Bleeding and thrombosis in intestinal transplantation; data from 145 consecutive adult transplants
Background: Cambridge University Hospitals NHS Foundation Trust provides an adult intestinal/multivisceral transplant service to the United Kingdom. These patients can have complex thrombotic histories and are at risk of bleeding and thrombosis posttransplant. Objectives: We describe our experience...
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Elsevier
2025-07-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037925003140 |
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| author | Francesca Reeder Jessica Griffin Matthew Carter Holly Lowing Praharsh Babu Andrew Quarrell Tracy Moore Theodora Foukaneli Martin Besser Irum Amin Jeremy Woodward Neil Russell Dunecan Massey Rohit Gaurav Lisa Sharkey Charlotte Rutter Andrew Butler Will Thomas |
| author_facet | Francesca Reeder Jessica Griffin Matthew Carter Holly Lowing Praharsh Babu Andrew Quarrell Tracy Moore Theodora Foukaneli Martin Besser Irum Amin Jeremy Woodward Neil Russell Dunecan Massey Rohit Gaurav Lisa Sharkey Charlotte Rutter Andrew Butler Will Thomas |
| author_sort | Francesca Reeder |
| collection | DOAJ |
| description | Background: Cambridge University Hospitals NHS Foundation Trust provides an adult intestinal/multivisceral transplant service to the United Kingdom. These patients can have complex thrombotic histories and are at risk of bleeding and thrombosis posttransplant. Objectives: We describe our experience of (a) bleeding and thrombosis posttransplant, (b) transplantation for acute abdominal vascular catastrophe, and (c) use of direct oral anticoagulants (DOACs) posttransplant. Methods: A retrospective study of recipients of intestinal transplants at our center between 2007 and June 2023 was conducted. Results: Of 138 recipients (who received 145 grafts), 96 (70%) had a history of thrombosis pretransplant. Of the 145 grafts, 138 (95%) received blood products in the immediate operative period (up to 24 hours postoperatively; day +1) and 6 of 145 (4%) had an intraoperative thrombosis. Major bleeding and thrombosis rates from day +2 to +92 posttransplant were 38.0% (95% CI, 30.0%-46.0%) and 26.1% (95% CI, 19.1%-33.5%), respectively. Bleeds were predominantly gastrointestinal, surgical site, or intra-abdominal. The majority of thromboses (32 of 38 [84%]) were venous (especially catheter associated). No particular relationship between thrombotic and bleeding complications was observed. Eight recipients were transplanted as salvage procedures due to abdominal vascular catastrophe with generally favorable results, although in 3 recipients, no etiology was identified, and anticoagulant failures were seen. Five received DOACs posttransplant, and adequate peak drug levels were seen without bleeding or thrombotic complications. Conclusion: Patients who undergo intestinal transplant are at high risk of bleeding and thrombosis posttransplant. Intestinal transplant was used successfully as a salvage treatment for acute abdominal vascular catastrophe. DOACs were used in selected posttransplant patients. Further multicenter studies are required. |
| format | Article |
| id | doaj-art-eec3329499d64e86b7ca1e064dee5cb4 |
| institution | Kabale University |
| issn | 2475-0379 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-eec3329499d64e86b7ca1e064dee5cb42025-08-23T04:48:49ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792025-07-019510299010.1016/j.rpth.2025.102990Bleeding and thrombosis in intestinal transplantation; data from 145 consecutive adult transplantsFrancesca Reeder0Jessica Griffin1Matthew Carter2Holly Lowing3Praharsh Babu4Andrew Quarrell5Tracy Moore6Theodora Foukaneli7Martin Besser8Irum Amin9Jeremy Woodward10Neil Russell11Dunecan Massey12Rohit Gaurav13Lisa Sharkey14Charlotte Rutter15Andrew Butler16Will Thomas17Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomSchool of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United KingdomSchool of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United KingdomDepartment of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom; Correspondence Will Thomas, Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.Background: Cambridge University Hospitals NHS Foundation Trust provides an adult intestinal/multivisceral transplant service to the United Kingdom. These patients can have complex thrombotic histories and are at risk of bleeding and thrombosis posttransplant. Objectives: We describe our experience of (a) bleeding and thrombosis posttransplant, (b) transplantation for acute abdominal vascular catastrophe, and (c) use of direct oral anticoagulants (DOACs) posttransplant. Methods: A retrospective study of recipients of intestinal transplants at our center between 2007 and June 2023 was conducted. Results: Of 138 recipients (who received 145 grafts), 96 (70%) had a history of thrombosis pretransplant. Of the 145 grafts, 138 (95%) received blood products in the immediate operative period (up to 24 hours postoperatively; day +1) and 6 of 145 (4%) had an intraoperative thrombosis. Major bleeding and thrombosis rates from day +2 to +92 posttransplant were 38.0% (95% CI, 30.0%-46.0%) and 26.1% (95% CI, 19.1%-33.5%), respectively. Bleeds were predominantly gastrointestinal, surgical site, or intra-abdominal. The majority of thromboses (32 of 38 [84%]) were venous (especially catheter associated). No particular relationship between thrombotic and bleeding complications was observed. Eight recipients were transplanted as salvage procedures due to abdominal vascular catastrophe with generally favorable results, although in 3 recipients, no etiology was identified, and anticoagulant failures were seen. Five received DOACs posttransplant, and adequate peak drug levels were seen without bleeding or thrombotic complications. Conclusion: Patients who undergo intestinal transplant are at high risk of bleeding and thrombosis posttransplant. Intestinal transplant was used successfully as a salvage treatment for acute abdominal vascular catastrophe. DOACs were used in selected posttransplant patients. Further multicenter studies are required.http://www.sciencedirect.com/science/article/pii/S2475037925003140bleedingdirect-oral anticoagulantsintestinal transplantationmultivisceral transplantationthrombosis |
| spellingShingle | Francesca Reeder Jessica Griffin Matthew Carter Holly Lowing Praharsh Babu Andrew Quarrell Tracy Moore Theodora Foukaneli Martin Besser Irum Amin Jeremy Woodward Neil Russell Dunecan Massey Rohit Gaurav Lisa Sharkey Charlotte Rutter Andrew Butler Will Thomas Bleeding and thrombosis in intestinal transplantation; data from 145 consecutive adult transplants Research and Practice in Thrombosis and Haemostasis bleeding direct-oral anticoagulants intestinal transplantation multivisceral transplantation thrombosis |
| title | Bleeding and thrombosis in intestinal transplantation; data from 145 consecutive adult transplants |
| title_full | Bleeding and thrombosis in intestinal transplantation; data from 145 consecutive adult transplants |
| title_fullStr | Bleeding and thrombosis in intestinal transplantation; data from 145 consecutive adult transplants |
| title_full_unstemmed | Bleeding and thrombosis in intestinal transplantation; data from 145 consecutive adult transplants |
| title_short | Bleeding and thrombosis in intestinal transplantation; data from 145 consecutive adult transplants |
| title_sort | bleeding and thrombosis in intestinal transplantation data from 145 consecutive adult transplants |
| topic | bleeding direct-oral anticoagulants intestinal transplantation multivisceral transplantation thrombosis |
| url | http://www.sciencedirect.com/science/article/pii/S2475037925003140 |
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