Time is of the essence: A single‐center experience of hepatic arterial supply impairment management in pediatric liver transplant recipients

Abstract

Background: Impairment of hepatic arterial flow including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), and splenic artery steal syndrome (SASS) is potentially life-threatening complications. The proposed early diagnosis and urgent treatment strategy of graft arterial flow reduction aim to decrease morbidity and mortality. Methods: Pediatric patients with known hepatic arterial flow impairment were retrospectively reviewed. Patients were grouped by occlusive (HAT) and non-occlusive (HAS/SASS) arterial flow reduction. Patients with HAT were further divided in two groups based on the estimated maximal hepatic artery occlusion time ≤8 and >8 hours. Results: Impairment of hepatic arterial flow developed in 32 of 416 pediatric liver transplant recipients. HAT, HAS, and SASS incidences were 4.1% (n = 17), 2.2%(n = 9), and 1.4% (n = 6), respectively. Neither graft loss nor death occurred in the non-occlusive group. The probabilities of sepsis (OR, 1.7; 95% CI, 1.14-2.53; P=.008) and graft loss or death (OR, 1.42; 95% CI, 1.04-1.92; P=.046) were higher in the occlusive group. Patients with estimated maximal duration of hepatic artery occlusion ≤ 8 hours (n = 7; 41.2%) did not have ischemic-type biliary lesions and sepsis (P=.044 and 0.010, respectively) but had excellent 3-year graft survival compared with > 8 hours group (100% vs 40%; P=.037). Multivariate analysis revealed HAT manifestation by fever was associated with increased chances of graft loss or death. Conclusion:Occlusive arterial complications impose higher risks of graft loss and death. Thorough arterial supply monitoring by Doppler ultrasonography and urgent endovascular arterial flow restoration may salvage both graft and the recipient.

Growth Hormone and Insulin-like Growth Factor-1 in Children with Cholestatic Diseases and Pediatric Liver Transplantation

“…With incomplete biliary atresia, some children may live up to 10 years. Therefore, congenital anomalies affecting the biliary tract are a strong indication for LT. LTs performed at Shumakov Center fully cover the needs for this type of care in Russia [50].…”

“…The results we achieved at Shumakov Center are fully consistent with global ones. For example, the average 1-year survival rate was 93%, and the 3-year survival rate was up to 90% [50,54].…”

Treatment strategies for hepatic artery complications after pediatric liver transplantation: A systematic review

“…The use of magnification loupe was reported in 12 studies (Table 1). [5,16,[18][19][20]22,23,25,26,28,29,31] Doppler ultrasound imaging was performed as part of standard clinical routine in all centers, with varying screening protocols and assessment criteria (Supplemental Table S4, http://links.lww.com/LVT/A493). The anticoagulation protocol used was reported in 16 studies, with heparin most frequently used (n = 6).…”

“…The type of treatments and outcomes of the 283 patients included in subgroup analyses are described in Table 3. Of these patients, 86 received conservative treatment, [16,17,20,27,31] 112 underwent surgical revascularization, [5,15,17,19,21,24,[26][27][28]30] 41 underwent endovascular revascularization, [15,18,21,25,30] and 44 underwent retransplantation. [5,26,29,31] Early HAT was reported in 113 patients, [19,20,[24][25][26]29,30] with 23 patients in the conservative treatment group, [20] 57 in the surgical revascularization group, [19,24,26,30] 14 in the endovascular revascularization radiology group, [25,30] and 19 in the retransplantation group.…”

“…Of these patients, 25 underwent endovascular revascularization and 14 underwent surgical revascula-rization. [8,18,22,23] For endovascular therapy, percutaneous transluminal angioplasty was described in 19 patients and percutaneous transluminal angioplasty with stent placement in 6 patients. [8,18,22] For surgical revascularization, studies reported reanastomosis in 4 patients and surgical thrombectomy in 10 patients.…”