Effect of perioperative Sonoclot monitoring on early thrombosis after pediatric liver transplantation: a prospective observational study

Background: Postoperative thrombosis is the most serious and common complication for children. The Sonoclot device is used to monitor coagulation function in transplant patients. However, no Sonoclot-based threshold for identifying children at risk of thrombosis has been established. This study aimed to identify the Sonoclot parameter and its optimal cutoff value for predicting early postoperative thrombosis in pediatric living-donor liver transplantation.

Methods: This was a single-center, prospective and observational study. The study was performed in Tianjin First Central Hospital, Tianjin, China, between September 2019 to May 2021. Clinical data of 200 children with living-donor liver transplantation (LDLT) were collected and observed. The effects of coagulation function monitoring by Sonoclot devices at 1 h after ischemia-reperfusion on early thrombosis were analyzed. Receiver operating characteristic (ROC) analysis was used to obtain the sensitivity and cutoff value of Sonoclot parameters for the diagnosis of thrombosis.

Results: A total of 38 cases (19%) had thrombosis complications. Twenty-three cases (11.5%) had postoperative hepatic artery thrombosis and 15 cases (7.5%) had portal vein and hepatic vein thrombosis. Univariate and multivariate analyses showed that whole blood activated clotting time (ACT) was independent risk factor for early postoperative thrombosis. ROC analysis found that the area under the curve (AUC) of ACT for the diagnosis of postoperative thrombosis was 0.918 (95% confidence interval: 0.872–0.954), and the cutoff value to predict early postoperative thrombosis was 228.5 s. The lower-ACT group had a higher incidence of overall thrombosis and hepatic artery thrombosis.

Conclusions: ACT after ischemia-reperfusion was a risk factor for early postoperative thrombosis. Maintaining ACT above 228.5 s was associated with a lower incidence of early thrombosis in this cohort. Prospective randomized studies are needed to confirm a causal therapeutic target.