title: The arterial anastomosis in liver transplantation: complications, treatment and outcome.
abstract: OBJECTIVE
  Arterial complications continue to be a major source of morbidity, graft loss and mortality after liver transplantation (OLT). In this study we analyzed the incidence, treatment and outcome of arterial complications in patients who underwent OLT in our center.
  
  
  METHODS
  Between February 2002 and May 2009, 210 whole-organ OLTs were performed in 199 adults. Analyzed patients were divided into group I (the first 100 OLTs) and group II (subsequent 110 OLTs). Factors that could contribute to the development of arterial complications were analyzed.
  
  
  RESULTS
  Fourteen (6.5%) arterial complications occurred in 13 patients resulting in graft loss in 4 (31%) and mortality in 5 (38%) cases. There were two (1%) serious intraoperative bleedings requiring major arterial reconstruction. The most frequent arterial complication was hepatic artery thrombosis (3.3%; 7/210), requiring re-OLT in 5 cases and resulting in death in 4 patients. Hepatic artery kinking was found in 3 (1.4%) patients while the splenic artery steal syndrome and hepatic artery stenosis coexistent with portal vein stenosis occurred in one patient each. The incidence of arterial complications (9% vs. 4.6%; p=NS), related graft loss (3% vs. 0.9%; p=NS) and mortality (4% vs. 0.9%; p=NS) were comparable in both groups.
  
  
  CONCLUSIONS
  Arterial complications remain a major source of graft loss and mortality after OLT. Their occurrence and related graft loss and mortality were not associated with a significant learning curve in our series. Hepatic artery thrombosis although rare, is a devastating complication requiring re-OLT in majority of cases. Early diagnosis and prompt therapy are crucial to improve outcome.
authors: Division of Hepatobiliary Surgery and Liver Transplantation Marie Curie Hospital, Szczecin, Poland.
authors: Monika
authors: M
authors: Pakosz-Golanowsha
authors: Jerzy
authors: J
authors: Lubikowski
authors: Mariola
authors: M
authors: Post
authors: Konrad
authors: K
authors: Jarosz
authors: Katarzyna
authors: K
authors: Zasada-Cedro
authors: Piotr
authors: P
authors: Milkiewicz
authors: Maciej
authors: M
authors: Wójcicki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D016009:Chi-Square Distribution; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome