title: Hepatic artery graft in pediatric liver transplantation: single-center experience with 58 cases.
abstract: BACKGROUND
  The use of arterial grafts (AG) in pediatric orthotopic liver transplantation (OLT) is an alternative in cases of poor hepatic arterial inflow, small or anomalous recipient hepatic arteries, and retransplantations (re-OLT) due to hepatic artery thrombosis (HAT). AG have been crucial to the success of the procedure among younger children. Herein we have reported our experience with AG.
  
  
  METHODS
  We retrospectively reviewed data from June 1989 to June 2010 among OLT in which we used AG, analyzing indications, short-term complications, and long-term outcomes.
  
  
  RESULTS
  Among 437 pediatric OLT, 58 children required an AG. A common iliac artery interposition graft was used in 57 cases and a donor carotid artery in 1 case. In 38 children the graft was used primarily, including 94% (36/38) in which it was due to poor hepatic arterial inflow. Ductopenia syndromes (n = 14), biliary atresia (BA; n = 11), and fulminant hepatitis (n = 8) were the main preoperative diagnoses among these children. Their mean weight was 18.4 kg and mean age was 68 months. At the mean follow-up of 27 months, multiple-organ failure and primary graft nonfunction (PNF) were the short-term causes of death in 9 children (26.5%). Among the remaining 29 patients, 2 (6,8%) developed early graft thrombosis requiring re-OLT; 5 (17%) developed biliary complications, and 1 (3.4%) had asymptomatic arterial stenosis. In 20 children, a graft was used during retransplantation. The main indication was HAT (75%). BA (n = 15), ductopenia syndromes (n = 2), and primary sclerosing cholangitis (n = 2) were the main diagnoses. Their mean weight was 16.7 kg and age was 65 months. At a mean follow-up of 53 months, 7 children died due to multiple-organ failure or PNF. Among the remaining 13 patients, 3 developed biliary complications and 1 had arterial stenosis. No thrombosis was observed.
  
  
  CONCLUSIONS
  The data suggested that use of an AG is useful alternative in pediatric OLT. The technique is safe with a low risk of thrombosis.
authors.affiliation: Instituto da Criança, Hospital das Clínicas, Pediatric Surgery and Liver Transplantation Division, Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: A N
authors.initials: AN
authors.lastname: Backes
authors.forename: N E M
authors.initials: NE
authors.lastname: Gibelli
authors.forename: A C A
authors.initials: AC
authors.lastname: Tannuri
authors.forename: M M
authors.initials: MM
authors.lastname: Santos
authors.forename: M L
authors.initials: ML
authors.lastname: Pinho-Apezzato
authors.forename: W C
authors.initials: WC
authors.lastname: Andrade
authors.forename: J G
authors.initials: JG
authors.lastname: Maksoud-Filho
authors.forename: A J R
authors.initials: AJ
authors.lastname: Queiróz
authors.forename: U
authors.initials: U
authors.lastname: Tannuri
mesh_terms: D000714:Anastomosis, Surgical; D002648:Child; D006499:Hepatic Artery / Q000637:transplantation*; D006801:Humans; D016031:Liver Transplantation