Incidence and Risk Factors of Hepatic Artery Thrombosis and Stenosis After Pediatric Liver Transplantation: Results From the HEPATIC Registry

Background. The incidence and risk factors of hepatic artery complications (HACs), including thrombosis (HAT) and stenosis (HAS), after pediatric liver transplantation (pLT) are not well characterized. This study aimed to assess the incidence and risk factors of HACs after pLT and quantify the screening effort required to identify a single HAC. Methods. We performed a retrospective multicenter analysis using the HEPATIC registry, including pLTs from 32 centers over a 20-y period. HAC incidence was assessed across subgroups defined by pLT indication, recipient age, donor type, transplant era, and annual center volume. Timing of HAC occurrence and the number needed to screen were analyzed. Results. Among 11 443 pLTs, HACs occurred in 4.8% (HAT 3.6%; HAS 1.2%). Most HACs developed within the first-month posttransplant (82.4%), with HAT peaking in the first 2 wk, whereas HAS was more evenly distributed. The overall incidence increased in 2012–2021 (5.3%), with rising HAS and stable HAT rates. Modifiable factors included living donor transplantation (3.4%) and high-volume centers (3.8%), both associated with lower HAC rates, whereas whole grafts in infants <1 y with biliary atresia (15.3%) were associated with higher incidence (all P < 0.001). Patient-related risk factors included retransplantation following previous HACs (11.3%) and noncirrhotic metabolic diseases (7.6%, both P < 0.001). The number needed to screen ranged from 173 to 1907 and was lower in high-risk groups. Conclusions. HACs occurred in 4.8% of pLTs, with recent increases driven by HAS. Infants <1 with biliary atresia receiving whole grafts and patients undergoing retransplantation after prior HACs were at the highest risk.