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Risk factors and treatments for hepatic arterial complications in pediatric living donor liver transplantation
Author(s) -
Sanada Yukihiro,
Wakiya Taiichi,
Hishikawa Shuji,
Hirata Yuta,
Yamada Naoya,
Okada Noriki,
Ihara Yoshiyuki,
Urahashi Taizen,
Mizuta Koichi,
Kobayashi Eiji
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.49
Subject(s) - medicine , liver transplantation , incidence (geometry) , laparotomy , surgery , multivariate analysis , transplantation , complication , retrospective cohort study , artery , gastroenterology , physics , optics
Abstract Background Hepatic artery complications ( HAC ) are a serious complication in pediatric liver transplant recipients because its incidence is high and it can occasionally lead to graft liver failure. We herein present a retrospective analysis of our 10‐year experience with pediatric living donor liver transplantation ( LDLT ) focusing on the risk factors and treatments for HAC . Methods Between M ay 2001 and N ovember 2011, 209 LDLT s were performed for 203 pediatric recipients. We performed the multivariate analyses to identify the factors associated with HAC and showed the therapeutic strategy and outcome for HAC. Results The overall incidence of HAC was 7.2%, and the graft survival of recipients with HAC was 73.3%. The multivariate analysis showed that the pediatric end‐stage liver disease score (≥20), post‐transplant laparotomy except for HAC treatment and extra‐anatomical hepatic artery reconstruction were independent risk factors for HAC ( P = 0.020, P = 0.015 and P = 0.002, respectively). Eleven surgical interventions and 13 endovascular interventions were performed for 15 recipients with HAC . The serum aspartate aminotransferase levels pre‐ and post‐treatment for HAC were significantly higher in the surgical group than in the endovascular group ( P = 0.016 and P = 0.022, respectively). Conclusions It is important for recipients with risk factors to maintain strict post‐transplant management to help prevent HAC and detect it in earlier stages. Endovascular intervention can be a less invasive method for treating HAC than surgical intervention, and can be performed as an early treatment.