title: Graft survival following three occurrences of hepatic arterial thrombosis after living-related liver transplantation. A case report.
abstract: Hepatic arterial thrombosis is a major cause of morbidity and graft loss in patients undergoing liver transplantation. We report the case of a patient who underwent living-related liver transplantation and suffered three instances of early hepatic arterial thrombosis requiring revascularization in the first 8 days after grafting. The patient was discharged with good graft function. A 21-month-old female with biliary atresia underwent living-related liver transplantation using her mother's extra-lateral segment. The donor middle hepatic artery was anastomosed end-to-end to the posterior branch of the donor's hepatic artery. The time of operation was 8 hr 36 min, and the blood loss was 193 mL. On postoperative day 5, the patient was returned to surgery to close a perforation in the transverse colon. At operation we found hepatic arterial thrombosis and performed a thrombectomy and redid the arterial anastomosis. Hepatic arterial thrombosis recurred during the operation, so we interposed the recipient's right radial artery between the graft artery and recipient posterior branch. On postoperative day 8, ultrasound showed a fluid collection in Winslow's pouch. After removing the fibrin clot, we discovered that hepatic arterial thrombosis had recurred in the interposed artery. We revascularized the graft using the right gastroepiploic artery. Arterial blood flow was restored, and graft function remained excellent.
authors.affiliation: First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyou-ku, Tokyo 113-8603, Japan. Taniain@nms.ac.jp
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Onda
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Koho
authors.initials: K
authors.lastname: Akimaru
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yokomuro
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Sho
authors.initials: S
authors.lastname: Mineta
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshioka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirakata
mesh_terms: D001656:Biliary Atresia / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D017534:Radial Artery / Q000637:transplantation; D012008:Recurrence; D012086:Reoperation; D017131:Thrombectomy; D013927:Thrombosis / Q000601:surgery