Risk Factors Associated With Hepatic Artery Thrombosis: Analysis of 1050 Liver Transplants

Abstract

Background: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones. Aim: To evaluate the risk factors for the development of hepatic artery thrombosis. Methods: The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient. Results: Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Conclusions: Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.

Preliminary Data on Liver Transplantation in Hydatidosis Disease

“…The procedure lasted for 7 h, with 6 h and 17 min of cold ischemia and 20 min of warm ischemia. The Piggyback technique was used, with the classical portal and arterial anastomosis 11 , 15 . Due to the cysts’ invasion of the biliary tract, its anastomosis was performed by Roux-en-Y hepaticojejunostomy.…”

Protocol for Liver Transplantation in Hilar Cholangiocarcinoma

“…It is important to assess locoregional lymph nodes in order to avoid LT in cases with positive lymph node disease 11 , 15 . Just as in the protocols performed at the Mayo Clinic 16 , 20 , there is the suggestion of performing laparoscopy or laparotomy with evaluation of the lymph node chains mentioned above (8a, 8p, 12a and 12p).…”

Protocolo De Transplante Hepático Para Metástase Colorretal Irressecável

“…Nas últimas duas décadas houve progresso na sobrevida após TH em 20-30%, melhorias nos exames de imagem e introdução de imunossupressores com ação antineoplásica (inibidores do mTOR) 15,17 . Esta evolução técnica aliada ao peculiar panorama de transplantes na Noruega, onde há mais doadores de órgãos do que receptores em lista, proporcionou o cenário ideal para retomar a utilização do TH nas MHCCR.…”

“…In the past two decades, there has been improvement in the survival rates after LT by 20-30% and improvement in the imaging examinations; there was also the introduction of immunosuppressants with antineoplastic action (mTOR inhibitors) 15 , 17 . This technical progress combined with the peculiar transplantation scenario in Norway, which has more organ donors than recipients on the list, provided the ideal scenario for performing LT in CRLM.…”