Feasibility and effectiveness of a new algorithm in preventing hepatic artery thrombosis after liver transplantation.
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.
Müller
Sascha A
SA
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
Schmied
Bruno M
BM
Mehrabi
Arianeb
A
Welsch
Thilo
T
Schemmer
Peter
P
Hinz
Ulf
U
Weitz
Jürgen
J
Werner
Jens
J
Büchler
Markus W
MW
Schmidt
Jan
J
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*