P3842 - Impact of Protein-C and Antithrombin-III Deficiency and Leiden Factor-V Mutation in Venous Thromboembolic Events (VTE) and Overall Post-Operative Donor Outcomes
SUNY Upstate Medical University, New York Syracuse, New York
Abdul Wahab Dogar, MBBS, FCPS1, Kaleem Ullah, MBBS, FCPS1, Azhar Hussain, MD2, Shams Ud-Din, MBBS, FCPS1, Abdul Ghaffar, MBBS, FCPS1, Ameer Hamza, MBBS, FCPS1, Abu Hurairah, MD3, Chaudhary Abdul Fatir, MBBS4, Salman Pervaiz, MBBS4 1Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Sindh, Pakistan; 2SUNY Upstate Medical University, New York, Syracuse, NY; 3AdventHealth, Orlando, FL; 4Ameer Ud Din Medical College, Lahore, Punjab, Pakistan
Introduction: The main aim of this study was to determine the frequency of hereditary thrombophilia in the Pakistani population and share our centers' safety and VTE prophylaxis protocols in live liver donors.
Methods: Thrombophilia testing that included Protein C (PC), Antithrombin (AT) III, and Leiden factor-V mutation was done in 567 living donor candidates between July 2018 and April 2022. Donors were divided into normal, borderline, and high-risk groups. The safety endpoints were VTE occurrence, bleeding complications, or mortality.
Results: Among them, 21 (3.7%) donors were deficient in protein C, 14(2.5%) were deficient in anti-thrombin-III, and 45(7.9%) had Leiden factor-V mutation. Donor operation was performed in 44 candidates in the borderline group and 7 in the high-risk group. Complications after surgery were comparable between the two groups. One donor in the normal donor group developed pulmonary embolism, but none of the donors in either borderline or high-risk group developed VTE. No mortality and bleeding occured.
Discussion: Due to lacking a suitable alternative donor, 51 living donors with marginal or high-risk findings from thrombophilia screening tests underwent right lobe hepatectomy in this prospective cohort study. Other LDLT facilities typically administer pharmacological prophylaxis against VTE to living donors in the marginal risk population, such as subcutaneous LMWH or low-dose unfractionated heparin or enoxaparin administered postoperatively to reduce the risk of VTE. However, according to our center's policies, LDLT normal and marginal group donors are not routinely given any pharmacological prophylaxis. Instead, we treated them conservatively using elastic stockings and intermittent pneumatic compression (IPC) and encourage early postoperative ambulation. We performed 07 donors who underwent right lobe hepatectomy from the high-risk group (having Protein C levels greater than 50%, at least) due to the lack of an alternate donor and the emergent nature of LDLT in their recipients. None of these donors in either group ever experienced VTE after surgery. We administered pharmacological prophylaxis against VTE with Rivaroxaban postoperatively in addition to conservative measures to reduce the risk of VTE in high-risk groups only. These prophylactic approaches prevented any donor in the marginal or high-risk groups from having VTE without significantly increasing the risk of experiencing bleeding-related problems due to the non-calculated administration of anticoagulants.
Disclosures:
Abdul Wahab Dogar indicated no relevant financial relationships.
Kaleem Ullah indicated no relevant financial relationships.
Azhar Hussain indicated no relevant financial relationships.
Shams Ud-Din indicated no relevant financial relationships.
Abdul Ghaffar indicated no relevant financial relationships.
Ameer Hamza indicated no relevant financial relationships.
Abu Hurairah indicated no relevant financial relationships.
Chaudhary Abdul Fatir indicated no relevant financial relationships.
Salman Pervaiz indicated no relevant financial relationships.
Abdul Wahab Dogar, MBBS, FCPS1, Kaleem Ullah, MBBS, FCPS1, Azhar Hussain, MD2, Shams Ud-Din, MBBS, FCPS1, Abdul Ghaffar, MBBS, FCPS1, Ameer Hamza, MBBS, FCPS1, Abu Hurairah, MD3, Chaudhary Abdul Fatir, MBBS4, Salman Pervaiz, MBBS4. P3842 - Impact of Protein-C and Antithrombin-III Deficiency and Leiden Factor-V Mutation in Venous Thromboembolic Events (VTE) and Overall Post-Operative Donor Outcomes, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.