Long-term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation

Abstract

Hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) is a serious complication resulting in bile duct necrosis and often requiring retransplantation. Immediate surgical thrombectomy/thrombolysis has been reported to be a potentially successful treatment for restoring blood flow and avoiding urgent retransplantation. The long-term results of this strategy remain to be determined. In 232 pediatric liver transplants, we analyzed long-term outcomes after urgent revascularization for early HAT. HAT developed in 32 patients (13.7%). In 16 children (50%), immediate surgical thrombectomy was performed in an attempt to salvage the graft. Fourteen patients (44%) underwent urgent retransplantation, and 2 (6%) died before further intervention. Immediate thrombectomy resulted in long-term restoration of the hepatic artery flow in 6 of 16 patients (38%) and in 1-and 5-year graft and patient survival rates of 83% and 67%, respectively. In 10 patients, revascularization was unsuccessful, and retransplantation was inevitable. The 1-and 5-year patient survival rates in this group decreased to 50% and 40%, respectively. After immediate retransplantation, the 5-year patient survival rate was 71%. In conclusion, immediate surgical thrombectomy for HAT after pediatric OLT results in long-term graft salvage in about onethird of patients. However, when thrombectomy is unsuccessful, long-term patient survival is lower than the survival of patients who underwent immediate retransplantation. Liver Transpl 16:847-855,

Liver transplantation in Indian Armed Forces—initial experience

“…Whenever there is suspicion of HAT, urgent angiography is done to confirm the presence of HAT and emergency revascularisation of the graft is attempted. 17 Standard immunosuppression protocol consists of inj Methylprednisolone during the an hepatic phase and then converting to oral prednisolone and tacrolimus (TAC) daily from the first postoperative day. Mycophenolate mofetil (MMF) is added when the thrombocytopenia resolves.…”

Clinical experience with microdialysis catheters in pediatric liver transplants

“…In particular, vascular complications such as hepatic artery thrombosis (HAT; 5%‐18%) and portal vein thrombosis (PVT; 5%‐10%) occur more frequently in pediatric grafts versus adult grafts and are major contributors to the loss of grafts and patients' lives . Early detection is imperative for enabling interventions before the occurrence of graft necrosis or biliary complications ultimately necessitating retransplantation . Performed by trained radiologists, Doppler ultrasound is a sensitive and specific method for detecting vascular occlusions, but continuous Doppler monitoring with implanted microprobes is currently not available for routine clinical use…”

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“…[3][4][5] Early hepatic artery thrombosis usually is treated surgically with thrombectomy and revision of the anastomosis, but treatment failure may occur in 20% to 60% patients. 6 Percutaneous transluminal angioplasty may have 90% success for treatment of late hepatic artery thrombosis, but complications may include thrombosis and dissection of the artery. 7 When all other treatment fails and hepatic artery thrombosis recurs, revision liver transplant may be the only effective treatment.…”