Antiplatelet agent for the prevention of late hepatic vascular complications in living donor liver transplant dominant population

Deok-Gie Kim; Sung Hwa Kim; Jun Young Lee; Jae Geun Lee

doi:10.1016/j.asjsur.2024.04.002

Antiplatelet agent for the prevention of late hepatic vascular complications in living donor liver transplant dominant population

Asian J Surg. 2024 Apr 18:S1015-9584(24)00635-3. doi: 10.1016/j.asjsur.2024.04.002. Online ahead of print.

Authors

Deok-Gie Kim¹, Sung Hwa Kim², Jun Young Lee³, Jae Geun Lee⁴

Affiliations

¹ Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea.
² Department of Statistics, Yonsei University Wonju College of Medicine, Wonju, South Korea.
³ Department of Nephrology Yonsei University Wonju College of Medicine, Wonju, South Korea. Electronic address: junyoung07@yonsei.ac.kr.
⁴ Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: drjg1@yuhs.ac.

PMID: 38641537
DOI: 10.1016/j.asjsur.2024.04.002

Abstract

Background: Evidence for the long-term use of antiplatelet drugs to prevent hepatic vascular complications (HVC) is scarce in liver transplantation (LT).

Methods: From national claim data, LT recipients (about 80 % of living donor LT [LDLT]) without graft loss, HVC, or cardiovascular events within 1 year, were classified into those who took antiplatelets for ≥1 year (n = 1744) and for <1 year (n = 1975). Outcomes were compared after the 1-postoperative year index time point.

Results: During a mean follow up of 4.5 years, the risk of graft loss was similar between the groups (aHR 1.16, P = 0.23). However, ≥1-year antiplatelet therapy was associated with a higher risk of graft loss after 3 years (aHR 2.19, P < 0.01). HVC (aHR 0.94, P = 0.87) and major adverse cardiac events (aHR 1.20, P = 0.46) did not correlate with antiplatelet therapy for both groups. In contrast, ≥1-year antiplatelet therapy showed a significantly higher risk of severe bleeding compared to <1-year antiplatelet therapy (aHR 2.24, P < 0.01). This trend was similar in the LDLT subgroup. In our cohort, antiplatelet therapy for ≥1 year did not improve graft survival or HVC; however, it increased the risk of severe bleeding.

Conclusion: We recommend against antiplatelet therapy for more than 1 year in clinically stable LT recipients.

Keywords: Antiplatelet; Liver transplantation; Living donor; Vascular complication.