Risk and factors associated with venous thromboembolism following abdominal transplantation

Sara Sakowitz; Syed Shahyan Bakhtiyar; Arjun Verma; Elsa Kronen; Konmal Ali; Nikhil Chervu; Peyman Benharash

doi:10.1016/j.sopen.2023.03.006

Risk and factors associated with venous thromboembolism following abdominal transplantation

Surg Open Sci. 2023 Mar 30:13:18-23. doi: 10.1016/j.sopen.2023.03.006. eCollection 2023 Jun.

Authors

Sara Sakowitz¹, Syed Shahyan Bakhtiyar^{1

2}, Arjun Verma¹, Elsa Kronen¹, Konmal Ali¹, Nikhil Chervu^{1

3}, Peyman Benharash^{1

3}

Affiliations

¹ Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America.
² Department of Surgery, University of Colorado, Aurora, CO, United States of America.
³ Department of Surgery, University of California, Los Angeles, CA, United States of America.

Abstract

Background: Venous thromboembolism (VTE) remains under-studied among patients undergoing kidney, liver and pancreas (abdominal) transplantation. We characterized the risk and predictors of VTE using a nationally-representative cohort.

Methods: The 2014-2019 Nationwide Readmissions Database was queried to identify all adults undergoing abdominal transplantation. Patients who developed pulmonary embolism or deep venous thrombosis were considered the VTE cohort (others: nonVTE). Multivariable models were developed to identify factors linked with VTE and assess the independent associations between VTE and key outcomes.

Results: Of ~141,977 transplant recipients, 1.9 % (2722) developed VTE. The VTE cohort was similarly female (39.2 vs 38.0, p = 0.51), but more often demonstrated a higher Elixhauser comorbidity index (4.19 ± 1.40 vs 3.93 ± 1.39, p < 0.001).After adjustment, congestive heart failure (AOR 1.54, 95%CI 1.25-1.91), cardiac arrhythmias (AOR 1.54, 95%CI 1.34-1.78), peripheral vascular disease (AOR 1.29, 95%CI 1.02-1.63), coagulopathies (AOR 1.63, 95%CI 1.38-1.92), previous history of VTE (AOR 1.14, 95%CI 1.06-1.22), and heparin-induced thrombocytopenia (AOR 2.61, 95%CI 2.07-3.28) were associated with VTE. The development of VTE was linked with significantly greater in-hospital mortality (AOR 4.56, 95%CI 2.07-10.10), as well as infectious (AOR 2.59, 95%CI 1.55-4.21), cardiac (AOR 2.59, 95%CI 1.39-4.82), and respiratory (AOR 1.78, 95%CI 1.21-2.63) complications. VTE was further associated with increased length of stay (+8.18 days, 95%CI +1.32-15.41), expenditures (+$42,000, 95%CI $24,800-59,210), and odds of VTE upon readmission (AOR 4.51, 95%CI 1.32-15.41).

Conclusions: VTE after abdominal transplantation is linked with significantly greater in-hospital mortality, complications, resource utilization, and risk of VTE at readmission. Novel risk assessments and prophylaxis protocols are needed to reduce VTE incidence and sequelae.

Keywords: Clinical outcomes; Deep venous thrombosis; Kidney transplant; Liver transplant; Pancreas transplant; Pulmonary embolism; Risk prophylaxis; Solid organ transplantation; Venous thromboembolism.