Introduction: Among surgical complications of liver transplantation (LT) in children, hepatic artery thrombosis (HAT) still constitutes a particular challenge in terms of prevention and management. This work reviews the incidence and outcome of HAT in a high volume centre along the last 31 years, with a particular focus on chronology and results of surgical redos in terms of overall survival and biliary complications. Methods: Between March 1984 and March 2015, a total of 1000 pediatric LT (median age: 1.9 years; range: 0.1-19.9) were performed in 882 recipients at Cliniques universitaires Saint-Luc, Brussels. Main pre-LT diagnoses were biliary atresia (n=542, 61%), cholestastic diseases (n=113, 13%), metabolic diseases (n=94, 11%), liver malignancies (n=51, 6%) and other diagnoses. The characteristics of post-LT HAT cases were recorded, including conservative/surgical management, survival and biliary complications. Each HAT case was paired with an equivalent pediatric LT recipient according to diagnosis, age at LT, type of graft (whole, reduced, split, living donor) and transplant era. Both groups were compared assessing patient/graft survival, retransplantation rate, and biliary complications. Results: Overall one year patient survivals were 76%, 84%, 89%, 95%, 100%, and 95%, during the 1984-88, 89-92, 93-99, 2000-06, 07-10, and 11-15 eras, respectively. Overall, HAT was observed in 36 cases (4.1%). This event could be fully documented in 35 cases (HAT group), and these children were compared to the paired series of recipients without HAT (control group). 5 year patient survivals were 77% vs 84%, in HAT and control groups, respectively (NS). Corresponding graft survivals were 20% vs 81%, respectively (p<0.0001). Retransplantation rates were 78% vs 11% in HAT and control groups, respectively (p<0.0001). Corresponding 5 year biliary complication-free survivals were 12% vs 80% (p<0.0001). Regarding the management of HAT, 16 were reoperated, with 6/16 (38%) successfully revascularized. Among these 6 latter children, 1 year patient/graft survivals were 100%/33%, with a 67% retransplantation rate. In the 10 cases with failed revascularization, the corresponding rates were 60%, 0%, and 90%. Regarding timing of HAT and management, early HAT (<14 days, n=28, 80% of HAT cases) were reoperated in 16/28 cases (57%). Among these reoperated HAT cases, 14 cases were reoperated within 7 days post-LT (revascularization obtained in 6/14, 43%), whereas no revascularization could be observed in the 2 cases operated beyond 7 days post-LT. Conclusion: These data confirmed the pejorative prognosis of developing HAT in terms of graft survival. Patient survival in HAT cases could be partly preserved through retransplantation. This analysis suggested that HAT cases should be reoperated if occurring within 7 days post-LT, with an improvement of patient and graft survivals, as well as of the retransplantation rate.
Channaoui et al. (Tue,) studied this question.