title: The impact of meticulous management for hepatic artery thrombosis on long-term outcome after pediatric living donor liver transplantation.
abstract: To analyze the risk factors in the development of hepatic artery thrombosis (HAT) and assess the impact of our perioperative management for HAT on the long-term outcome after pediatric living donor liver transplantation (LDLT), we reviewed 382 patients under 12 yr of age who underwent 403 LDLT from January 1996 to December 2005. One- and 10-yr patient survival rates were 78% and 78% in the patients with HAT (27 patients; 6.7%), and 84% and 76% in the patients without HAT, respectively (p = n.s.). Univariate analysis showed gender (female), body weight (lower), and graft-to-recipient weight ratio (higher) were significant risk factors in the patients with HAT (p < 0.05). Patients with Doppler ultrasound signal loss of the hepatic artery (HA) accompanied by an increase of liver enzymes underwent thrombectomy and reanastomosis (S-group, n = 13), and patients with a weak HA signal underwent anticoagulant therapy (M-group, n = 13). One patient underwent re-LDLT. One- and five-yr patient survival rates were 83% and 83% in the S-group, and 77% and 77% in the M-group (p = n.s.). The incidence of biliary complications in the S-group (58%) was significantly higher than that of the M-group (15%). For a successful long-term outcome, the early detection of HAT and prompt medical and surgical intervention are crucial to minimize the insult of HAT.
authors.affiliation: Department of Surgery, Kyoto University, Kyoto, Japan. uchiday@kuhp.kyoto-u.ac.jp
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Uchida
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Kaoru
authors.initials: K
authors.lastname: Taira
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Kenji
authors.initials: K
authors.lastname: Uryuhara
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kamiyama
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017131:Thrombectomy; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants