Etiology and management of hepatic artery thrombosis after adult liver transplantation

Abstract

Hepatic artery thrombosis (HAT) represents a major cause of graft loss and mortality after liver transplantation. It occurs in up to 9% of adult recipients. The early diagnosis of HAT decreases septic complications, multiorgan failure, and graft loss, and there are better outcomes after treatment. In this study, we reviewed 102 episodes of HAT, which were classified as early hepatic artery thrombosis (E-HAT) when they were diagnosed within the first 21 days after transplantation. The overall incidence of HAT was 7%: 31 episodes (30.4%) were identified as E-HAT, and 71 episodes (69.6%) were identified as late hepatic artery thrombosis (L-HAT). Graft dysfunction was the commonest presentation (30 cases or 29%). Most E-HAT cases were managed with retransplantation (74%), whereas early revascularization was carried out for only 13% with a 75% success rate. The incidence of retransplantation for L-HAT was only 41%, whereas 32% were too ill for relisting and eventually died. Successful conservative management was noted for 13 of the 102 patients (13%) with collateralization and good hepatic perfusion, with biliary complications encountered in 7 cases (54%) subsequently. A multivariate analysis showed that previous episodes of HAT, the number of arterial anastomoses, and a low donor weight were independent risk factors for E-HAT, whereas a history of upper abdominal operations (non-HAT), a previous history of HAT, a low donor weight, and a recipient age < 50 years were independent risk factors for L-HAT. The graft survival rates for HAT patients were 52%, 36.6%, and 27.4% at 1, 3, and 5 years, whereas the corresponding rates were 81.4%, 81.2%, and 76.4% for non-HAT patients. In conclusion, prompt revascularization for E-HAT patients decreases the incidence of serious, irreversible septic complications and graft loss and improves overall outcomes. A significant number of L-HAT patients do not require further intervention despite the high incidence of ischemic cholangiopathy. Liver transplantation (LT) is the ideal therapy for endstage liver disease. Vascular complications after LT are not uncommon despite the marked improvements and innovations in anastomotic vascular techniques; they frequently result in hepatic insufficiency and graft failure and thus the need for retransplantation.

Variables Associated With the Risk of Early Death After Liver Transplantation at a Liver Transplant Unit in a University Hospital

“…We observed that high MELD score, CTP C, or severe patients with major complications and mortality were associated with HAT as a risk factor for early death, as reported in the literature [2,17,18].…”

Improving Research Practice in Rat Orthotopic and Partial Orthotopic Liver Transplantation: A Review, Recommendation, and Publication Guide

“…data]. Furthermore, rearterialized rat OLT models better approximate the physiologic situation and the clinical scenario, where hepatic arterial thrombosis is one of the most dreadful complications and a major cause of graft loss and mortality [99,100]. …”

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“…Indeed, recent studies have suggested that late HA thrombosis may have a lesser effect on liver function and graft survival and that its incidence may even be underes timated, mainly owing to arterial collateralization allowing adequate hepatic perfusion, although the incidence of a biliary complication remains high in that context. 21 In conclusion, RAR using CIAA represents an effective, safe, and readily available approach for the treatment of HACs in LT patients, with a limited risk of infection. Despite the high rate of HA thrombosis encountered, this strategy provides satisfactory longterm graft and patient survival and should therefore challenge the classical modalities of rescue treatment.…”