Long-term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation

Authors

  • Nienke Warnaar,

    1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, Groningen, the Netherlands
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  • Wojciech G. Polak,

    1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, Groningen, the Netherlands
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  • Koert P. de Jong,

    1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, Groningen, the Netherlands
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  • Marieke T. de Boer,

    1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, Groningen, the Netherlands
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  • Henkjan J. Verkade,

    1. Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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  • Egbert Sieders,

    1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, Groningen, the Netherlands
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  • Paul M. J. G. Peeters,

    1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, Groningen, the Netherlands
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  • Robert J. Porte

    Corresponding author
    1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, Groningen, the Netherlands
    • Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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    • Telephone: +31-50-3612896; FAX: +31-50-3611745


  • See Editorial on Page 812

Abstract

Hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) is a serious complication resulting in bile duct necrosis and often requiring retransplantation. Immediate surgical thrombectomy/thrombolysis has been reported to be a potentially successful treatment for restoring blood flow and avoiding urgent retransplantation. The long-term results of this strategy remain to be determined. In 232 pediatric liver transplants, we analyzed long-term outcomes after urgent revascularization for early HAT. HAT developed in 32 patients (13.7%). In 16 children (50%), immediate surgical thrombectomy was performed in an attempt to salvage the graft. Fourteen patients (44%) underwent urgent retransplantation, and 2 (6%) died before further intervention. Immediate thrombectomy resulted in long-term restoration of the hepatic artery flow in 6 of 16 patients (38%) and in 1- and 5-year graft and patient survival rates of 83% and 67%, respectively. In 10 patients, revascularization was unsuccessful, and retransplantation was inevitable. The 1- and 5-year patient survival rates in this group decreased to 50% and 40%, respectively. After immediate retransplantation, the 5-year patient survival rate was 71%. In conclusion, immediate surgical thrombectomy for HAT after pediatric OLT results in long-term graft salvage in about one-third of patients. However, when thrombectomy is unsuccessful, long-term patient survival is lower than the survival of patients who underwent immediate retransplantation. Liver Transpl 16:847–855, 2010. © 2010 AASLD.

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