title: Risk factors and treatments for hepatic arterial complications in pediatric living donor liver transplantation.
abstract: BACKGROUND
  Hepatic artery complications (HAC) are a serious complication in pediatric liver transplant recipients because its incidence is high and it can occasionally lead to graft liver failure. We herein present a retrospective analysis of our 10-year experience with pediatric living donor liver transplantation (LDLT) focusing on the risk factors and treatments for HAC.
  
  
  METHODS
  Between May 2001 and November 2011, 209 LDLTs were performed for 203 pediatric recipients. We performed the multivariate analyses to identify the factors associated with HAC and showed the therapeutic strategy and outcome for HAC.
  
  
  RESULTS
  The overall incidence of HAC was 7.2%, and the graft survival of recipients with HAC was 73.3%. The multivariate analysis showed that the pediatric end-stage liver disease score (≥20), post-transplant laparotomy except for HAC treatment and extra-anatomical hepatic artery reconstruction were independent risk factors for HAC (P = 0.020, P = 0.015 and P = 0.002, respectively). Eleven surgical interventions and 13 endovascular interventions were performed for 15 recipients with HAC. The serum aspartate aminotransferase levels pre- and post-treatment for HAC were significantly higher in the surgical group than in the endovascular group (P = 0.016 and P = 0.022, respectively).
  
  
  CONCLUSIONS
  It is important for recipients with risk factors to maintain strict post-transplant management to help prevent HAC and detect it in earlier stages. Endovascular intervention can be a less invasive method for treating HAC than surgical intervention, and can be performed as an early treatment.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. yuki371@jichi.ac.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.forename: Taiichi
authors.initials: T
authors.lastname: Wakiya
authors.forename: Shuji
authors.initials: S
authors.lastname: Hishikawa
authors.forename: Yuta
authors.initials: Y
authors.lastname: Hirata
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
authors.forename: Eiji
authors.initials: E
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D057510:Endovascular Procedures; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods; D006499:Hepatic Artery / Q000293:injuries / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Endovascular intervention; Extra-anatomical hepatic artery reconstruction; Hepatic arterial complications; Pediatric living donor liver transplantation; Post-transplant laparotomy