title: Twenty Years of Experience in Pediatric Living Donor Liver Transplantation: Focus on Hepatic Artery Reconstruction, Complications, and Outcomes.
abstract: Hepatic artery thrombosis (HAT) increases morbidity and mortality after liver transplantation (LT). The identification of risk factors for HAT may aid transplant teams in the development of strategies aimed at reducing HAT. This article describes the risk factors for HAT and outcomes after LT.
  
  
  
  This report describes a retrospective study (1995 to 2015) of primary pediatric living donor LT (LDLT). Pretransplant and technical variables were included in the study. Binary logistic regression was used for data analysis.
  
  
  
  This study included 656 primary LDLT. The median age, body weight, and pediatric end-stage liver disease score at the time of transplant were 13 months, 8.4 kg and 15, respectively. Twenty-one (3.2%) patients developed HAT. Intraoperative HAT (odds ratio, 62.63; 95% confidence interval, 12.64-310.19; P < 0.001) and the use of liver grafts with a graft-to-recipient weight ratio less than 1.1% (odds ratio, 24.46; 95% confidence interval, 4.55-131.56; P < 0.001) retained statistical significance in the multivariate model. Patient and graft survivals were significantly worse in cases with HAT. The overtime trend analysis revealed a decrease in the incidence of HAT (P = 0.008) and an increase in the use of 2-arterial anastomosis (P < 0.001).
  
  
  
  A graft-to-recipient weight ratio of 1.1% or less and intraoperative HAT were independently associated with HAT. Trend analysis further revealed a significant reduction in the incidence of HAT over time, as well as the increased use of 2 hepatic arteries for anastomosis during graft implantation. The double artery anastomosis may represent an extra protection to pediatric recipients undergoing LDLT.
authors.affiliation: 1 Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, SP, Brazil. 2 Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, SP, Brazil. 3 Liver Transplant Service, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: João
authors.initials: J
authors.lastname: Seda-Neto
authors.forename: Eduardo
authors.initials: E
authors.lastname: Antunes da Fonseca
authors.forename: Renata
authors.initials: R
authors.lastname: Pugliese
authors.forename: Helry L
authors.initials: HL
authors.lastname: Candido
authors.forename: Marcel R
authors.initials: MR
authors.lastname: Benavides
authors.forename: Rogério
authors.initials: R
authors.lastname: Carballo Afonso
authors.forename: Romerito
authors.initials: R
authors.lastname: Neiva
authors.forename: Gilda
authors.initials: G
authors.lastname: Porta
authors.forename: Irene K
authors.initials: IK
authors.lastname: Miura
authors.forename: Hsiang W
authors.initials: HW
authors.lastname: Teng
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Iwase
authors.forename: Mônica L
authors.initials: ML
authors.lastname: Rodrigues
authors.forename: Luis Augusto
authors.initials: LA
authors.lastname: Carneiro de Albuquerque
authors.forename: Mario
authors.initials: M
authors.lastname: Kondo
authors.forename: Paulo
authors.initials: P
authors.lastname: Chapchap
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D000925:Anticoagulants / Q000737:chemistry; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult
chemical_list: D000925:Anticoagulants