was used to study age- and size-related outcomes for this specific device. All patients <19 years of age from the EUROMACS database supported with a BHE between 2000 and November 2021 were included. Maximally selected rank statistics were used to determine body surface area (BSA) cut-off values. Multivariable Cox proportional hazard regression using ridge penalization was performed to identify factors associated with outcomes. In total, 303 patients were included [mean age: 2.0 years (interquartile range: 0.6-8.0, males: 48.5%)]. Age and BSA were not significantly associated with mortality (n = 74, P = 0.684, P = 0.679). Factors associated with a transplant (n = 175) were age (hazard ratio 1.07, P = 0.006) and aetiology other than congenital heart disease (hazard ratio 1.46, P = 0.020). Recovery rates (n = 42) were highest in patients with a BSA of <0.53 m2 (21.8% vs 4.3-7.6% at 1 year, P = 0.00534). Patients with a BSA of ≥0.73 m2 had a lower risk of early pump thrombosis but a higher risk of early bleeding compared to children with a BSA of <0.73 m2. Mortality rates in Berlin Heart-supported patients cannot be predicted by age or BSA. Recovery rates are remarkably high in the smallest patient category (BSA <0.53 m2). This underscores that the BHE is a viable therapeutic option, even for the smallest and youngest patients.

Targeting the Crosstalk of Immune Response and Vascular Smooth Muscle Cells Phenotype Switch for Arteriovenous Fistula Maturation.

Plaque formation, thrombosis, and embolism are the underlying causes of acute cardiovascular events such as myocardial infarction and stroke while early thrombosis and stenosis are common pathologies for the maturation failure of arteriovenous fistula (AVF). Chronic inflammation is a common underlying pathogenesis mediated by innate and adaptive immune response involving infiltration of immune cells and secretion of pro- and anti-inflammatory cytokines. Impaired immune cell infiltration and change in vascular smooth muscle cell (VSMC) phenotype play a crucial role in the underlying pathophysiology. However, the change in the phenotype of VSMCs in a microenvironment of immune cell infiltration and increased secretion of cytokines have not been investigated. Since change in VSMC phenotype regulates vessel remodeling after intimal injury, in this study, we investigated the effect of macrophages and pro-inflammatory cytokines, IL-6, IL-1β, and TNF-α, on the change in VSMC phenotype under in vitro conditions. We also investigated the expression of the markers of VSMC phenotypes in arteries with atherosclerotic plaques and VSMCs isolated from control arteries. We found that the inhibition of cytokine downstream signaling may mitigate the effect of cytokines on the change in VSMCs phenotype. The results of this study support that regulating or targeting immune cell infiltration and function might be a therapeutic strategy to mitigate the effects of chronic inflammation to attenuate plaque formation, early thrombosis, and stenosis, and thus enhance AVF maturation.

Performance of stent thrombosis and bleeding risk scores in out-of-hospital cardiac arrest due to acute coronary syndromes

BackgroundPatients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndromes (ACS) who undergo percutaneous coronary intervention (PCI) are at high risk of bleeding and thrombosis. While predictive bleeding and stent thrombosis risk scores have been established, their performance in patients with OHCA has not been evaluated. MethodsAll consecutive patients admitted for OHCA due to ACS who underwent PCI between January 2007 and December 2019 were included. The ACTION and CRUSADE bleeding risk scores and the Dangas score for early stent thrombosis risk were calculated for each patient. A C-statistic analysis was performed to assess the performance of these scores. ResultsAmong 386 included patients, 82 patients (21.2%) experienced severe bleeding and 30 patients (7.8%) experienced stent thrombosis. The predictive performance of the ACTION and CRUSADE bleeding risk scores for major bleeding was poor, with areas under the curve (AUCs) of 0.596 and 0.548, respectively. Likewise, the predictive performance of the Dangas stent thrombosis risk score was poor (AUC 0.513). Using multivariable analysis, prolonged low-flow (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05; P=0.025), reduced haematocrit or fibrinogen at admission (OR 0.93, 95% CI 0.88–0.98; P=0.010 and OR 0.61; 95% CI 0.41–0.89; P=0.012, respectively) and the use of glycoprotein IIb/IIIa inhibitors (OR 2.10, 95% CI 1.18–3.73; P=0.011) were independent risk factors for major bleeding. ConclusionThe classic bleeding and stent thrombosis risk scores have poor performance in a population of patients with ACS complicated by OHCA. Other predictive factors might be more pertinent to determine major bleeding and stent thrombosis risks in this specific population.

S1277 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)

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. (Table) Conclusion: 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. Table 1. - Comparison of demographics, surgical features, and postoperative complications of LLDs in donor groups 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 GenderMaleFemale 290(56.2%)226(43.7%) 24(54.5%)20(45.4%) 4(57.1%)3(42.8%) 0.97 Marital statusUnmarriedMarried 351(68.1%)165 (31.9%) 25(56.9%)19 (43.1%) 5(71.4%)2(28.5%) 0.06 Donor's relation to recipientsSonBrotherNephewDaughterSisterFatherSwapOthersType of Graft Modified right lobe graftModified extended right lobe graftLeft lobe graftLeft lateral segment graftGRWRMean 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 ± 0.6310.99 ± 6.09407.94 ± 64.86516 6 (13.6%)5 (11.3%)5(11.3%)5 (11.3%)5 (11.3%)3 (6.8%)011 (25.0%)36 (81.8%)8 (18.1%)7 (15.9%)001.4 ± 0.6810.68 ± 4.08412.27 ± 89.1144 1(14.2%)2(28.5%)1(14.2%)00003(42.8%)6(85.7%)1(14.2%)001.2 ± 0.6313.86 ± 7.26422.86 ± 62.377 0.008NSNSNS0.76 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%)0000 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%)01 (2.2%)1 (2.2%)1 (2.2%) 00000 0.15 Grade 3B Re-open 6(1.1%) 1 (2.2%) 0 0.45 Grade 4A Need ICU care/ ventilatorGrade 4B Multi-organ failure 1 (0.1%)0 1 (2.2%)0 00 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.

The Predictive Value of Systemic Inflammatory Markers, the Prognostic Nutritional Index, and Measured Vessels' Diameters in Arteriovenous Fistula Maturation Failure.

Background: An arteriovenous fistula (AVF) is the first-line vascular access pathway for patients diagnosed with end-stage renal disease (ESRD). In planning vascular access, it is necessary to check the diameters of the venous and arterial components for satisfactory long-term results. Furthermore, the mechanism underlying the maturation failure and short-term patency in cases of AVFs is not fully known. This study aims to verify the predictive role of inflammatory biomarkers (the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), and C-reactive protein (CRP)), Ca-P product, the prognostic nutritional index (PNI), and the diameters of the venous and arterial components in the failure of AVF maturation. Methods: The present study was designed as an observational, analytical, and retrospective cohort study with a longitudinal follow-up, and included all patients with a diagnosis of ESRD that were admitted to the Vascular Surgery Clinic of the Targu Mures Emergency County Hospital, Romania, between January 2019 and December 2021. Results: The maturation of AVF at 6 weeks was clearly lower in cases of patients in the high-NLR (31.88% vs. 91.36%; p < 0.0001), high-PLR (46.94% vs. 85.55%; p < 0.0001), high-SII (44.28% vs. 88.89%; p < 0.0001), high-CRP (46.30% vs. 88.73%; p < 0.0001), high-Ca-P product (40.43% vs. 88.46%; p < 0.0001), and low-PNI (34.78% vs. 91.14%; p < 0.0001) groups, as well as in patients with a lower radial artery (RA) diameter (40% vs. 94.87%; p = 0.0009), cephalic vein (CV) diameter (44.82% vs. 97.14%; p = 0.0001) for a radio-cephalic AVF (RC-AVF), and brachial artery (BA) diameter (30.43% vs. 89.47%; p < 0.0001) in addition to CV diameter (40% vs. 94.59%; p < 0.0001) for a brachio-cephalic AVF (BC-AVF), respectively. There was also a significant increase in early thrombosis and short-time mortality in the same patients. A multivariate analysis showed that a baseline value for the NLR, PLR, SII, CRP, Ca-P product, and PNI was an independent predictor of adverse outcomes for all of the recruited patients. Furthermore, for all patients, a high baseline value for vessel diameter was a protective factor against any negative events during the study period, except for RA diameter in mortality (p = 0.16). Conclusion: Our findings concluded that higher NLR, PLR, SII, CRP, Ca-P product, and PNI values determined preoperatively were strongly predictive of AVF maturation failure, early thrombosis, and short-time mortality. Moreover, a lower baseline value for vessel diameter was strongly predictive of AVF maturation failure and early thrombosis.

Predictors of thrombosis and bleeding in 1613 myelofibrosis patients from the Spanish Registry of Myelofibrosis

Available data have proved insufficient to develop consensus recommendations on the prevention of thrombosis and bleeding in myelofibrosis (MF). We evaluated the incidence and risk factors of vascular complications in 1613 patients from the Spanish Myelofibrosis Registry. Over a total of 6981 patient-years at risk, 6.4% of the study population had at least one thrombotic event after MF diagnosis, amounting to an incidence rate of 1.65 per 100 patient-years. Prior history of thrombosis, the JAK2 mutation, and the intermediate-2/high-risk International Prognostic Scoring System (IPSS) categories conferred an increased thrombotic risk after adjustment for the risk-modifying effect of anti-thrombotic and cytoreductive treatments. History of thrombosis and the JAK2 mutation allowed us to pinpoint a group of patients at higher risk of early thrombosis. No decreased incidence of thrombosis was observed while patients were on anti-thrombotic or cytoreductive treatment. An increased risk of venous thrombosis was found during treatment with immunomodulatory agents. A total of 5.3% of patients had at least one episode of major bleeding, resulting in an incidence rate of 1.5 events per 100 patient-years. Patients in the intermediate-2/high-risk IPSS categories treated with anti-coagulants had an almost sevenfold increased risk of major bleeding. These findings should prove useful for guiding decision-making in clinical practice.

Decellularized bovine jugular vein and hand-sewn ePTFE valved conduit for right ventricular outflow tract reconstruction in children undergoing Ross procedure.

BackgroundThe Ross procedure is recommended as an optimal aortic valve replacement (AVR) in children and young adults due to several advantages. Nevertheless, multiple reconstructions of the right ventricular outflow tract (RVOT) with new valve conduits have caused some concern regarding the durability of the Ross AVR. Decellularized bovine jugular vein conduit (BJVC) (DP-BJVC) and hand-sewn expanded polytetrafluoroethylene valved conduits (ePTFE VC) are widely employed to reconstruct the RVOT with satisfactory long-term outcomes. However, few studies have compared the safety and efficacy between the two valve conduits. We aimed to evaluate the early outcomes and report our single center experience in the application of these conduits.MethodsTwenty-two pediatric patients (aged < 18 years) who underwent Ross procedures with DP-BJVC and ePTFE VC in our center between 1 June, 2017 and 31 January, 2022 were enrolled. The Kaplan–Meier method was used to evaluate survival, freedom from RVOT reintervention, and freedom from RVOT graft dysfunction. Mixed-effects analysis with the Geisser–Greenhouse correction and Sidak's multiple comparisons test for post-hoc analysis was employed to compare the peak gradient across the conduit at varying follow-ups.ResultsAll patients were followed up in full. The total early survival rate was 90.9%; two patients in the DP-BJVC group died. There was no significant difference in early mortality, cross-clamp time (p = 0.212), in-hospital stay (p = 0.469), and RVOT graft thrombosis or endocarditis between the two groups. There was similarly no significant difference between Kaplan–Meier freedom from RVOT graft dysfunction curve (P = 0.131). The transprosthetic gradient gradually increased over time in both groups and was significantly higher in the DP-BJVC group at follow-up (P < 0.05).ConclusionsBoth conduits show excellent early and midterm outcomes for RVOT reconstruction in the Ross procedure. We suggest that DP-BJVC is more suitable for infants, and ePTFE conduit is more suitable for older children who require larger conduits.

312.1: Implementation of Longitudinal Portoplasty for Hypoplasic Portal Veins in Children With Biliary Atresia in a Liver Transplantation Centre in Argentina

Objective: Biliary atresia (BA) represents the most frequent cause of liver transplantation (LT) in the pediatric population. An association between BA and portal hypoplasia has been previously described, making this group at higher risk of portal complications, which could eventually lead to portal hypertension, graft failure or even graft loss. The main objective of this work is to analyze and compare the results before and after the implementation of longitudinal portoplasty (LP) as the technique of choice during LT for patients with BA and hypoplasic portal vein in our center. Materials and Methods: Retrospective study including all patients transplanted due to BA and a preoperative diagnosis of portal hypoplasia (diameter measured by doppler ultrasound or CT scan less or equal to 5 mm). Results were analyzed before (group 1) and after the introduction of the new reconstruction technique in 2016 (group 2). Primary endpoints were the occurrence of early portal vein thrombosis (within 30 days of transplantation) and patient survival. Secondary endpoints were the occurrence of portal complications. Results: A total of 100 patients (out of 346 transplants, 78.1% of patients with BA) had a preoperative diagnosis of BA with portal hypoplasia and were included (50 patients in each group). Baseline characteristics did not differ among groups. Reduced grafts were used in 96% of the cases, and living donors in 43%. Overall rate of portal early thrombosis was 22% (n=11) in the first group and 2% (n=2) in the second (p= 0.002). An association between early portal early thrombosis and LP was found (p: 0.025 OR: 0.089 95% CI: 0.011-0.74). With regard to the technique used, portal early thrombosis was found in 12.7% (n=6) of end to end anastomosis, in 41.7% (n=5) of graft interposition and in 2.4% (n=1) of LP (p: 0.001). Patient survival at 12 and 24 months in the first group was 79.5% and 77.3%, while in the second group was 92% and 92% (log rank test 0.048). Median follow-up was 2 years. No statistical significant difference between survival and LP was found (p: 0.06 HR: 0.34 95% CI: 0.11-1.05). Overall rate of portal complications was 28%. With the implementation of LP there was a decrease of 24% in portal complications (p: 0.008). No statistical difference was found for stenosis among groups. Conclusion: Since the implementation of LP, a decrease in early portal thrombosis was seen. Limitations of this study are the fact that it is a retrospective and single institution study. Although results showed favorable trends towards LP, survival did not reach statistical significance yet, possibly due to lack of power in this context of limited cases to analyze. Larger sample size and longer follow-up studies are required to confirm these findings in the future. In conclusion, the routine use of LP could possibly minimize the occurrence of portal complications in patients with BA and portal hypoplasia, and could be considered in these cases with good results.

P9.02: Percutaneous Transhepatic TIPS for Budd-Chiari Syndrome As a Bridge to Liver Transplantation

Purpose: To evaluate the effectiveness of percutaneous transhepatic direct simultaneous puncture of portal vein and inferior vena cava in Budd-Chiari syndrome and the clinical outcomes. Material and Methods: From January 2006 to January 2022, we performed TIPS in 65 consecutive patients (mean age, 33 years) with BCS (8 patients with acute BCS and 57 patients with subacute and chronic BCS). Doppler US was performed first day, one week, one month and then 3 months apart. Portography and pressure measurements were performed every year if no shunt dysfunction was detected before. Mean follow-up of 52 months (range, 6 months -119 months). Results: TIPS procedure was technically successful in all patients. In all patients, bare stents were used. Patients were anticoagulated with warfarin after TIPS procedure. Early thrombosis (in one week) was diagnosed in 13 (20%) patients and TIPS revision was required. One year primary patency was 65.2%. Clinical success was achieved in 60 patients. 5 patients required liver transplantation because of liver function deterioration but only 3 of them had liver transplantation(7months, 1.5 year and 2 year later from TIPS) other 2 patients died while in the waiting list. Conclusion: Percutaneous direct puncture of portal vein and inferior vena cava is safe and effective in patients with Budd-Chiari syndrome. This procedure may provide an effective alternative for the management of Budd-Chiari patients that necessitates TIPS. Close follow-up and second intervention is necessary to get good clinical outcome.

Outcomes of Surgical Strategies for Living Donor Liver Transplantation in Patients With Portal Vein Thrombosis: A Cohort Study

Adequate portal flow to the liver graft is the requirement of a successful liver transplant (LT). Historically, portal vein thrombosis (PVT) was a contraindication for LT, especially for living donor LT (LDLT), demanding technically more difficult operations and advanced technique. In this study, the outcomes of patients with and without PVT after LDLT were compared. Adult LDLTs performed by 2 centers (n=335) between 2013 and 2020 were included into this large cohort study. PVT was classified based on Yerdel classification grade 1 to 4. Sixty-two patients with PVT constituted 19% of the study cohort of 335 recipients. While mean platelet count was found to be lower (P=.011) in the PVT group, patient age (P=.035), operation duration (P=.001), and amount of intraoperative blood transfusion (P=.010) were found to be higher. Incidence of PVT was higher in female patients than males (22.7% vs 16.1%, P=.037). There was no significant difference in survival between patients with and without PVT on 30-day (P=.285), 90-day (P=.565), 1-year (P=.777), and overall survival (P=.917). Early thrombosis did not show a better survival rate than Grades 2, 3, or 4 PVT. Thrombosis limited to portal vein was not found to bring a survival advantage compared with Grade 3 and 4 thromboses. Eversion thrombectomy was the most common procedure (66%) to overcome PVT intraoperatively. Although technically more challenging, PVT is not a contraindication of LDLT. Similar outcomes can be achieved in LDLT in patients with PVT after proper restoration of portal flow, which eliminates the default survival disadvantage of patients with PVT.

343.4: Pancreas Transplant Outcomes With No Early Graft Loss at A Single Institution

Introduction: The reported 3-month graft failure rate for pancreas allograft remains high ranging from 7-22%. We report outcomes and experience from a single institution with no technical graft loss. Method: A retrospective chart review was conducted of patients who underwent pancreas transplant +/- a kidney transplant from 2012-2021 with a maximum follow-up of five years. Information on pancreas and kidney graft failure was obtained and defined by current 2019 Organ Procurement and Transplantation Network (OPTN) criteria. Results: There were a total 74 patients included. The average age was 47.2 (+/- 9.97) with an average duration of diabetes of 22 years. 35.1% of patients were White, 40.5% Black and 24.3% other. 25% of patients identified as Hispanic. 70% of patients were male and 30% female. 65% of patients had type I diabetes and 35% type II diabetes. Most patients underwent simultaneous pancreas kidney (SPK) transplant (92%). 5.4% had pancreas transplant after kidney (PAK) and 2.7% had a pancreas transplant alone (PTA). The 3-month pancreas and kidney allograft survival was 100%. The 1-year survival for both pancreas and kidney were 97%. 5-year survival for pancreas allograft was 90.4% and 91.8% for kidney allograft. There was no pancreas graft failure due to vascular thrombosis or technical complications. Reasons for failure (n = 8) included post-transplant lymphoproliferative disorder (PTLD), vascular compromise after one year, weight gain with diagnosis of type II diabetes after transplantation for type I diabetes (n= 2), death due to other causes such as burn, graft vs. host disease, chronic obstructive pulmonary disease complications and lung cancer. The causes for kidney graft failure (n=5) included the previous deaths mentioned and PTLD. Conclusion: We report improved survival after pancreas transplantation with no early vascular thrombosis or technical complications and good pancreas and kidney allograft survival due to optimization of technique in addition to protocolized pre- and post-operative management protocol.

Management of Open Tile C Pelvic Fractures and Their Outcomes: A Retrospective Study of 30 Cases.

BackgroundOpen Tile C pelvic fractures are particularly severe. However, reports on their management and outcomes are relatively rare. This study analyzed the demographic and clinical characteristics of patients with open Tile C pelvic fractures and describes our management and outcomes of these injuries.MethodsThis retrospective review included all patients with open Tile C pelvic fractures treated in our department between January 2014 and June 2021. Data on patient demographics, characteristics of the injuries, surgical management, and outcomes were analyzed.ResultsThirty patients with a mean age of 34.0 years met the diagnostic criteria. The average Injury Severity Score was 40.3. According to the Tile fracture classification, 6 patients sustained type C1.1, 12 sustained type C1.2, 3 sustained type C1.3, 5 sustained C2 and 4 sustained type C3. Most patients had soft tissue injuries in multiple zones. All patients sustained associated injuries. Management consisted of bed rest in 8 cases, external fixation as the final strategy in 14, conversion from external fixation to internal fixation in 3, open reduction with internal fixation in 5, and amputation in 6. The average amount of packed red blood cells transfused was 33.3 units, the average intensive care unit stay was 11.3 days, the mean number of operations required was 6.2, and the mean length of hospital stay was 81.8 days. The main complications were early soft tissue infections and venous thrombosis. One patient died of sepsis and multi-organ failure. Soft tissue injuries in multiple zones increased utilization of hospital resources whereas anorectal injuries did not. Vascular damage accompanying truck crush injuries had a high amputation rate.ConclusionOpen Tile C pelvic fractures require multidisciplinary diagnosis and management and consume considerable hospital resources. More emphasis needs to be placed on this complex injury.

Transjugular Intrahepatic Portosystemic Shunt

Transjugular intrahepatic portosystemic shunt (TIPS) is now a well established percutaneous means of decreasing portal hypertension. The major clinical indications for transjugular intrahepatic portosystemic shunt are refractory variceal hemorrhage and refractory ascites. The shunt itself is created by placing a stent between the portal vein and the hepatic vein. The resultant shunting of portal venous flow to the systemic circulation helps reduce the portosystemic gradient and alleviate bleeding and ascites without changing the extrahepatic anatomy. History and Development The transjugular intrahepatic portosystemic shunt was initially described in 1969, originally by prolonged balloon dilation of a percutaneously created tract between the portal and hepatic veins. Unfortunately, short patency of the track remained a major clinical hurdle to its widespread use. The development of balloon expandable metallic stents and the subsequent introduction of flexible bare-metal stents helped improve patency rates. Intimal hyperplasia within the stent, especially at the hepatic venous end, required frequent secondary interventions such as balloon dilation and re-stenting. Early thrombosis was felt to be secondary to placing the transjugular intrahepatic portosystemic shunt across a major bile duct. Advances in stent technology and the introduction of polytetrafluoroethylene-covered stents over a decade ago has led to further increase in clinical patency and improved long-term results with TIPS.

Enoxaparin versus Unfractionated Heparin for the Perioperative Anticoagulant Therapy in Patients with Mechanical Prosthetic Heart Valve Undergoing Non-Cardiac Surgery.

Background and Objectives: Immediate postoperative anticoagulation regimens in patients with mechanical prosthetic valves undergoing non-cardiac surgery are clear only for unfractionated heparin (UH), whereas the few low-molecular-weight heparin (LMWH) trials available to date concern the use of Enoxaparin in general/orthopedic surgery. We performed a single-center real-world data study comparing the efficacy and safety of LMWH—Enoxaparin (E)— and UH during the perioperative period in non-cardiac surgical procedures in patients with mechanical prosthetic valve replacement in the mitral, aortic, or tricuspid positions. Materials and Methods: We enrolled 380 patients, who received E or UH together with oral anticoagulation with antivitamin K (acenocoumarol) until they achieved an optimal International Normalized Ratio (INR). Objective assessment of E efficacy included the following: normal value for all the parameters of ultrasound prosthetic functioning, no early thrombosis of the prosthesis, and rapid achievement of target INR with a decreased period of subcutaneous anticoagulation. Subjective assessment included the following: clinical improvement with decreased immobilization and in-hospital stay, fewer gluteal ulcerations, and fewer postoperative depression and anxiety episodes. Results: Comparing with UH, anticoagulation with E was more effective (p < 0.0001 and p = 0.02). The probability of death was smaller in the E group compared with the UH group. No major hemorrhagic event was reported. Mild bleeding episodes and thrombocytopenia were more common in the UH group. Patient’s compliance and quality of life were better with E due to shortened hospitalization, decreased need for testing of coagulation (every 6 h for UH), better dosing (SC every 12 h for E versus continuous infusion for UH), shortened immobilization during the immediate postoperative period with subsequent improvement in the psychological status, as well as due to lack of significant side effects. Conclusions: Taking into consideration the improved efficiency and safety, as well as all the supplementary advantages, such as no need for anticoagulation monitoring, the ease of administration, and reduced duration of hospitalization, E should be seen as an attractive alternative for anticoagulation which deserves further investigation.

Distal facial vein catheterization for prevention and management of thrombosis in vascularized lymph node transfers.

This study investigated the outcomes of the distal facial vein catheterization (DFVC) to manage venous thrombosis in vascularized submental lymph nodes (VSLN) flap transplantations. Between March 2017 and December 2020, patients who underwent VSLN flaps were divided into Group I: combined delayed primary retention sutures (DPRS) with DFVC, and Group II: DPRSalone. Primary outcomes were early (within 72 h) and late venous thrombosis. Secondary outcomes included other nonvascular complications and mechanical factors of the thrombosis. A total of 105 patients who underwent 106 VSLN flaps, including 37 and 69 flaps in Groups I and II, respectively, were included. There were no statistically significant differences in age, body mass index, Taiwan lymphoscintigraphy staging, and surgical factors between the two groups (all p > 0.05). Early venous thrombosis requiring re-exploration developed in one (2.7%) and three (4.3%) flaps in Groups I and II, respectively (p = 0.20). One flap (2.7%) and eight (11.5%) flaps developed late venous thrombosis in Groups I and II, respectively (p < 0.01). There was no statistically significant difference in total complication rates between both groups (p = 0.9). VSLN flap transplantation had a significantly higher risk of late venous thrombosis. DFVC significantly decreased the late venous thrombosis.

OS076 - High-risk Thrombophilia predict early thrombosis recurrence in acute non-cirrhotic portal vein thrombosis related to local factors: LOCAPORT

OS076 - High-risk Thrombophilia predict early thrombosis recurrence in acute non-cirrhotic portal vein thrombosis related to local factors: LOCAPORT

Early Perceval Valve Thrombosis

We report a case of early thrombosis of a sutureless Perceval valve after aortic valve replacement (AVR). Previous reports described Perceval AV thrombosis between 1-12 months [1, 2]. However, the patient was diagnosed with valve dysfunction 3 days later.