title: Hepatic artery thrombosis in pediatric liver transplantation: graft salvage after thrombectomy.
abstract: Hepatic artery thrombosis (HAT) is a devastating complication that may occur after orthotopic liver transplantation (OLT). A higher incidence has been reported in children. Salvage of the graft by thrombectomy has been suggested as an alternative to re-transplantation. In this study we report the outcome of three children who underwent thrombectomy for HAT. Between January 1992 and June 1998, 14 children (< 17 yrs of age) underwent liver transplantation. Three developed HAT (one a whole-liver graft recipient, age 17; two living-related graft recipients, ages 4 and 4.5 yr). In the first patient, thrombosis of the hepatic artery was associated with scattered areas of parenchymal necrosis on computed tomography. In the two living-related patients, HAT was found incidentally during re-exploration for bleeding (day 2 and day 10). Thrombectomy was performed in all three patients. At 18-24 months after thrombectomy, all three children had normal graft function. In the first patient, complete regeneration of the liver has been documented by computed tomography and a late asymptomatic recurrent thrombosis is suggested by absence of arterial flow on Doppler examination. The hepatic artery is patent in the two living-related recipients. One of these living-related recipients developed ischemic bile duct stricture and underwent successful percutaneous balloon dilatation. We conclude that long-term normal graft function can be achieved by thrombectomy in pediatric liver recipients with HAT, even in the presence of limited parenchymal damage.
authors.affiliation: Department of Transplantation, Amedesqua Hospital, Guatemala City, Guatemala.
authors.forename: R
authors.initials: R
authors.lastname: Garcia-Gallont
authors.forename: N
authors.initials: N
authors.lastname: Bar-Nathan
authors.forename: E
authors.initials: E
authors.lastname: Shaharabani
authors.forename: A
authors.initials: A
authors.lastname: Yussim
authors.forename: R
authors.initials: R
authors.lastname: Shapira
authors.forename: I
authors.initials: I
authors.lastname: Zahavi
authors.forename: Z
authors.initials: Z
authors.lastname: Shapira
authors.forename: G
authors.initials: G
authors.lastname: Dinari
authors.forename: E
authors.initials: E
authors.lastname: Mor
mesh_terms: D000293:Adolescent; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome