title: Feasibility and effectiveness of a new algorithm in preventing hepatic artery thrombosis after liver transplantation.
abstract: BACKGROUND
  The incidence of hepatic artery thrombosis (HAT) after liver transplantation (LTx) is up to 9% in adult recipients.
  
  
  METHODS
  To minimize HAT, we developed an algorithm that we have routinely applied since 2001. The algorithm is a cascade of potentially necessary procedures to improve hepatic artery blood flow before proceeding with LTx when arterial blood flow is impaired. Incidence, outcome, and possible therapeutic approaches of HAT were analyzed in prospectively non-controlled collected data during a 5-year period. There were 335 LTx in 299 adults (199 male, 100 female) with a median age of 49.7 years.
  
  
  RESULTS
  HAT was defined as early and late HAT (diagnosis within or after 30 days following LTx). After a mean follow-up of 17 months, nine HAT were documented (2.7%; five early and four late HAT). Treatment consisted of thrombolysis (n = 1), surgical thrombectomy (n = 4), and re-transplantation (n = 4). Five HAT patients died during follow-up.
  
  
  CONCLUSIONS
  Complex arterial reconstruction was associated with HAT compared to branch-patch anastomoses (P = 0.0193). Median arterial intraoperative blood flow was no risk factor for HAT. One-year patient survival after HAT was 31%. Once HAT occurs, complication rates are high and long-term results are devastating.
  
  
  CONCLUSIONS
  Therefore, we have implemented the presented algorithm, which showed an acceptable HAT rate.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Müller
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.forename: Thilo
authors.initials: T
authors.lastname: Welsch
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000465:Algorithms; D000714:Anastomosis, Surgical / Q000379:methods; D002985:Clinical Protocols; D005240:Feasibility Studies; D005260:Female; D006499:Hepatic Artery / Q000502:physiology / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D013927:Thrombosis / Q000401:mortality / Q000517:prevention & control*