Transplantation 1989 Jun;47(6):971-7

Hepatic artery thrombosis after pediatric liver transplantation--a medical or
surgical event?

Mazzaferro V, Esquivel CO, Makowka L, Belle S, Kahn D, Koneru B, Scantlebury VP,
Stieber AC, Todo S, Tzakis AG, et al

The Department of Surgery, University of Pittsburgh School of Medicine,
Pennsylvania 15213

Abstract

Hepatic artery thrombosis (HAT) is one of the most serious complications after
orthotopic liver transplantation, and is associated with a high morbidity and
mortality. This study retrospectively reviewed 66 liver transplants in children
under the age of 10 years during a year-long period at a single institution. A
total of 28 perioperative variables were analyzed to identify responsible
factors of HAT. Of the 66 children, 18 (26%) developed HAT within 15 days after
the transplant (HAT group); 29 (42%) had an uneventful postoperative course
(control group). To avoid the possible influence of other complications 19
patients were excluded. Of the variables compared between the 2 study groups,
three surgical factors (diameter of the hepatic artery--greater or less than 3
mm; type of arterial anastomosis--end-to-end versus the use of an iliac graft or
aortic conduit; and number of times the anastomosis was redone--one versus more
than one), were found to be significantly different (P less than .05) between
HAT and control groups. Two medical factors also were significantly different:
the use of intraoperative transfusion of fresh frozen plasma (FFP) and the
administration of postoperative prophylactic anticoagulant treatment. A heparin
and dextran-40 protocol appeared to be effective in preventing HAT (P less than
.02). Moreover, after multivariate analysis, anticoagulation therapy was
demonstrated to be the major independent variable influencing HAT. A better
definition of factors responsible for the occurrence of HAT is required. This
study should help in formulating effective methods to decrease the incidence of
this dreaded complication after liver transplantation