Diagnosis, treatment, and outcomes of hepatic artery thrombosis after liver transplantation

RATIONALE: Hepatic Artery Thrombosis (HAT) is the most common and severe vascular complication in patients undergoing Liver Transplantation (LT), with an incidence ranging from 2% to 9% and mortality between 11% and 60%. Despite its clinical relevance, Brazilian publications on the topic remain limited. OBJECTIVES: To evaluate the diagnosis, treatment, and outcomes of HAT in patients undergoing LT at three Brazilian hospitals (Hospital Santa Isabel, Blumenau, Santa Catarina; Hospital das Clínicas, Curitiba, Paraná; and Hospital Nossa Senhora das Graças, Curitiba, Paraná). METHODS: This was a longitudinal, observational, retrospective study including patients diagnosed with HAT after LT between September 1991 and December 2023 at three major Brazilian medical centers. Data were obtained from electronic medical records and institutional protocols. RESULTS: Among 1,362 transplants performed, 35 patients developed HAT, corresponding to an incidence of 2.6%. Doppler ultrasound detected the condition within the first 48 hours in 43.8% of cases. Intraoperative assessment of arterial pulse alone was not associated with mortality (p = 0.16). Patients who underwent retransplantation showed a trend toward lower mortality (p = 0.076). CONCLUSION: Retransplantation is associated with reduced mortality in HAT cases and is considered the gold-standard treatment. Intraoperative Doppler ultrasound should be considered not only as a screening tool but also as an aid in surgical decision-making.