Long-term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation.
Hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) is a serious complication resulting in bile duct necrosis and often requiring retransplantation. Immediate surgical thrombectomy/thrombolysis has been reported to be a potentially successful treatment for restoring blood flow and avoiding urgent retransplantation. The long-term results of this strategy remain to be determined. In 232 pediatric liver transplants, we analyzed long-term outcomes after urgent revascularization for early HAT. HAT developed in 32 patients (13.7%). In 16 children (50%), immediate surgical thrombectomy was performed in an attempt to salvage the graft. Fourteen patients (44%) underwent urgent retransplantation, and 2 (6%) died before further intervention. Immediate thrombectomy resulted in long-term restoration of the hepatic artery flow in 6 of 16 patients (38%) and in 1- and 5-year graft and patient survival rates of 83% and 67%, respectively. In 10 patients, revascularization was unsuccessful, and retransplantation was inevitable. The 1- and 5-year patient survival rates in this group decreased to 50% and 40%, respectively. After immediate retransplantation, the 5-year patient survival rate was 71%. In conclusion, immediate surgical thrombectomy for HAT after pediatric OLT results in long-term graft salvage in about one-third of patients. However, when thrombectomy is unsuccessful, long-term patient survival is lower than the survival of patients who underwent immediate retransplantation.
Warnaar
Nienke
N
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, Groningen, the Netherlands.
Polak
Wojciech G
WG
de Jong
Koert P
KP
de Boer
Marieke T
MT
Verkade
Henkjan J
HJ
Sieders
Egbert
E
Peeters
Paul M J G
PM
Porte
Robert J
RJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome