INTRODUCTION: The incidence of hepatic artery thrombosis (HAT) after liver transplantation (LTx) is up to 9% in adult recipients. MATERIAL AND METHODS: To minimize HAT, we developed an algorithm that we have routinely applied since 2001. The algorithm is a cascade of potentially necessary procedures to improve hepatic artery blood flow before proceeding with LTx when arterial blood flow is impaired. Incidence, outcome, and possible therapeutic approaches of HAT were analyzed in prospectively non-controlled collected data during a 5-year period. There were 335 LTx in 299 adults (199 male, 100 female) with a median age of 49.7 years. RESULTS: HAT was defined as early and late HAT (diagnosis within or after 30 days following LTx). After a mean follow-up of 17 months, nine HAT were documented (2.7%; five early and four late HAT). Treatment consisted of thrombolysis (n = 1), surgical thrombectomy (n = 4), and re-transplantation (n = 4). Five HAT patients died during follow-up. DISCUSSION: Complex arterial reconstruction was associated with HAT compared to branch-patch anastomoses (P = 0.0193). Median arterial intraoperative blood flow was no risk factor for HAT. One-year patient survival after HAT was 31%. Once HAT occurs, complication rates are high and long-term results are devastating. CONCLUSION: Therefore, we have implemented the presented algorithm, which showed an acceptable HAT rate.
INTRODUCTION: The incidence of hepatic artery thrombosis (HAT) after liver transplantation (LTx) is up to 9% in adult recipients. MATERIAL AND METHODS: To minimize HAT, we developed an algorithm that we have routinely applied since 2001. The algorithm is a cascade of potentially necessary procedures to improve hepatic artery blood flow before proceeding with LTx when arterial blood flow is impaired. Incidence, outcome, and possible therapeutic approaches of HAT were analyzed in prospectively non-controlled collected data during a 5-year period. There were 335 LTx in 299 adults (199 male, 100 female) with a median age of 49.7 years. RESULTS: HAT was defined as early and late HAT (diagnosis within or after 30 days following LTx). After a mean follow-up of 17 months, nine HAT were documented (2.7%; five early and four late HAT). Treatment consisted of thrombolysis (n = 1), surgical thrombectomy (n = 4), and re-transplantation (n = 4). Five HAT patients died during follow-up. DISCUSSION: Complex arterial reconstruction was associated with HAT compared to branch-patch anastomoses (P = 0.0193). Median arterial intraoperative blood flow was no risk factor for HAT. One-year patient survival after HAT was 31%. Once HAT occurs, complication rates are high and long-term results are devastating. CONCLUSION: Therefore, we have implemented the presented algorithm, which showed an acceptable HAT rate.
Authors: Michael A Silva; Periyathambi S Jambulingam; Bridget K Gunson; David Mayer; John A C Buckels; Darius F Mirza; Simon R Bramhall Journal: Liver Transpl Date: 2006-01 Impact factor: 5.799
Authors: S Bhattacharjya; B K Gunson; D F Mirza; D A Mayer; J A Buckels; P McMaster; J M Neuberger Journal: Transplantation Date: 2001-06-15 Impact factor: 4.939
Authors: F Velasco; R Villalba; M Fernandez; M de la Mata; J Roman; V Rubio; S Rufian; E Varo; C Pera; A Torres Journal: Transplantation Date: 1992-06 Impact factor: 4.939
Authors: Arianeb Mehrabi; Peter Schemmer; Jan Schmidt; Peter Sauer; Helmut Friess; Thomas Kraus; Eike Martin; Markus W Büchler; Waldemar Uhl Journal: Nephrol Dial Transplant Date: 2004-07 Impact factor: 5.992
Authors: Bettina M Buchholz; Shakeeb Khan; Miruna D David; Bridget K Gunson; John R Isaac; Keith J Roberts; Paolo Muiesan; Darius F Mirza; Dhiraj Tripathi; M Thamara P R Perera Journal: Transplant Direct Date: 2017-07-05