Management and outcome of hepatic artery thrombosis with whole-liver transplantation using donors less than one year of age

• Published in: Journal of pediatric surgery 2022-11, Vol.57 (11), p.656-665
• Main Authors: Xu, Min, Dong, Chong, Sun, Chao, Wang, Kai, Zhang, Wei, Wu, Di, Qin, Hong, Han, Chao, Yang, Yang, Zhang, Fubo, Wang, Zhen, Zheng, Weiping, Gao, Wei
• Format: Article
• Language: English
• Subjects: Anticoagulant therapy; Anticoagulants - therapeutic use; Biliary complications; Child; Hepatic Artery - surgery; Hepatic artery thrombosis; Humans; Liver Transplantation - methods; Pediatric liver transplantation; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Thrombosis - epidemiology; Thrombosis - etiology; Whole liver
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.05.009

•The incidence of hepatic artery thrombosis in whole liver transplantation with donor age less than one year of age.•Recanalization can be performed using anticoagulant therapy.•HAT does not reduce the survival rate of recipients and grafts. The incidence of hepatic artery thrombosis (HAT) in recipients is high after pediatric LT using young donors. In this study we investigated the management and outcome of HAT after whole-LT using donors less than one year of age. And evaluate the safety of pediatric donors, and increase the utilization of pediatric donors overall. We retrospectively analyzed the clinical data encompassing children who underwent whole-liver transplantation in our department from January 2014 to December 2019. Recipients receiving a liver from a donor ≥1 month and ≤12 months were included, and a total of 110 patients were included in this study. The results showed an incidence for HAT of 20% and the median time to HAT diagnosis was 3.0 (2.0, 5.3) days post-operation. Anticoagulant therapy was used for 19 cases and 94.7% of them achieved hepatic artery recanalization or collateral formation. The median time of recanalization was 12 (5, 15) days. Bile leakage and biliary strictures occurring in the HAT group were higher than in the non HAT group (13.6% vs. 1.1% and 31.8% vs. 3.4%). There were no significant differences in the survival rates of recipients or grafts among the two groups (P = 0.474, P = 0.208, respectively). We confirmed that the incidence of HAT in LT recipients use donors less than 1 year is high, but recanalization can be performed using anticoagulant therapy. Although biliary complications increased significantly after HAT, the survival rates of patients and grafts were satisfactory. Level III.