Hepatic artery thrombosis (HAT) after liver transplantation (LT) is a devastating complication associated with ischemic biliary cholangiopathy (IBC) that can occur even after successful revascularization. However, the routine performance of immediate retransplantation for all HAT cases is not indicated in an era of organ shortage. Our objective is to explore long-term outcomes following HAT in adult LT recipients who did not receive immediate retransplantation, focusing on biliary complications with its probability, risk factors and resolution.

In 2113 consecutive adult LT performed in our institution for the last two decades, 44 HAT (2.0 %) were identified. Thirty-three patients did not receive immediate retransplantation, but received revascularization with thrombectomy/thrombolysis (n=19), or non-revascularization management (n=15). Among the 33 without immediate retransplanation, 16 patients (48 %) developed IBC median of 45 days after HAT diagnosis and required long-term biliary stent placement for median of 530 days (150-1857 days). Affected biliary system was extrahepatic duct alone in 7, limited to hilar area in 3, and diffuse intrahepatic ducts in 6 patients. Biliary complication-free graft survival rate 3-year after HAT diagnosis was equivalently low in both a revascularization and non-revascularization group (33% vs 20%, p= 0.97). However, biliary stricture in the revascularization group was more likely to be limited area and more probable to have resolution {5 of 8 (62%) vs. 0 of 8 (0%)} compared to the non-revascularization group. Salvage retransplantation after failure of non-transplant management was performed in 7 patients with graft survival rate equivalent to that after immediate retransplantation.

IBC can develop in half of HAT cases treated without immediate retransplantation with milder extent and higher probability of resolution in revascularized patients compared to those who were not. Salvage retransplantation should be considered for IBC in those who were not revascularized because of its dismal chance of resolution.

CITATION INFORMATION: Fujiki M, Hashimoto K, Diago T, Quintini C, Aucejo F, Kelly D, Eghtesad B, Fung J, Miller C. Probability, Risk Factors, and Long-Term Outcomes of Biliary Complications After Hepatic Artery Thrombosis in Adult Liver Transplant Recipients: 20 Years Experience from a Single Center. Am J Transplant. 2016;16 (suppl 3).

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