Risk factors associated with early and late HAT after adult liver transplantation

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 30; pp. 10545 - 10552
• Main Author: Yang, Yi
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14.08.2014
• Subjects: Adolescent; Adult; Aged; Arterial Occlusive Diseases - diagnosis; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - physiopathology; artery; Chi-Square Distribution; Female; Hepatic; Hepatic Artery - diagnostic imaging; Hepatic Artery - physiopathology; Humans; Liver; Liver Transplantation - adverse effects; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Retrospective Studies; Retrospective Study; Risk Factors; thrombosis; Thrombosis - diagnosis; Thrombosis - etiology; Thrombosis - physiopathology; Time Factors; transplantation; Treatment Outcome; Ultrasonography, Doppler; Vascular Patency; Young Adult; Complication; Hepatic artery thrombosis; Blood transfusion; Risk factors; Liver transplantation
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v20.i30.10545

AIM:To identify risk factors that might contribute to hepatic artery thrombosis(HAT)after liver transplantation(LT).METHODS:The perioperative and follow-up data of a total of 744 liver transplants,performed from February1999 to July 2010,were retrospectively reviewed.HAT developed in 20 patients(2.7%).HAT was classified as early(occurring in fewer than 30 d post LT)or late(occurring more than 30 d post LT).Early HAT developed in 14 patients(1.9%).Late HAT developed in 6patients(0.8%).Risk factors associated with HAT were analysed using theχ2 test for univariate analysis and logistic regression for multivariate analysis.RESULTS:Lack of ABO compatibility,recipient/donor weight ratio≥1.15,complex arterial reconstruction,duration time of hepatic artery anastomosis>80 min,duration time of operation>10 h,dual grafts,number of units of blood received intraoperatively≥7,number of units of fresh frozen plasma(FFP)received intraoperatively≥6,postoperative blood transfusion and postoperative FFP use were significantly associated with early HAT in the univariate analysis(P<0.1).After logistic regression,independent risk factors associated with early HAT were recipient/donor weight ratio≥1.15(OR=4.499),duration of hepatic artery anastomosis>80 min(OR=5.429),number of units of blood received intraoperatively≥7(OR=4.059)and postoperative blood transfusion(OR=6.898).Graft type(whole/living-donor/split),duration of operation>10 h,retransplantation,rejection reaction,recipients with diabetes preoperatively and recipients with a high level of blood glucose or diabetes postoperatively were significantly associated with late HAT in the univariate analysis(P<0.1).After logistic regression,the independent risk factors associated with early HAT were duration of operation>10 h(OR=6.394),retransplantation(OR=21.793)and rejection reactions(OR=16.936).CONCLUSION:Early detection of these risk factors,strict surveillance protocols by Doppler ultrasound and prophylactic anticoagulation for recipients at risk might be determined prospectively.