Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations

Abstract

Hepatic artery thrombosis (HAT) after liver transplantation is associated with a marked increase in morbidity, leading to graft and patient loss. We evaluated the outcomes of adult living donor liver transplantation patients with HAT under an aggressive surgical intervention. A total of 1355 recipients underwent adult living donor liver transplantation at the Seoul National University Hospital. Surgical redo reconstruction for HAT was performed in all cases except in those with graft hepatic artery injury and late detection of HAT. Postoperative HAT developed in 33 cases (2.4%) at a median time of 3.5 days. Thirty patients (90.9%) underwent redo-arterial reconstruction. The survival rates in patients with HAT were similar to the rates in those without HAT (72.7% vs. 83.8%, p = 0.115). Although graft survival rates were lower in patients with HAT (84.8%) than in those without HAT (98.0%) (p < 0.001), the graft survival rate was comparable (92.0% vs. 98.0%, p = 0.124) in the 25 patients with successful revascularization. Biliary complication rates were higher in patients with HAT (54.5%) than in those without HAT (32.0%) (p = 0.008). In conclusion, the successful redo reconstruction under careful selection criteria saved the graft without retransplantation in 96.0% of the cases. Surgical revascularization should be preferentially considered for the management of HAT in adult living donor liver transplantation.

Reply: Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations

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To the editor, We would like to express our gratitude to Guo et al for their interest and comments on our publication, "Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations." [1] Their insightful observations and constructive opinions are valuable in furthering the discussion on this topic.In the procedure of surgical revascularization after hepatic artery thrombosis (HAT), it is preferred to use the initially anastomosed hepatic artery (HA) for reconstruction if its quality and length are acceptable. [2] If the length after removal of the damaged part is short or the quality of the existing HA is poor, using an alternative HA is the next option.

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“…To the editor, We would like to express our gratitude to Guo et al for their interest and comments on our publication, "Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations." [1] Their insightful observations and constructive opinions are valuable in furthering the discussion on this topic.…”

Letter to the Editor: Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations

“…Retransplantation is an early option, but is limited by donor shortages. The recent study by Hong et al, 2 published in Liver Transplantation , evaluated the outcomes of adult living donor liver transplantation patients with HAT under an aggressive surgical intervention. The study found that successful revascularization saved the graft without retransplantation in 96.0% of the cases.…”