Hepatic artery thrombosis following orthotopic liver transplantation: A 10-year experience from a single centre in the United Kingdom

Abstract

Hepatic artery thrombosis (HAT) occurs in 3-9% of all liver transplants and acute graft loss is a possible sequelae. We present our experience in the management of HAT over a 10-year period. Prospectively collected data from April 1994 to April 2004 were analyzed. There were 1,257 liver transplants, 669 males, median age 51 (16-73) years. There were 61 (4.9%) cases of HAT. Early HAT occurred in 21 (1.8%). Thirty six had graft dysfunction, 11 required a regraft, and 14 died. Positive CMV serology in the donor, cold ischemia time, duration of operation, transfusions of more than 6 units of blood, and 15 units of plasma, an aortic conduit for arterial reconstruction, Roux-en-Y biliary reconstructions, regrafts and relaparotomy were associated with HAT. At multivariate analysis, type of biliary anastomosis was the only significant factor associated with HAT. Split or reduced liver graft were not risk factors for HAT. Number of hepatic arteries requiring multiple arterial anastomosis was not a risk for HAT. HAT resulted in a reduction in overall survival post liver transplantation. The incidence of HAT was 4.9%; with 1.8% early HAT and HAT impacted on survival. Surgical technique was not an aetiological factor for HAT. In conclusion, while a Roux-en-Y biliary reconstruction was an independent risk factor for HAT, cold ischemia and operative times, the use of blood and plasma and the use of aortic conduits in arterial reconstruction were associated with HAT. Regrafts and reoperation were also identified risk factors. Liver Transpl 12: 146 -151, 2006.

Hepatic Artery Thrombosis

“…Although HAT is more common in the pediatric population, 16 it has been reported to complicate 3% to 5% of adult orthotopic LT procedures. [16][17][18] This is consistent with the data from the UK Transplant Registry, which has reported a 2.9% incidence of early HAT (occurring within 90 days of transplantation), and with the data from the center in Birmingham, which has reported a 3.1% incidence of late HAT (occurring after 90 days) during the period of study. The high incidence of HAT in AIP patients was previously unreported and is considerably higher than the rate expected for the general LT population.…”

Vascular complications after orthotopic liver transplantation

“…Несмотря на то, что технические факто-ры остаются доминирующими в генезе тромбозов печеночной артерии, к настоящему моменту уста-новлено, что проблема артериальных осложнений после ОТП является многофакторной и не может быть объяснена только техническими аспектами формирования артериального анастомоза [1,[5][6][7].…”

“…Кроме того, наличие нескольких независимых источников артериального кровоснабжения, как правило, требует выполнения сложных артериальных реконструкций на этапе "back-table", что также является одним из факторов риска артериально-го тромбоза [1,2,5,9]. Так, в работах T. [6,[13][14][15]. Таким образом, приходится признать, что к настоящему времени единства мнений относи-тельно роли нестандартной артериальной анато-мии в генезе ТПА нет [16].…”

Interventional radiology procedures in adult patients who underwent liver transplantation

“…HAT is a dramatic, potentially life-threatening, complication of LT occurring in 3%-9% of adult livertransplanted patients [8,9] . Risk factors for HAT are considered to be surgical technique, small donor vessels, slow flow secondary to hepatic artery stenosis (HAS), ischemia-reperfusion injury, coagulation abnormalities, ABO blood group incompatible transplantation, use of aortic jumping graft and multiple rejection episodes.…”