title: Low incidence of hepatic artery thrombosis after pediatric liver transplantation without the use of intraoperative microscope or parenteral anticoagulation.
abstract: The risk of hepatic artery thrombosis (HAT) after pediatric liver transplantation (PLT) has been reported to range from 0 to 25%. We report our experience focusing on the interrelationships between risk factors, surgical technique and the incidence of HAT after liver transplantation in the pediatric age group. From February 18, 1997 to December 31, 2003, 150 consecutive liver transplants were performed in 132 pediatric patients. There were similar numbers of whole grafts when compared with partial grafts, 80 (53.3%) vs. 70 (46.7%), p = 0.30. Four grafts (2.7%) developed HAT. Of the grafts with HAT, three were successfully revascularized within the first 24 h. Only one graft (0.66%) was lost to HAT. A single surgeon utilizing 3.5-6.0 magnification loupes performed all but one hepatic arterial anastomoses. All patients were followed postoperatively by a daily ultrasound protocol and with anticoagulation of aspirin and alprostadil only. Living and deceased donor left lateral segment grafts had an increased rate of HAT when compared with whole liver grafts. HAT with subsequent graft loss may be minimized in PLT with the use of surgical loupes only, anticoagulation utilizing aspirin, alprostadil, and daily ultrasounds.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Heffron
authors.forename: David
authors.initials: D
authors.lastname: Welch
authors.forename: Todd
authors.initials: T
authors.lastname: Pillen
authors.forename: Carlos
authors.initials: C
authors.lastname: Fasola
authors.forename: Doug
authors.initials: D
authors.lastname: Redd
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Smallwood
authors.forename: Enrique
authors.initials: E
authors.lastname: Martinez
authors.forename: George
authors.initials: G
authors.lastname: Atkinson
authors.forename: Mark
authors.initials: M
authors.lastname: Guy
authors.forename: Changwoo
authors.initials: C
authors.lastname: Nam
authors.forename: Stuart
authors.initials: S
authors.lastname: Henry
authors.forename: Rene
authors.initials: R
authors.lastname: Romero
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D015994:Incidence; D007223:Infant; D016031:Liver Transplantation; D008853:Microscopy; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000925:Anticoagulants