Hepatic artery thrombosis versus neurological complications – Role of antiplatelet medications in adult living donor liver transplantation

Abstract

Aspirin used in the post-operative period as prophylaxis for hepatic artery thrombosis (HAT) increases the risk of neurological complications (NC) in adult living donor liver transplantation (LDLT) recipients was the hypothesis. Case control study was done on 1400 cases operated in our institute. Pediatric transplants, combined liver kidney, cadaver transplants, dual lobe transplants, preexisting organic neurological dysfunction and patients whose records were missing were excluded from the study. There were effectively 880 cases in non-aspirin group (NAG) and 440 cases in aspirin group (AG). The groups were matched for various factors. There were more alcoholics in AG and more ALFs in NAG. On subgroup analysis these two etiological factors were found to be statistically insignificant P > 0.05. So the prophylactic protocol was aspirin 75 mg once daily in all adults (age >12 years) once the platelet counts have reached 50,000 and there is no evidence of bleeding elsewhere. In pediatric population our protocol is use of aspirin 75 mg and clopidogrel 75 mg once daily once the platelet counts have reached 50,000 and there is no evidence of bleeding anywhere else.

Keywords

• Antiplatelets
• Living donor liver transplantation
• Hepatic artery thrombosis
• Neurological complications
• Central pontine myelinolysis