title: Hepatic artery thrombosis in living related liver transplantation.
abstract: BACKGROUND
  Hepatic artery thrombosis (HAT) after orthotopic liver transplantation remains a significant cause of graft loss in pediatric patients. We previously reported that the microsurgical techniques for arterial anastomosis can reduce the incidence of HAT in living related liver transplantation (LRLT). The purpose of this study is to analyze the risk factors for HAT after LRLT. A total of 245 patients received 250 liver transplants.
  
  
  METHODS
  Eight arteries in eight patients, reconstructed with the use of loupe magnification (HAT; 1/8, 12.5%), were excluded from this study. We observed HAT in 4 patients of the 242 transplants (1.7%, HAT group). Seventeen factors were compared between the HAT and the control group (those without HAT).
  
  
  RESULTS
  HAT occurred in 3 of 33 grafts (9%) from ABO-incompatible donors, whereas it occurred in 1 of 209 grafts (0.5%) from identical or compatible donors (P=0.008). The corrected volume of fresh-frozen plasma intraoperatively transfused in the HAT group (46.9+/-30.3 ml/kg) was significantly (P=0.015) different from that in the control group (10.2+/-1.9 ml/mg). In all four patients with HAT, emergent revisions of the anastomosis were performed. Two patients with ABO-incompatible grafts died of hepatic failure and sepsis.
  
  
  CONCLUSIONS
  Although microsurgical techniques can minimize the surgical risk factors for HAT, overtransfusion of fresh-frozen plasma in high-risk patients (ABO incompatible) may be a critical factor in the development of HAT in LRLT.
authors.affiliation: Department of Gastroenterological Surgery, Kyoto University, Graduate School of Medicine, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Hatano
authors.forename: H
authors.initials: H
authors.lastname: Terajima
authors.forename: S
authors.initials: S
authors.lastname: Yabe
authors.forename: K
authors.initials: K
authors.lastname: Asonuma
authors.forename: H
authors.initials: H
authors.lastname: Egawa
authors.forename: T
authors.initials: T
authors.lastname: Kiuchi
authors.forename: S
authors.initials: S
authors.lastname: Uemoto
authors.forename: Y
authors.initials: Y
authors.lastname: Inomata
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Yamaoka
mesh_terms: D001157:Arterial Occlusive Diseases / Q000453:epidemiology* / Q000209:etiology; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008866:Microsurgery; D012307:Risk Factors