OBJECTIVE: To summarize the experience in prevention, diagnosis, and management of hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT). METHODS: The clinical data of 198 patients undergoing OLT from April 1993 to September 2003 were analyzed among which 96 underwent anastomosis of hepatic artery with 7/0 prolene by running suture (group 1) and 102 by intermittent suture (group 2). Ultrasonic examination was routinely performed every day within two weeks after operation and then performed selectively afterwards. RESULTS: The incidence rate of HAT in group 2 was 1.0% (1/102), significantly lower than that in group 1 (6.3%, 6/96) (chi(2) = 4.027, P = 0.045). HAT was discovered by color ultrasonography in 6 of the 7 cases, and by exploratory laparotomy in 1 case. Out of the 7 patients with HAT, 6 received emergency thrombectomy, and 1 received conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 out of the 6 cases after thrombectomy of whom 2 died of liver failure and one waited for retransplantation. One of the other 3 cases died of renal failure, and 2 cases survived. The mortality of patients with HAT was 57.1% (4/7). CONCLUSION: The technique of hepatic artery anastomosis is the key factor for the prevention of HAT. Routine ultrasonography is important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.
OBJECTIVE: To summarize the experience in prevention, diagnosis, and management of hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT). METHODS: The clinical data of 198 patients undergoing OLT from April 1993 to September 2003 were analyzed among which 96 underwent anastomosis of hepatic artery with 7/0 prolene by running suture (group 1) and 102 by intermittent suture (group 2). Ultrasonic examination was routinely performed every day within two weeks after operation and then performed selectively afterwards. RESULTS: The incidence rate of HAT in group 2 was 1.0% (1/102), significantly lower than that in group 1 (6.3%, 6/96) (chi(2) = 4.027, P = 0.045). HAT was discovered by color ultrasonography in 6 of the 7 cases, and by exploratory laparotomy in 1 case. Out of the 7 patients with HAT, 6 received emergency thrombectomy, and 1 received conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 out of the 6 cases after thrombectomy of whom 2 died of liver failure and one waited for retransplantation. One of the other 3 cases died of renal failure, and 2 cases survived. The mortality of patients with HAT was 57.1% (4/7). CONCLUSION: The technique of hepatic artery anastomosis is the key factor for the prevention of HAT. Routine ultrasonography is important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.