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

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MeSH: Adult ; Aged ; Female ; Follow-Up Studies ; Graft Survival* ; Humans ; Liver Transplantation* / adverse effects ; Living Donors* ; Male ; Middle Aged ; Platelet Aggregation Inhibitors* / administration & dosage ; Platelet Aggregation Inhibitors* / adverse effects ; Postoperative Complications / epidemiology ; Postoperative Complications / etiology ; Postoperative Complications / prevention & control ; Retrospective Studies ; Time Factors ; Vascular Diseases / etiology ; Vascular Diseases / prevention & control

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

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.