PB1072 - Bleeding and thrombosis in intestinal and multivisceral transplantation: experience from 145 consecutive cases

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

FR

Francesca Reeder

Haematology Specialist Registrar
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom

Co-Author(s)

JG

Jessica C. Griffin

Haematology Specialist Registrar
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
MC

Matthew Carter

Haematology Registrar
Addenbrookes Hospital
London, England, United Kingdom
HL

Holly Lowing

Haematology Medical Secretary
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
AQ

Andrew Quarrell

Medical Student
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
PB

Praharsh Babu

Medical Student
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
TM

Tracy Moore

Senior BMS, Blood Sciences Training Manager
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
AB

Andrew Butler

Consultant Surgeon
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
LS

Lisa Sharkey

Consultant Gastroenterologist
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
CR

Charlotte Rutter

Consultant Gastroenterologist
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
IA

Irum Amin

Consultant Transplant Surgeon
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
RG

Rohit Gaurav

Consultant Hepatobiliary Transplant Surgeon
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
DM

Dunecan Massey

Consultant gastroenterologist
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
NR

Neil Russell

Consultant surgeon
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
JW

Jeremy Woodward

Consultant gastroenterologist
Cambridge University Hospitals NHS Foundation Trust
Cambridge, England, United Kingdom
WT

Will Thomas

Cambridge University, United Kingdom

Background: Solid organ transplantation, and its associated complication rates, are well established internationally. Associated rates of bleeding and thrombotic complications are as yet unestablished in intestinal and multivisceral transplantation.

Aims: To describe the bleeding and thrombotic incidence and experience in intestinal/multivisceral transplants performed over a 15 year period since establishment of the United Kingdom’s designated adult multivisceral transplant centre

Methods: Retrospective analysis of 145 consecutive cases. Bleeding or thrombotic events occuring in the 92 days postoperative were observed. Data collection for either event stopped at first occurrence. Bleeding was defined using the ISTH definition of major bleeding in surgical patients.

Results: Between 2008 and 2023, 139 patients received 145 transplants; 48% females, mean age 44 years and 70% with a prior history of thrombosis. Of the 145 transplants, 6/145 (4.1%) had a thrombotic event either in surgery or in the 24 hours after surgery. The cumulative incidence of thrombosis was 26.1% (95% CI 19.1 – 33.5%) from day 2-92 (Figure 1). Median transfusion requirements (units) for day of surgery and 24 hours after were 10 (red cells), 4 (plasma), 1 (platelets) and 2 (cryoprecipitate). The cumulative incidence of major bleeding was 38.0% (95% CI 30.0 – 36.0%) from day 2-92 (Figure 2). Thrombotic events occurred in 22 (15%), bleeding events in 38 (27%), and both bleeding and thrombotic events in 15 (11%). There were no bleeding or thrombotic events in 67 (47%) transplants. 8 patients were transplanted for abdominal vascular catastrophe, where long-term survival would not be possible without transplantation (further details will be presented). 6 patients received direct oral anticoagulants post-transplant; drug levels were in the expected range.

Conclusion(s): There is a high incidence of major bleeding and thrombosis following intestinal/multivisceral transplantation, illustrating the brittle haemostasis in these patients.