The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver Transplantations

The aim of our study was to assess risk factors for hepatic artery thrombosis (HAT) and to evaluate the impact of HAT management on long-term outcomes after pediatric living donor liver transplantation (LDLT). We retrospectively analyzed 400 patients who underwent primary LDLT between 1999 and 2020. We compared preoperative data, surgical factors, complications, and patient and graft survivals in patients with HAT (HAT Group) and without HAT (non-HAT Group). A total of 27 patients (6.75%) developed HAT. Acute liver failure, a hepatic artery (HA) anastomosis diameter below 2 mm, and intraoperative HA flow dysfunction were significantly more common in the HAT Group (p < 0.05, p = 0.02026, and p = 0.0019, respectively). In the HAT Group, 21 patients (77.8%) underwent urgent surgical revision. The incidence of biliary stenosis and retransplantation was significantly higher in the HAT Group (p = 0.00002 and p < 0.0001, respectively). Patient and graft survivals were significantly worse in the HAT Group (p < 0.05). The close monitoring of HA flow with Doppler ultrasound during the critical period of 2 to 3 weeks after LDLT and the immediate attempt of surgical revascularization may attenuate the elevated risk of biliary stenosis, graft loss, and the need for retransplantation due to HAT.

Automated summary

The aim of this study was to analyze the risk factors for hepatic artery thrombosis (HAT) and its impact on long-term outcomes in pediatric living donor liver transplantation (LDLT). The study included 400 patients who underwent primary LDLT between 1999 and 2020. The results showed that acute liver failure, a hepatic artery anastomosis diameter below 2 mm, and intraoperative hepatic artery flow dysfunction were associated with a higher risk of HAT. Patients in the HAT group had worse survival rates and higher rates of biliary stenosis and retransplantation compared to the non-HAT group. Close monitoring of hepatic artery flow and immediate surgical revascularization can help mitigate the risks associated with HAT.