Hepatic artery thrombosis in pediatric liver transplantation: graft salvage after thrombectomy.
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.
Garcia-Gallont
R
R
Department of Transplantation, Amedesqua Hospital, Guatemala City, Guatemala.
Bar-Nathan
N
N
Shaharabani
E
E
Yussim
A
A
Shapira
R
R
Zahavi
I
I
Shapira
Z
Z
Dinari
G
G
Mor
E
E
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