Hepatic Artery Thrombosis After Pediatric Liver Transplantation—a Medical or Surgical Event?1

Mazzaferro, Vincenzo; Esquivel, Carlos O.; Makowka, Leonard; Belle, Steven H.; Kahn, Delawir; Koneru, Baburao; Scantlebury, Velma P.; Stieber, Andrei C.; Todo, Satoru; Tzakis, Andreas G.; Starzl, Thomas E.

doi:10.1097/00007890-198906000-00011

Cited by 233 publications

(159 citation statements)

References 15 publications

(7 reference statements)

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“…Technical improvements and the use of perioperative heparin or dextran may contribute to decreasing frequency of hepatic artery thrombosis in recent years. 11,12 As shown in this study, LD grafts also experience significant vascular complications.…”

Section: Discussionmentioning

confidence: 55%

“…Hepatic artery thrombosis was responsible for over 50% of the grafts lost in these young children and accounted for a large portion of the decreased survival. 8 Mazzaferro et al 11 demonstrated a higher incidence of hepatic artery thrombosis if donor arteries were less than 3 mm diameter. Technical improvements and the use of perioperative heparin or dextran may contribute to decreasing frequency of hepatic artery thrombosis in recent years.…”

Section: Discussionmentioning

confidence: 99%

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Survival among pediatric liver transplant recipients: Impact of segmental grafts

et al. 2004

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Segmental liver transplantation with living donor (LD), reduced cadaveric (Reduced), and split cadaveric (Split) allografts has expanded the availability of size-appropriate organs for pediatric recipients. The relevance of recipient age to the selection of graft type has not been fully explored, but could offer the potential to maximize recipient outcome and donor utilization. We conducted a retrospective cohort study among children 12 years of age or less utilizing the United Network of Organ Sharing (UNOS) database. Cox proportional-hazards analysis was used to explore the association of recipient age and graft type to graft and patient survival. Among children <1 year of age and those 1 to 2 years of age, 3-year LD graft survival was superior to whole cadaveric (CAD) organs, Split grafts, and Reduced grafts (for children <1 year of age: 79.4 vs. 61.5, 66.0, and 61.1%, respectively, P ‫؍‬ .0003; and for children 1-2 years of age: 79.2 vs 66.9, 57.1, and 63.9%, respectively, P ‫؍‬ .02). However, in children 3 to 12 years of age, after controlling for multiple donor and recipient factors, LD grafts failed to offer a survival advantage (hazard ratio ‫؍‬ .61; 95% confidence interval ‫؍‬ .37-1.02) compared to CAD organs. In an adjusted analysis examining patient survival, there appeared to be minimal association between recipient age and graft type. Much of the difference in graft survival could be attributed to events in the perioperative period. In conclusion, LD liver transplantation provides improved graft survival in children 2 years of age or less.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Survival among pediatric liver transplant recipients: Impact of segmental grafts

et al. 2004

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“…Hepatic artery thrombosis (HAT) is a cause of morbidity and graft loss in approximately 7% (range, 4% to 25%) of adults with an orthotopic liver transplant. [1][2][3] HAT is reported to occur in 10% to 40% [4][5][6] of pediatric patients receiving a primary liver transplant. This disparity occurs because of smaller caliber donor and/or recipient arteries and greater postoperative fluctuations in coagulation factor concentrations and hematocrits in children.…”

mentioning

confidence: 99%

“…This disparity occurs because of smaller caliber donor and/or recipient arteries and greater postoperative fluctuations in coagulation factor concentrations and hematocrits in children. 5 In adults, such potential risk factors as abnormal arterial anatomy of the donor or recipient arteries, technical complications during reconstruction, or such predisposing anatomy as the presence of a compressing median arcuate ligament 7 are increasingly rare because many are prevented by reconstructive techniques.…”

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confidence: 99%

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

et al. 2001

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“…Such changes have been known and studied in animals and humans for more than 30 years. 1,2 In particular, hepatic artery thrombosis (HAT) and other vascular complications (hepatic artery stenosis [HAS], portal vein thrombosis [PVT] and deep vein thrombosis [DVT]) remain devastating complications after LT. 2,3 The reported incidence of HAT is estimated to be 25% in living related allografts, 4 10% to 25% in pediatric cadaver liver recipients, [5][6][7][8] 2.6% to 20% in adult cadaver liver recipients, 9 and as high as 30% in children younger than 1 year old. 10 Early onset HAT usually develops within the first 2 months, 11,12 especially the first 5 days after LT. 13 Clinical presentations include acute, massive hepatic necrosis leading to fulminant hepatic failure, relapsing bacteremia with recurrent biliary sepsis from cholangitis, biliary tract ischemia leading to bile duct necrosis and leaks, and asymptomatic presentation with normal liver function tests.…”

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confidence: 99%

Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation

Pungpapong

2002

Liver Transplantation

139

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Hepatic artery thrombosis (HAT) and other vascular comIn patients with a history of cigarette smoking, incidence of vascular complications was higher than in those without history of cigarette smoking (17.8% v 8%, P ‫؍‬ .02). Having quit cigarette smoking 2 years before liver transplantation reduced the incidence of vascular complications by 58.6% (24.4% v 11.8%, P ‫؍‬ .04). The incidence of arterial complications was also higher in patients with a history of cigarette smoking compared with those without such history (13.5% v 4.8%, P ‫؍‬ .015). Cigarette smoking cessation for 2 years also reduced the risk of arterial complications by 77.6% (21.8% v 5.9%, P ‫.)500.؍‬ However, the incidence of venous complications was not associated with cigarette smoking. Furthermore, there was no significant association between development of vascular complications and all other characteristics studied. Cigarette smoking is associated with a higher risk for developing vascular complications, especially arterial complications after liver transplantation. Cigarette smoking cessation at least 2 years before liver transplantation can significantly reduce the risk for vascular complications. Cigarette smoking cessation should be an essential requirement for liver transplantation candidates to decrease the morbidity C hanges in coagulation after successful liver transplantation (LT) include a tendency toward a hypercoagulable state leading to an increased incidence of vascular complications. Such changes have been known and studied in animals and humans for more than 30 years. 1,2 In particular, hepatic artery thrombosis (HAT) and other vascular complications (hepatic artery stenosis [HAS], portal vein thrombosis [PVT] and deep vein thrombosis [DVT]) remain devastating complications after LT. 2,3 The reported incidence of HAT is estimated to be 25% in living related allografts, 4 10% to 25% in pediatric cadaver liver recipients, 5-8 2.6% to 20% in adult cadaver liver recipients, 9 and as high as 30% in children younger than 1 year old. 10 Early onset HAT usually develops within the first 2 months, 11,12 especially the first 5 days after LT. 13 Clinical presentations include acute, massive hepatic necrosis leading to fulminant hepatic failure, relapsing bacteremia with recurrent biliary sepsis from cholangitis, biliary tract ischemia leading to bile duct necrosis and leaks, and asymptomatic presentation with normal liver function tests. 7,14,15 HAT occurring early after LT is more likely to be associated with an aggressive course and higher rate of allograft loss in comparison to late onset HAT (beyond 2 months after LT). 11,14 Some evidence suggests that a prompt and accurate diagnosis by duplex ultrasonography [16][17][18][19] with confirmation by hepatic artery angiography 20 or exploratory laparotomy, followed by urgent allograft rescue modalities (e.g., interventional radiology, surgical and medical therapy) can provide temporary or permanent support, avoiding higher morbidity and mortality from retransplantation. 21,22 The repo...

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Hepatic Artery Thrombosis After Pediatric Liver Transplantation—a Medical or Surgical Event?1

Abstract: terns of antigenic expression on the surface of human monocytes lymphocyte subsets in long-term survivors with renal allotranand macrophages defined by monoclonal antibodies.

Cited by 233 publications

References 15 publications

Survival among pediatric liver transplant recipients: Impact of segmental grafts

Survival among pediatric liver transplant recipients: Impact of segmental grafts

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation

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