title: Hepatic artery thrombosis following orthotopic liver transplantation: a 10-year experience from a single centre in the United Kingdom.
abstract: Hepatic artery thrombosis (HAT) occurs in 3-9% of all liver transplants and acute graft loss is a possible sequelae. We present our experience in the management of HAT over a 10-year period. Prospectively collected data from April 1994 to April 2004 were analyzed. There were 1,257 liver transplants, 669 males, median age 51 (16-73) years. There were 61 (4.9%) cases of HAT. Early HAT occurred in 21 (1.8%). Thirty six had graft dysfunction, 11 required a regraft, and 14 died. Positive CMV serology in the donor, cold ischemia time, duration of operation, transfusions of more than 6 units of blood, and 15 units of plasma, an aortic conduit for arterial reconstruction, Roux-en-Y biliary reconstructions, regrafts and relaparotomy were associated with HAT. At multivariate analysis, type of biliary anastomosis was the only significant factor associated with HAT. Split or reduced liver graft were not risk factors for HAT. Number of hepatic arteries requiring multiple arterial anastomosis was not a risk for HAT. HAT resulted in a reduction in overall survival post liver transplantation. The incidence of HAT was 4.9%; with 1.8% early HAT and HAT impacted on survival. Surgical technique was not an aetiological factor for HAT. In conclusion, while a Roux-en-Y biliary reconstruction was an independent risk factor for HAT, cold ischemia and operative times, the use of blood and plasma and the use of aortic conduits in arterial reconstruction were associated with HAT. Regrafts and reoperation were also identified risk factors.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, United Kingdom.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Silva
authors.forename: Periyathambi S
authors.initials: PS
authors.lastname: Jambulingam
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: David
authors.initials: D
authors.lastname: Mayer
authors.forename: John A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000792:Angiography; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D014184:Transplantation, Homologous; D014656:Vascular Surgical Procedures / Q000379:methods