Early Hepatic Artery Thrombosis After Liver Transplantation: What is the Impact of the Arterial Reconstruction Type?

Abstract

The type of arterial reconstruction used for arterial anastomosis during primary liver transplantation has an impact on the occurrence of early HAT. The use of a long graft artery is an independent risk factor of early HAT. Thereby, we recommend the use of a short graft artery with a direct path when feasible to reduce the occurrence of early HAT after primary liver transplantation.

Aggressive prevention and preemptive management of vascular complications after pediatric liver transplantation: A major impact on graft survival and long‐term outcome

“…All of the transplants were performed over a relatively short time span (7 years) by a single team, using all of the same standardized operative strategies and techniques, as well as by employing those stated protocols for both perioperative management and immunosuppression. Interestingly, the surgical approaches that were applied for these patients were a combination of what have been recommended by different teams over the last decade, for instance, the use of microsurgical techniques, PV hypoplasia corrections, reducing the use of arterial vascular grafts, multiple USD checks during and after the LTs, and an early diagnosis and a rapid aggressive management for any vascular problem, among others . With a zero incidence of graft loss related to vascular problems and with only two of the 122 currently functioning grafts having a non‐clinically relevant vascular sequela, it can be concluded that the strategy was instrumental in achieving the excellent outcomes.…”

“…As per the protocol, all of the patients had received the same induction (anti‐interleukin‐2 monoclonal antibodies) and maintenance immunosuppression therapy (intent for tacrolimus monotherapy—associated with steroids and/or mycophenolate mofetil, when required by their clinical needs). In addition, as per the protocol, all of the patients were followed perioperatively by implementing a multifaceted strategy aimed at reducing the incidence of vascular complications; this latter strategy was used during the whole period of the study and it consisted of 4 main complementary aspects:…”

“…A separate‐stitch suture with Prolene 8/0 was the standard anastomosis for arteries ≤4 mm in diameter, while a continuous suture with absorbable material was used for the larger ones. As a standard practice, a preference was given to using a short length of a donor artery, with a single anastomosis into a distal recipient site (proper HA, or right or left branch) (Figure ); the gastroduodenal artery was kept intact unless a division was necessary for dissecting the PV and for reaching the confluence with the splenic and mesenteric veins. When the liver graft was procured with multiple arteries, a back‐table reconstruction was performed in the case of a cadaveric procurement, in order to avoid multiple in situ anastomoses; if the graft was from a living donor, the largest graft artery was anastomosed first, with the second (smaller) artery being reconstructed only when a retrograde pulsatile perfusion was absent.…”

Short‐ and long‐term outcomes of arterial reconstruction on recipient splenic artery in adult liver transplantation. Single‐center prospective study 25 years after first description

“…No adequate arterial flow was based on surgeon 0 s judgment and/or in the case of flow lower than 100 ml/min measured by intraoperative transit-time ultrasound. Alternative approaches to arterialize the graft are needed in these cases [2,19,20], with aortohepatic conduits being the most commonly reported option [19,20]. We excluded patients with arterial conduits from our study.…”

“…Numerous studies have evaluated the results of using aortohepatic conduits [19]. In most of these studies, the use of arterial conduits has been demonstrated to be and independent risk factor for both early and late HAT as well as for biliary complications [19,20]. Indeed, some studies have shown lower patient and graft survival rates when using arterial conduits [7,21], leading authors, such as Hibi et al [7], to recommend strictly limiting their use.…”