Oral surgery in liver transplant candidates: a retrospective study on delayed bleeding and other complications

Publication date: Available online 13 February 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jaana Helenius-Hietala, Fredrik Åberg, Jukka H. Meurman, Arno Nordin, Helena Isoniemi
ObjectiveUntreated dental infections pose a threat for immunocompromised liver transplant (LT) recipients. Therefore, pretransplant dental evaluations are recommended. However, risk of bleeding should be considered among patients with end-stage liver disease and prophylactic blood transfusions may be used to prevent bleeding. We retrospectively studied the incidence of and risk factors for oral surgery-related bleeding in candidates for LT and hypothesized that complications may occur despite pre- and peri-operative hemostatic actions.Study DesignOne hundred thirty four patients who had tooth extractions by oral and maxillofacial surgeons pre-LT were studied. The primary endpoint was bleeding between 24 h and 2 weeks post-extraction. Bleeding risk was analyzed by pre-operative platelet (PLT) count and INR. Invasiveness of procedures, severity of liver disease, PLT, INR, prophylactic transfusions of PLT, fresh frozen plasma, and tranexamic acid (TA) were included in uni- and multivariate logistic regression analysis to further assess risk.ResultsTwelve patients exhibited minor bleeding; four despite PLT>100×10⁹/L and INR<1.5. Increased bleeding associated with INR and prophylactic transfusions by univariate analysis; by multivariate analyses, prophylactic TA (OR=8.0, 95%CI 1.7-37.0) and PLT (OR=8.3, 95%CI 1.1-62.7) remained significant.ConclusionMost extractions were safe, but prophylactic transfusions did not ensure adequate hemostasis. Local hemostatic measures and close follow-up are warranted.



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