Premium
Long‐term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation
Author(s) -
Warnaar Nienke,
Polak Wojciech G.,
de Jong Koert P.,
de Boer Marieke T.,
Verkade Henkjan J.,
Sieders Egbert,
Peeters Paul M. J. G.,
Porte Robert J.
Publication year - 2010
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.22063
Subject(s) - medicine , liver transplantation , revascularization , thrombosis , transplantation , cardiology , intensive care medicine , myocardial infarction
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.