18 February 2025 : Case report
Pulmonary Embolism Following Living Donor Hepatectomy: A Report of 4 Cases and Literature Review
Ling-Li Cui1ABCDEF, Xu-Ming Liu
1BCE, Liang Zhang 1BDF, Shen Liu1BF, Bo Wu2BF, Yun Wang1ADFG*, Zhi-Jun Zhu34ADF
DOI: 10.12659/AOT.946752
Ann Transplant 2025; 30:e946752
Table 2 Review of the literature.
| Publication year | Sample size | Age (years) | Gender | Surgery type | Preoperative risk factors | |
|---|---|---|---|---|---|---|
| 1 | 1996 | 1 | 36 | Male | Left hepatectomy | None |
| 2 | 2002 | 1 | 51 | Male | Right hepatectomy | Increased von Willebrand factor activity |
| 3 | 2005 | 1 | 33 | Male | Right hepatectomy | Smoking, obesity |
| 4 | 2008 | 1 | 35 | Female | Right hepatectomy | Smoking, obesity |
| 5 | 2019 | 1 | 57 | Male | Left hepatectomy | Smoking |
| 6 | 2023 | 1 | 31 | Female | Left hepatectomy | None |
| 1 | None | POD 1 | Dyspnea, hypoxemia | Pulmonary arteriogram, perfusion lung scintiscan | A single dose of urokinase (120 KIU) combined with heparin (5 KIU) was administered, followed by continuous infusion of urokinase (120 KIU/day) and heparin (10 KIU/day). Urokinase was discontinued after 20 hours, and the heparin dose was gradually reduced over 3 days before switching to warfarin | Discharged on POD 21 |
| 2 | MTP, PTP | POD 2 | Dyspnea, tachycardia, fever, hypoxemia | Enhanced chest CT, venous ultrasound | Heparin (500 IU/kg/day) was infused, but discontinued after 7 days due to upper gastrointestinal bleeding caused by a duodenal ulcer. The patient was given 3 units of red blood cells, omeprazole 40 mg/day, and vitamin K as an antagonist | Discharged in the third week post-surgery |
| 3 | MTP | POD 2 | Severe chest pain, dyspnea, hypoxemia | Pulmonary perfusion scanning, venous ultrasound, Doppler cardiac ultrasound echography | A continuous infusion of urokinase (360,000 U/day) and sodium heparin (5,000 U) was administered, with urokinase being stopped after 9 hours and the heparin dose gradually reduced. After 3 days, the patient was transitioned to warfarin | Discharged on POD 15 |
| 4 | MTP | POD 1 | Dyspnea, cardiac arrest | Doppler cardiac ultrasound echography, arterial blood gas analysis | TPA 200 mg was infused, resulting in coagulopathy and intra-abdominal bleeding, followed by hemodynamic deterioration, acute renal failure, and cerebral edema. The patient died on the postoperative day 11 due to multiple organ dysfunction syndrome | Died on POD 11 |
| 5 | MTP | POD 2 | Hypoxemia | D-dimer levels, Enhanced chest CT, venous ultrasound, echocardiography | Heparin was continuously infused, with dosage adjustments based on international normalized ratio levels, before switching to warfarin for a three-month course | Discharged on POD 20 |
| 6 | PTP | POD 2 | Dyspnea, tachycardia, hypoxemia | Computed tomography angiography, echocardiography | A TPA (50 mg/h) and heparin infusion was administered, but due to a right rectus abdominis hematoma, the treatment was switched to subcutaneous enoxaparin. After discharge, the patient continued on oral bemiparin (1 dose, 7,500 IU/0.3 mL) and warfarin | Recovered |
| POD – postoperative day; MTP – mechanical thromboprophylaxis; PTP – pharmacological thromboprophylaxis; TPA – tissue plasminogen activator. | ||||||