Prolonged preservation in University of Wisconsin solution associated with hepatic artery thrombosis after orthotopic liver transplantation.
Hepatic artery thrombosis (HAT) after liver transplantation (LTx) usually mandates retransplantation. Prolonged preservation with Eurocollins solution has been associated with HAT. We reviewed our experience with 359 LTx patients to identify risk factors for HAT. All grafts were preserved in University of Wisconsin solution. HAT developed in 12 patients (3%) within 50 days. Seven patients were asymptomatic; four presented with biliary sepsis and 1 with poor graft function. Two patients had suffered acute rejection; another 2 had severe preservation injury. Technical problems accounted for 4 cases; in the remaining 8, no etiology was found. Diagnosis was at a mean 14.7 days after LTx. One patient maintains normal graft function 3 years after LTx without intervention. Eight underwent re-LTx, 3 of whom died. Routine surveillance via duplex enabled early diagnosis and revascularization in 3 patients; in all 3, no biliary complications occurred between 6 and 20 months. Overall graft and patient survival after HAT were 33.3% and 75%, respectively. Cold ischemic time (CIT) averaged 813 min in patients with HAT and 669 min in those without HAT (P < .05). HAT occurred in 7/165 patients with CIT > 12 hr, and in 3/234 patients with CIT < 12 hr (P = 0.0699). By avoiding CIT > 12 hr, we have recently avoided HAT in 78 consecutive patients. We conclude that CIT > 12 hr may increase the risk of HAT. When HAT is diagnosed before biliary sepsis develops, flow can often be restored and retransplantation averted.
Mor
E
E
Department of Surgery, Mount Sinai Medical Center, New York, New York 10029-6574.
Schwartz
M E
ME
Sheiner
P A
PA
Menesses
P
P
Hytiroglou
P
P
Emre
S
S
Kishikawa
K
K
Chiodini
S
S
Miller
C M
CM
D000241:Adenosine / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000009:adverse effects; D002675:Child, Preschool; D003080:Cold Temperature; D005978:Glutathione / Q000009:adverse effects; D006499:Hepatic Artery; D006801:Humans; D007328:Insulin / Q000009:adverse effects; D007511:Ischemia / Q000150:complications; D008099:Liver / Q000098:blood supply; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009926:Organ Preservation / Q000009:adverse effects*; D019188:Organ Preservation Solutions; D011887:Raffinose / Q000009:adverse effects; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013997:Time Factors; D014463:Ultrasonography
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose