The impact of meticulous management for hepatic artery thrombosis on long‐term outcome after pediatric living donor liver transplantation*

Abstract

To analyze the risk factors in the development of hepatic artery thrombosis (HAT) and assess the impact of our perioperative management for HAT on the long-term outcome after pediatric living donor liver transplantation (LDLT), we reviewed 382 patients under 12 yr of age who underwent 403 LDLT from January 1996 to December 2005. One- and 10-yr patient survival rates were 78% and 78% in the patients with HAT (27 patients; 6.7%), and 84% and 76% in the patients without HAT, respectively (p = n.s.). Univariate analysis showed gender (female), body weight (lower), and graft-to-recipient weight ratio (higher) were significant risk factors in the patients with HAT (p < 0.05). Patients with Doppler ultrasound signal loss of the hepatic artery (HA) accompanied by an increase of liver enzymes underwent thrombectomy and reanastomosis (S-group, n = 13), and patients with a weak HA signal underwent anticoagulant therapy (M-group, n = 13). One patient underwent re-LDLT. One- and five-yr patient survival rates were 83% and 83% in the S-group, and 77% and 77% in the M-group (p = n.s.). The incidence of biliary complications in the S-group (58%) was significantly higher than that of the M-group (15%). For a successful long-term outcome, the early detection of HAT and prompt medical and surgical intervention are crucial to minimize the insult of HAT.

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

“…Figure 1 (12,28,42,51,52,71,73,76,77) for the arterial anastomosis (3.1%) versus centers using loupe magnification (2.1%, p = 0.6) (25,37,53,54,74).…”

“…In only two centers routine DUS was not performed (3,46 (12,27,28,33,42,44,48,51,52,54,62,65,71,84 (12,16,17,21,25,27,28,33,35,(41)(42)(43)(45)(46)(47)(48)(53)(54)(55)57,59,67,(70)(71)(72)(73)80,82,(84)(85)(86)(87) (12,27,28,33,42,…”

“…7 Only manuscripts mentioning the outcome are included. I 2,12,16,17,21,27,28,30,35,41,42,45,46,48,[51][52][53][54][55][56][57][58][59]61,62,64,65,[67][68][69][70][71][72][73]77,80,82,[84][85][86][87]16,17,21,25,27,28,33,35,[41][42][43]…”

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“…26,27 We observed that female sex was associated with greater morbidity, similar to a previous study from Kyoto that reported that female sex and high GRWR were independent risk factors for hepatic artery thrombosis after LDLT. 28 To our knowledge, few studies have reported outcomes of ICU-bound pediatric patients after LDLT. [3][4][5] Hereby, in ICU-bound pediatric patients, bacterial infection was diagnosed in 63% patients, fungal infection was diagnosed in 7.4% patients, and viral infection was diagnosed in 28% patients.…”

Pediatric transplantation: preventing thrombosis

“…Using this approach, the authors report a combined HAT/PVT rate of < 3% in 110 transplants over 21 years. Evidence from other centers also supports the efficacy and safety of AT replacement and prophylactic anticoagulation [26,27]. In contrast, other authors avoid the routine use of anticoagulants, FFP or AT concentrates, arguing that surgical factors are the major variables contributing to thrombosis risk [28].…”