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Presenter: Lee, Cummings, Kansas city, United States
Authors: Lee Cummings1, Cal Matsumoto1, Raffaele Girlanda1, Erin Fennelly1, Eddie Island1, Thomas Fishbein1
Lee Cummings, Cal Matsumoto, Raffaele Girlanda, Erin Fennelly, Eddie Island, Thomas Fishbein
Transplant Institute, Georgetown University Hospital, Washington, DC, United States
Adult Intestinal failure has numerous etiologies as a result of several clinical entities. In a high proportion of these patients an ischemic event plays an important role in the development of intestinal failure.
The aim of this study was to evaluate the pro-coagulant profile of patients with intestinal failure and subsequently its impact on intestinal transplantation (ITx).
Methods: A prospective database detailing pro-coagulant characteristics of all patients referred to our institute with intestinal failure from December 2009 to present was evaluated. We identified the specific underlying pro-coagulant characteristics of the patients and determined the need for perioperative anticoagulation. Patients were additionally evaluated on the impact of anticoagulation on their short term outcomes.
Results: 33/43 (76.7%) adult patients evaluated for ITx were identified as having a thrombophillia. 12 patients (27.9%) had 2 abnormalities, and 5 patients (11.3%) had 3 abnormalities. 16 (37.2 %) patients were Lupus Anticoagulant (LA) positive. 14 (32.6 %) had hyperhomocysteinemia. 8 (18.6%) had low protein S and 4 had a low Protein C (9.3%). 6 (13.9%) had MTHFR homozygous mutant genotype with 5/6 having hyperhomocysteinemia. 2 (4.7%) had mutant plasminogen activator inhibitor genotype. 2 had phosphatidylserine antibodies. 2 had positive ANA.
12 of the 33 indentified recipients with a thrombophilic state were transplanted and received perioperative anticoagulation (11 isolated ITx and 1 Multivisceral). 3 /12 (25%) of these patients required a reoperation for bleeding. 2 isolated intestine recipients suffered from acute graft thrombosis despite anticoagulation; one of which was salvaged successfully. Post-operative infection rate was 66% and 40% for anticoagulation and no anticoagulation groups.
Conclusion: Thrombophillic states were noted to be a frequent phenomenon in adult SGS patients we evaluated for ITx. Their detection and subsequent anticoagulation is critical, however, systemic anticoagulation can lead to more perioperative complications.
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