title: Diagnosis and outcomes of collateral arterial formation after irreversible early hepatic artery thrombosis in pediatric liver recipients.
abstract: BACKGROUND
  Early hepatic artery thrombosis (eHAT) has been recognized as an important cause of graft loss and mortality. However, the incidence, etiology and outcome are not clear, especially for children. The present study was to investigate the formation of collateral artery flow after irreversible eHAT and its impact on patient's prognosis.
  
  
  METHODS
  We analyzed eHAT after liver transplantation in children from October 2006 to April 2015 in our center, illustrated the formation of collateral hepatic artery flow after irreversible eHAT and explored the diagnosis, complications, treatment and prognosis. The basic and follow-up ultrasonographic images were also compared.
  
  
  RESULTS
  Of the 330 pediatric liver recipients, 22 (6.67%) developed eHAT within 1 month. Revascularization attempts including surgical thrombectomy, interventional radiology and conservational treatment (thrombolysis) were successful in 5 patients. Among the 17 patients who had irreversible eHAT, follow-up ultrasonography revealed that collateral artery flow was developed as early as 2 weeks after eHAT. Liver abscess and bile duct complication occurred secondary to eHAT in variable time.
  
  
  CONCLUSIONS
  Collateral arterial formation is a compensatory adaptation to eHAT to supply blood to liver grafts. However, the severe bile duct damage secondary to eHAT is irreversible and retransplantation is unavoidable.
authors.affiliation: Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China. renjilfh@163.com.
authors.forename: Li-Hong
authors.initials: LH
authors.lastname: Gu
authors.forename: Feng-Hua
authors.initials: FH
authors.lastname: Li
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xia
authors.forename: Hua
authors.initials: H
authors.lastname: Fang
authors.forename: Shi-Jun
authors.initials: SJ
authors.lastname: Zhang
authors.forename: Long-Zhi
authors.initials: LZ
authors.lastname: Han
mesh_terms: D000367:Age Factors; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D001649:Bile Duct Diseases / Q000209:etiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler