Safety and efficacy of extended thrombophilia screening directed venous thromboembolic events (VTE) prophylaxis in live liver donors: do we really need extended thrombophilia screening routinely?

Abdul Wahab Dogar; Azhar Hussain; Kaleem Ullah; Shams-Ud-Din; Abdul Ghaffar; Khabab Abbasher Hussien Mohamed Ahmed; Muhammad Junaid Tahir

doi:10.1097/MS9.0000000000001772

Safety and efficacy of extended thrombophilia screening directed venous thromboembolic events (VTE) prophylaxis in live liver donors: do we really need extended thrombophilia screening routinely?

Ann Med Surg (Lond). 2024 Jan 30;86(3):1297-1303. doi: 10.1097/MS9.0000000000001772. eCollection 2024 Mar.

Authors

Abdul Wahab Dogar¹, Azhar Hussain¹, Kaleem Ullah¹, Shams-Ud-Din¹, Abdul Ghaffar¹, Khabab Abbasher Hussien Mohamed Ahmed², Muhammad Junaid Tahir³

Affiliations

¹ Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Sindh.
² Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
³ Pakistan Kidney and Liver Institute and Research Centre (PKLI & RC), Lahore, Pakistan.

Abstract

Background and aims: The study aimed to determine the prevalence of hereditary thrombophilia, and stratify its severity among live liver donors in Pakistan. Also, the authors evaluated the safety and efficacy of thrombophilia profile testing directed venous thromboembolic events (VTE) prophylaxis while balancing bleeding risk and the need for routine thrombophilia testing before live liver donation among living donor candidates.

Materials and methods: Protein S (PS), protein C (PC), anti-thrombin (AT) III, and anti-phospholipid antibody panel (APLA) levels were measured in 567 potential donor candidates. Donors were divided into normal, borderline and high-risk groups based on Caprini score. The safety endpoints were VTE occurrence, bleeding complications or mortality.

Results: Among 567 donors, 21 (3.7%) were deficient in protein C, and 14 (2.5%) were deficient in anti-thrombin-III. IgM and IgG. Anti-phospholipids antibodies were positive in 2/567 (0.4%) and 2/567 (0.4%), respectively. IgM and IgG lupus anticoagulant antibodies were positive in 3/567 (0.5%) and 3/567 (0.5%), respectively. VTE events, bleeding complications and postoperative living donors liver transplantation-related complications were comparable among the three donor groups (P>0.05). One donor in the normal donor group developed pulmonary embolism, but none of the donors in either borderline or high-risk group developed VTE. The mean length of ICU and total hospital stay were comparable. No donor mortality was observed in all donor groups.

Conclusions: Due to thrombophilia testing directed VTE prophylaxis, VTE events were comparable in normal, borderline and high-risk thrombophilia donor groups, but more evaluations are required to determine the lower safe levels for various thrombophilia parameters including PC, PS and AT-III before surgery among living donor candidates.

Keywords: live liver donors; living donors liver transplantation (LDLT); thrombophilia screening; venous thromboembolic events.