@Article{chd.12825,
AUTHOR = {Uri Pollak, Tatyana Ruderman, Sharon Borik‐Chiger, David Mishaly, Alain Serraf, Amir Vardi},
TITLE = {Transfusion‐related acute hepatic injury following postoperative platelets administration in pediatric patients undergoing the Fontan procedure},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {968--977},
URL = {http://www.techscience.com/schd/v14n6/38897},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> 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.<br/>
<b>Design:</b> Single center retrospective cohort study.<br/>
<b>Setting:</b> Pediatric Cardiac Intensive Care Unit at a tertiary medical center.<br/>
<b>Patients:</b> Ninety‐nine pediatric patients undergoing the Fontan procedure between 
January 2009 and December 2016.<br/>
<b>Interventions:</b> None.<br/>
<b>Measurements and Main Results:</b> 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.<br/>
<b>Conclusions:</b> 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},
DOI = {10.1111/chd.12825}
}