Transplantation 1992 Feb;53(2):396-9

Hepatic artery thrombosis in infants. A comparison of whole livers, reduced-size
grafts, and grafts from living-related donors

Stevens LH, Emond JC, Piper JB, Heffron TG, Thistlethwaite JR Jr, Whitington PF,
Broelsch CE

Department of Surgery, University of Chicago, Illinois 60637

Abstract

Hepatic artery thrombosis (HAT) is a major cause of patient morbidity and graft
loss in pediatric liver transplantation (OLT). Although some grafts may be
salvaged by arterial thrombectomy and reconstruction, many patients require
retransplantation. Patient survival is reduced by HAT. It has been suggested
that the incidence of HAT may be altered by the use of reduced-size grafts
(RSG). We analyzed our series of infants receiving OLT to determine the
frequency of HAT in full-size OLT, cadaveric RSG, and living-related RSG. The
role of arterial anastomotic technique in the development of HAT was also
examined. Between 10/1/84 and 12/7/90 433 liver transplants were performed.
During this period 100 patients between 3 months and 2 years of age (mean 13
months) received 134 liver grafts. The mean weight at the time of transplant was
7.9 kg. (range: 1.9-15 kg). Of the 134 grafts, 60 were whole livers, 61 were
cadaveric RSGs, and 13 were living-related RSGs. The cadaveric RSGs were 9 right
lobe grafts, 21 left lobe grafts, and 31 left lateral segment grafts.
Twenty-seven of the cadaveric RSGs were from split livers, while the other 34
were simple reductions. All 13 living-related RSGs were left lateral segments.
HAT occurred in 15 of 60 (25%) whole livers, 9 of 61 (15%) cadaveric RSGs, and 3
of 13 (23%) of the living-related-donor RSGs (P = NS). Subdividing the cadaveric
RSGs revealed that HAT occurred in 3 of 9 (33%) right lobe grafts, 3 of 21 (14%)
left lobe grafts, and 3 of 31 (10%) left lateral segment grafts (P = NS). The
site of the arterial anastomosis in the recipient correlated with the incidence
of HAT (hepatic artery 21/86 [24%], celiac axis 1/9 [11%], aorta 2/32 [6%], P =
0.06). In conclusion, it appears that use of a cadaveric left lobe or left
lateral segment graft and an aortic arterial anastomosis reduces the risk of
hepatic artery thrombosis in liver transplant recipients less than 2 years of
age