Clinical Course of Hepatic Artery Thrombosis After Living Donor Liver Transplantation Using the Right Lobe

• Published in: Liver transplantation Vol. 24; no. 11; pp. 1554 - 1560
• Main Authors: Choi, Ho Joong, Kim, Dong Goo, Kim, Yumi, Kwak, Bong Jun, Han, Jae Hyun, Hong, Tae Ho, You, Young Kyoung
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2018
• Subjects: Adult; Allografts - blood supply; Anastomosis; Anastomosis, Surgical - methods; Angiography; Cardiovascular system; Computed tomography; Computed Tomography Angiography; Diagnosis; Endovascular Procedures - methods; Feasibility Studies; Female; Graft rejection; Graft Rejection - epidemiology; Graft Rejection - etiology; Graft Rejection - prevention & control; Grafts; Hepatic artery; Hepatic Artery - diagnostic imaging; Hepatic Artery - surgery; Humans; Liver - blood supply; Liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver transplants; Living Donors; Male; Middle Aged; Patients; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Reconstructive Surgical Procedures - methods; Reoperation - statistics & numerical data; Retrospective Studies; Thrombosis; Thrombosis - diagnostic imaging; Thrombosis - epidemiology; Thrombosis - etiology; Thrombosis - surgery; Time Factors; Treatment Outcome; Ultrasonography, Doppler; Vascularization
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.25065

Hepatic artery thrombosis (HAT) can result in biliary tree necrosis and graft loss, necessitating retransplantation. The most effective treatment approach is still controversial. This study was performed to review the outcomes of HAT after living donor liver transplantation (LDLT) and to clarify the feasibility of different strategies. From May 1996 to August 2017, LDLT using the right lobe was performed in 827 adult patients in our center. Our technique of hepatic artery (HA) reconstruction is end‐to‐end anastomosis under a microscope (10×). Diagnosis of HAT was performed using Doppler sonography and computed tomography (CT) angiography. HAT was initially treated with surgical or endovascular procedure, and retransplantation was considered according to the graft condition. Among the 827 cases of LDLT using the right lobe, HAT occurred in 16 (1.9%) cases within 1 month after transplantation. Within the first week, 7 of these HAT cases (43.8%) occurred (early HAT), while the remaining 9 cases (56.2%) occurred between the first week and 1 month (late HAT). The incidence of graft failure was high in early HAT (42.9%), and the frequency of biliary complications was high in late HAT (77.8%). The success rate of HA recanalization was 62.5% (10/16): 100% (5/5) after reoperation and 45.5% (5/11) after the endovascular procedure. Of the patients in whom treatment failed in late HAT (n = 5), 4 underwent neovascularization during observation. A total of 5 patients underwent graft failure, and 3 of these patients underwent repeat liver transplantation (LT). Mortality occurred in 3 patients, including 1 in the surgical group and 2 in the endovascular group. In conclusion, early diagnosis and aggressive treatment of HAT are necessary to avoid graft failure, and the choice of treatment depends on various factors. Although further studies are required, early HAT requires preparation for graft failure, while late HAT requires treatment for biliary complications.