*Purpose: Hepatic artery thrombosis (HAT) still constitutes a particular challenge in terms of prevention and management in pediatric liver transplantation (LT). This work reviews the incidence and outcome of HAT in a high volume centre along 31 years, with a particular focus on chronology and results of surgical redos in terms of overall survival and biliary complications.

*Methods: Between March 1984 and March 2015, a total of 1000 pediatric LT (median age: 1.9 years; range: 0.1-19.9) were performed in 882 recipients. Main pre-LT diagnoses were biliary atresia (n=542, 61%), cholestastic diseases (n=113, 13%), metabolic diseases (n=94, 11%), liver malignancies (n=51, 6%), and other diagnoses. The characteristics of post-LT HAT cases were recorded. Each HAT case was paired with an equivalent pediatric LT recipient according to diagnosis, age at LT, type of graft (whole, reduced, split, living donor), and transplant era. Both groups were compared assessing patient/graft survival, retransplantation rate, and biliary complications.

*Results: Overall 1 year patient survivals were 76%, 84%, 89%, 95%, 100%, and 95% during the 1984-88, 89-92, 93-99, 2000-06, 07-10, and 11-15 eras, respectively. Rate of HAT were 12.9% (15/116), 3.9% (7/177), 4.1% (8/195), 2.9% (5/172), 1.1% (1/91) and 0.0% (0/131), during the respective eras. Overall, HAT was observed in 36 cases (4.1%). This event could be fully documented in 35 cases (HAT group), and these children were compared to the paired series of recipients without HAT (control group). 5 year patient survivals were 77% vs 84%, in HAT and control groups, respectively (NS). Corresponding graft survivals were 20% vs 81%, respectively (p<0.0001). Retransplantation rates were 78% vs 11% in HAT and control groups, respectively (p<0.0001). Corresponding 5 year biliary complication-free survivals were 12% vs 80% (p<0.0001). Regarding timing of HAT and management, early HAT (<14 days, n=28, 80% of HAT cases) were reoperated in 16/28 cases (57%). Among the reoperated HAT cases, 14 cases were reoperated within 7 days post-LT (revascularization obtained in 6/14, 43%), whereas no revascularization could be observed in the 2 cases operated beyond 7 days post-LT. Only 6/16 cases (38%) could be successfully revascularized. Among these 6 latter children, 1 year patient/graft survivals were 100%/33%, with a 67% retransplantation rate. In the 10 cases with failed revascularization, the corresponding rates were 60%, 0%, and 90%.

*Conclusions: These data confirmed the pejorative prognosis of developing HAT in terms of graft survival. Fortunately, the rate of HAT decreased over the time with the learning curve. Patient survival in HAT cases could be partly preserved through retransplantation. This analysis suggested that HAT cases should be reoperated if occurring within 7 days post-LT, with some improvement of patient and graft survivals, as well as of the retransplantation rate.

« Back to 2019 American Transplant Congress