*Purpose: Hepatic artery thrombosis (HAT) is a leading cause of patient and graft loss after pediatric liver transplant (LT). We present our experience with hepatic artery revascularization for HAT occurring within 7 days from LT.
*Methods: A retrospective review of our institutional pediatric LT database was performed (08/1997-10/2022). All patients who suffered from a HAT less than 7 days of LT were included. Successful revascularization was defined as a patent hepatic artery at the completion of the surgical revascularization procedure based on Doppler examination. Comparisons were made between first (1997-2009) and second (2009-2002) eras of our program. A p value <0.05 was considered significant.
*Results: The overall rate of HAT within 7 days from LT was 7.8%. There was no difference in the rate of HAT <7 days based on type of graft for the entire study period (whole 6.1%, split 9.8%, reduced 10.4%, living donor 5.7%, p=0.44). Overall rate decreased in the second era from 9.5% (25/262) to 5.5% (11/201), p=0.096. Overall, 28 grafts were candidates for revascularization (Figure 1). A A combination of tissue plasminogen activator, full heparinization, and thrombectomy, either with or without an anastomotic revision (n=22, 78.6%) or conversion to an aortic conduit (n=6, 21.4%) were used. Revascularization was successful in 22 grafts (78.6%): 6 were ultimately retransplanted (median time to retransplant 19.5 days (7-54 days)), 5 because of HAT or bile duct complications (BD E2). Three patients (3/5) are still alive. All 6 unsuccessful revascularizations occurred in the first era of our program: 5 patients were retransplanted and only one is alive. Of the 16 grafts that were not retransplanted, 7 grafts were lost to patient death (none related to HAT or BD complications). The remaining 9 patients are alive with functional grafts at last follow-up (median 15.3 years (3.9-21.1 years). The overall patient survival of patients who underwent successful revascularization with or without subsequent retransplant improved non significantly in the modern era (5/8, 62.5% vs. early 10/20, 50%, p=0.55).
*Conclusions: Urgent arterial revascularization can salvage transplanted livers when HAT is diagnosed early. Retransplant may be necessary even if grafts are successfully revascularized. Early hepatic artery thrombosis continues to negatively impact graft and patient survival.

Caroline Lemoine

Lurie Children's Hospital/Northwestern University

Appearances