title: Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (A retrospective cohort study).
abstract: OBJECTIVE
  Hepatic arterial (HA) and portal venous (PV) complications of recipients after living donor liver transplantation(LDLT) result in patient loss. The aim of this study was to analyze these complications.
  
  
  METHODS
  We retrospectively analyzed HA and/or PV complications in 213 of 222 recipients underwent LDLT in our centre. The overall male/female and adult/pediatric ratios were 183/30 and 186/27 respectively.
  
  
  RESULTS
  The overall incidence of HA and/or PV complications was 19.7% (n = 42), while adult and pediatric complications were 18.3% (n = 39) and 1.4% (n = 3) respectively. However early (<1month) and late (>1month) complications were 9.4% (n = 20) and 10.3% (n = 22) respectively. Individually HA problems (HA stenosis, HA thrombosis, injury and arterial steal syndrome) 15% (n = 32), PV problems (PV thrombosis and PV stenosis) 2.8% (n = 6) and simultaneous HA and PV problems 1.9% (n = 4). 40/42 of complications were managed by angiography (n = 18), surgery (n = 10) or medically (Anticoagulant and/or thrombolytic) (n = 12) where successful treatment occurred in 18 patients. 13/42 (31%) of patients died as a direct result of these complications. Preoperative PVT was significant predictor of these complications in univariate analysis. The 6-month, 1-, 3-, 5- 7- and 10-year survival rates in patients were 65.3%, 61.5%, 55.9%, 55.4%, 54.5% and 54.5% respectively.
  
  
  CONCLUSIONS
  HA and/or PV complications specially early ones lead to significant poor outcome after LDLT, so proper dealing with the risk factors like pre LT PVT (I.e. More intensive anticoagulation therapy) and the effective management of these complications are mandatory for improving outcome.
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt.
authors.forename: Emad Hamdy
authors.initials: EH
authors.lastname: Gad
authors.affiliation: Radiology, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt.
authors.forename: Mohammed Alsayed
authors.initials: MA
authors.lastname: Abdelsamee
authors.affiliation: Anaesthesia, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Kamel
keywords: Hepatic artery complications; Living donor liver transplantation; Portal vein complications; Survival