Am Surg 1996 Mar;62(3):237-40

Etiology and management of symptomatic adult hepatic artery thrombosis after
orthotopic liver transplantation (OLT)

Drazan K, Shaked A, Olthoff KM, Imagawa D, Jurim O, Kiai K, Shackelton C,
Busuttil R

Dumont-UCLA Transplant Center, Los Angeles, California.

Abstract

Hepatic artery thrombosis (HAT) after adult orthotopic liver transplantation
(OLT) is associated with fulminant sepsis and irretrievable loss of the graft.
The purpose of this study was 1) to identify recipients at risk for the
development of HAT; 2) to define early signs and methods for diagnosis; 3) to
determine surgical treatment strategies following diagnosis of HAT. The charts
of 680 adults who underwent primary OLT were reviewed. Eleven patients were
symptomatic from HAT. Operative data revealed problematic arterial
reconstruction in 9/11, and were related to inadequate recipient inflow,
necessitating an interposition allogeneic iliac graft in seven patients, or
anastomosis to aberrant right hepatic artery in two recipients. Early HAT in
4/11 occurred within 4 weeks after transplantation, whereas late thrombosis in
7/11 was identified 30 days to 1 year after OLT. The postthrombosis course was
manifested by elevated liver transaminases (7/11), sepsis and recurrent
cholangitis (9/11), or gas gangrene of the liver (4/11). The treatment
modalities included thrombectomy and revision of the arterial anastomosis
(1/11), emergency hepatectomy with temporary portocaval shunt (2/11), and urgent
retransplantation (5/11). Antibiotic therapy and elective retransplantation was
the treatment in 4/11. Overall 1-year patient survival and satisfactory graft
function was 45 percent.