title: The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia.
abstract: BACKGROUND
  Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival.
  
  
  METHODS
  A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR.
  
  
  RESULTS
  Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71%, 61%, and 57% versus 85%, 85%, and 85%, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19%), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81% in group 1 and 100% in group 2 (P = 0.02).
  
  
  CONCLUSIONS
  In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.
authors.affiliation: Department of Surgery, Dumont-UCLA Transplant Center, UCLA School of Medicine, Los Angeles, California 90095, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Shackleton
authors.forename: J A
authors.initials: JA
authors.lastname: Goss
authors.forename: K
authors.initials: K
authors.lastname: Swenson
authors.forename: S D
authors.initials: SD
authors.lastname: Colquhoun
authors.forename: P
authors.initials: P
authors.lastname: Seu
authors.forename: M M
authors.initials: MM
authors.lastname: Kinkhabwala
authors.forename: S M
authors.initials: SM
authors.lastname: Rudich
authors.forename: J S
authors.initials: JS
authors.lastname: Markowitz
authors.forename: S V
authors.initials: SV
authors.lastname: McDiarmid
authors.forename: R W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000206:Actuarial Analysis; D001656:Biliary Atresia / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000098:blood supply; D016031:Liver Transplantation / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D012189:Retrospective Studies; D013927:Thrombosis / Q000517:prevention & control