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Statin therapy may reduce the risk of venous thromboembolism (VTE), which may impact solid organ transplant outcomes. We evaluated the incidence of VTE and other complications after liver transplantation stratified by hyperlipidemia status and statin use using a retrospective cohort study approach from a high-volume liver transplant center. We reviewed all primary orthotopic liver transplant (OLT) records from January 2014-December 2019 from our center. Intraoperative deaths were excluded. Recipient and donor clinical and demographic data were collected. We developed risk-adjusted models to assess the effect of statin use on the occurrence of VTE, hepatic artery complications, graft failure, and death, accounting for clinical covariates and competing risks. 672 OLT recipients were included in the analysis. 11.9% (n=80) of this cohort received statin therapy. 47 patients (7.0%) had VTE events. Hepatic artery complications occurred in 40 patients (6.0%). 42 (6.1%) patients experienced graft loss while 9.1% (n=61) of the cohort died during the study interval. 268 (39.9%) OLT recipients had hyperlipidemia, of which 80 (29.8%) were treated with statins. Of those treated with statins, 0% of patients had VTE vs. 7.9% of those not on statins (p=0.01). Hepatic artery complications were identified in 1.2% of the statin group and 6.8% of the non-statin group. Untreated hyperlipidemia was associated with a 2.1-fold higher risk of hepatic artery complications vs no hyperlipidemia status patients (p=0.05). Statins were associated with significantly better risk-adjusted thromboembolic event-free survival (absence of DVT, PE, CVA, MI, HAC, and death) (90% statins vs. 73.9% untreated; HR =0.37, p = 0.01). These data indicate that statin therapy is correlated with a lower rate of VTE and hepatic artery complications after liver transplantation. Prospective studies are warranted.

Background. Utilization of intraoperative transesophageal echocardiography (TEE) during orthotopic liver transplantation (OLT) is expanding annually in high-volume transplant centers. During OLT intraoperative TEE is used to gather real-time information on cardiovascular function and intravascular volume status. Although standardized TEE views exist, there are nontraditional views described in the literature which have the potential to diagnose evolving pathology and define normal variants of hepatic vasculature. Methods. A literature review was completed utilizing the PubMed database for English-only, peer-reviewed publications discussing nontraditional use of intraoperative TEE during OLT and hepatic vascular-related surgeries from 2009 to 2019. Both case reports and review articles were considered. Results. The PubMed literature search offered 8 publications for analysis, including 7 case reports and 1 article review, revealing several nontraditional TEE views not included in a comprehensive transesophageal echocardiographic examination. These nontraditional views were generally obtained using modifications to the transgastric and bicaval views to visualize liver vasculature. We present the various techniques for obtaining these views from the 8 articles identified. Conclusions. At high-volume transplant centers, TEE use during OLT is increasing. Intraoperative TEE is a valuable tool to assess hepatic vascular structures critical to allograft/organ function without interruption of the surgical procedure. Nontraditional use of TEE to diagnose intraoperative noncardiac pathology in OLT appears underutilized and underreported. The modified hepatic and modified transgastric views we describe can be used to evaluate hepatic vasculature, influence surgical decision-making and ultimately improve patient care.