Clinical Feature Analysis Of Heparin Induced Thrombocytopenia After Liver Transplantation In Children

Objective: Heparin is one of anticoagulants used after liver transplantation most commonly.It is mainly used for the prevention and treatment of arteriovenous thrombosis.The use of heparin can lead to the decrease of platelets,named HIT,which leads to harmful clinic effect.To date,very few studies on HIT after liver transplantation have yet been done,not to mention these studies on children.In clinic work,medical personnel make little of HIT,and have insufficient understanding on the possibility of causing serious consequences of thrombus.In this study,the clinical data of HIT in children after liver transplantation were summarized to explore the clinical characteristics of HIT after liver transplantation in children,and to explore the clinical strategy of safe use of heparin.Methods: The clinical data of 64 children with liver transplantation from June 2006 to March 2015 in Children's Hospital of Chongqing Medical University were retrospectively analyzed.Here were 30 males and 34 females with age ranging from 2 months to 15 years old and median age of 8 months.According to age group,47 cases were younger than 3 years old(age< 3 years old),17 cases were older than 3 years old(age>3 years old).According to the use of heparin,divided into unfractionated heparin(UFH)group of 41 cases,low molecular weight heparin(LMWH)group of 23 cases.In the UFH group,age> 3 years old in 8 cases,<3 years old in 33 cases.In the original disease,42 cases of biliary atresia,6 cases of hepatolenticular degeneration,6 cases of hepatic glycogen accumulation,3 cases of portal cortex,3 cases of primary cirrhosis and 3 cases of biliary cirrhosis,1 case of acute severe hepatitis.We do the detection of platelet count of all children during hospitalization,collect relevant clinical information of children.Including the age,sex,primary disease,liver transplantation,previous history of heparin exposure,heparin use and time of use,the time of hospitalization,vascular embolization,skin lesions occurrence and other complications and prognosis.SPSS 20.0 statistical software package was applied for data analysis on the incidence of HIT,children age,the relationship between heparin type and HIT,and the relationship between HIT and children with prognosis.Results:In the 64 cases of children with liver transplantation,41 cases were LMWH group,5 cases(5 of 41,12.2%)developed HIT,3 cases were female in HIT patients,2 cases were male;LMWH group,<3 years old infants 2 cases(2 of 33,6.1%),>3 years old infants 3 cases(3 of 8,37.5%)the difference between the two groups has statistically significance(P <0.05);There were no HIT cases in 23 patients with low molecular weight heparin.Of the 5 patients with HIT,3(3/5,60%)died within 30 days after surgery,and 2 patients underwent postoperative hepatic artery thrombosis..Nine out of 59 patients who did not have HIT died of HIT(9/59,15.3%),and were statistically significant(P <0.05)compared with HIT patients.Conclusion: HIT may be one of the reasons for the increase of perioperative mortality in children after liver transplantation.UFH is higher than that of LMWH,and children with age> 3 years are more likely to develop HIT during the use of heparin.Therefore,children with age >3 years of age should avoid using UFH.In the process of pediatric liver transplantation with heparin treatment,more attention should be paid to the observation of the disease,so that the detection of HIT can be confirmed as early as possible to reduce the occurrence of HIT.