Hepatic artery thrombosis (HAT) is a devastating complication that may occur after orthotopic liver transplantation (OLT). A higher incidence has been reported in children. Salvage of the graft by thrombectomy has been suggested as an alternative to re-transplantation. In this study we report the outcome of three children who underwent thrombectomy for HAT. Between January 1992 and June 1998, 14 children (< 17 yrs of age) underwent liver transplantation. Three developed HAT (one a whole-liver graft recipient, age 17; two living-related graft recipients, ages 4 and 4.5 yr). In the first patient, thrombosis of the hepatic artery was associated with scattered areas of parenchymal necrosis on computed tomography. In the two living-related patients, HAT was found incidentally during re-exploration for bleeding (day 2 and day 10). Thrombectomy was performed in all three patients. At 18-24 months after thrombectomy, all three children had normal graft function. In the first patient, complete regeneration of the liver has been documented by computed tomography and a late asymptomatic recurrent thrombosis is suggested by absence of arterial flow on Doppler examination. The hepatic artery is patent in the two living-related recipients. One of these living-related recipients developed ischemic bile duct stricture and underwent successful percutaneous balloon dilatation. We conclude that long-term normal graft function can be achieved by thrombectomy in pediatric liver recipients with HAT, even in the presence of limited parenchymal damage.
Today the main problem of bile duct cysts is based on their optimal therapy. Conservative approaches only are fit for single selected cases because of the complications and lethality rate inherent to these methods. The usual operative treatment with internal derivation of the cyst by diversion to an intestinal loop does not take account the nowadays well documented risk of development of cancer in the cyst's tissue, mainly in the adult patient. The modern classification according to Todani et al. [14] offers the possibility for a selective approach with regard to the local anatomic-pathological relations found in the intrahepatic as well as in the extrahepatic biliary tree in such patients. The problems of the clinical picture, diagnosis and therapy are discussed on the basis of 6 cases seen at our centre.
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