Background: Hepatic artery thrombosis (HAT) following pediatric liver transplantation is associated with increased morbidity and risk of graft failure. In our clinical practice, we have observed a decrease in the rate of HAT in recent years. Here, we examine the HAT events over time as well as potential contributing recipient and donor risk factors.

Methods: We performed a retrospective chart review of primary deceased-donor liver transplant recipients who were <25kg at time of transplant between 2003 and 2016. Multi-organ transplants were excluded. Period I (P1) was designated as from 2003 to 2009 and period II (P2) as 2010 to 2016.

Results: A total of 100 patients, 52 whole-liver (WL) and 48 split-liver (SL) graft recipients, with a median age of 1.1 years (range 10 days-10.4 years) were identified . P1 included 45 patients (23 WL, 22 SL) and P2 included 55 patients (29 WL, 26 SL). Fourteen patients experienced HAT. Overall, HAT was more frequent in WL than SL (21% vs. 6%, p=0.032). When assessed for preoperative indicators of portal hypertension, HAT group had less thrombocytopenia (0% vs. 35%, p<0.001) and less varices (0% vs. 15%, p<0.001). WL recipients with HAT had a significantly smaller mean donor weight (8.5kg vs. 14kg, p=0.028) as well as smaller donor-to-recipient weight ratio (0.99 vs. 1.5, p=0.006). HAT group experienced higher rate of biliary stricture (50% vs. 5%, p=0.006), operative biliary revision (36% vs. 9%, p=0.07), and endoscopic biliary intervention (43% vs. 2%, p=0.01) compared to non-HAT group. The 5-year graft survival was significantly lower in HAT compared to non-HAT group (70% vs. 94%, p=0.004), though with comparable patient survival (93% vs. 94%, p=0.91). When compared by periods, the overall (WL+SL) HAT rate was 20% in P1 vs. 9% in P2 (p=0.12), and in the WL group, 35% in P1 vs. 10% in P2 (p=0.032). For WL group, the donor-to-recipient weight ratio was 1.3 in P1 and 1.4 in P2 (p=0.83). Five-year patient survival was similar between the two periods (93.3% vs. 93.5%).

Conclusion: Whole-liver grafts are significantly more prone to hepatic artery thrombosis than split-liver grafts in recipients under 25kg. Donor-to-recipient weight ratio is significantly associated with hepatic artery thrombosis in whole-liver recipients. Aiming for a higher donor-to-recipient weight ratio rather than 1:1 size-matched donors may decrease hepatic artery thrombosis risk in pediatric whole-liver recipients.

CITATION INFORMATION: Kim S., Ramos-Gonzalez G., Labib Z., Kim H., Vakili K. Donor-to-Recipient Weight Ratio is Significantly Associated with Hepatic Artery Thrombosis Following Pediatric Whole Liver Transplantation Am J Transplant. 2017;17 (suppl 3).

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