Open Access

ARTICLE

Transfusion‐related acute hepatic injury following postoperative platelets administration in pediatric patients undergoing the Fontan procedure

by

1 Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Jerusalem, Israel
2 Pediatric Cardiology, Hadassah University Medical Center, Jerusalem, Israel
3 Pediatric Extracorporeal Support Program, Hadassah University Medical Center, Jerusalem, Israel
4 The Hebrew University Hadassah Medical School, Jerusalem, Israel
5 The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
6 Pediatric Cardiology, Edmond J Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
7 Pediatric and Congenital Cardiac Surgery, Edmond J Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
8 Pediatric Cardiac Intensive Care Unit, Edmond J Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel

* Corresponding Authors: Uri Pollak, Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Ein Kerem, POB 12000, Jerusalem 9112001, Israel. Email: , uri.pollak@ gmail.com

Congenital Heart Disease 2019, 14(6), 968-977. https://doi.org/10.1111/chd.12825

Abstract

Objective: The final common pathway of single ventricle patients is the Fontan procedure. Among the immediate postoperative complications is acute hepatic injury presented by marked elevation of liver enzymes (alanine transaminase [ALT] and aspartate transaminase [AST]). We aimed to determine the contribution of blood products transfusion to acute hepatic injury.
Design: Single center retrospective cohort study.
Setting: Pediatric Cardiac Intensive Care Unit at a tertiary medical center.
Patients: Ninety‐nine pediatric patients undergoing the Fontan procedure between January 2009 and December 2016.
Interventions: None.
Measurements and Main Results: Out of the four types of blood products, transfusion of platelets was found to significantly affect postoperative levels of ALT and AST. Additional factors included postoperative administration of sodium bicarbonate, decreased flow through the Fontan canal and decreased urine output. Preoperative pulmonary artery pressure and pulmonary vascular resistance, cardiopulmonary bypass time, aortic cross‐clamp time, amount of postoperative bleeding, and vasoactive‐ inotropic score did not influence liver enzymes levels.
Conclusions: In pediatric Fontan patients, platelets transfusions contribute to an acute hepatic injury. The relation between platelets and transfusion‐related acute lung injury (TRALI) has been well described, but this is the first time it is being described in regard to acute hepatic injury (TRAHI). Changing platelet transfusion strategy could decrease morbidity in Fontan patients but further research is needed. KEYWORDS acute hepatic injury, congenital heart defect, Fontan, pediatric cardiac surgery, platelets, transfusion‐related acute hepatic injury

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