Prevention and treatment of hepatic artery thrombosis after liver transplantation.

BACKGROUND

Hepatic artery thrombosis (HAT) which is a serious complication after orthotopic liver transplantation (OLT) remains a significant cause of graft loss. The purpose of this study was to sum up our experiences in the prevention, diagnosis and management of HAT after liver transplantation.

METHODS

From April 1993 to September 2003, a total of 198 patients underwent OLT at our hospital. The hepatic artery was anastomosed using 7/0 prolane with running continuous suture in 96 patients (group 1) and with interrupted suture in 102 (group 2). Ultrasonography was performed every day in two weeks after operation and selectively afterwards.

RESULTS

HAT occurred in 6 patients (6.3%, 6/96) of group 1, and in 1 (1%, 1/102) of group 2 (X2=4.027, P=0.045). Six patients received emergency thrombectomy, and 1 conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 patients after thrombectomy of whom 2 died of liver failure and one waited for retransplantation. In the other 3 patients after thrombectomy, 1 died of renal failure, and 2 survived. The mortality of patients with HAT was 57.1% (4/7).

CONCLUSIONS

The technique of hepatic arterial anastomosis is the key factor for the prevention of HAT. Routine ultrasonography is very important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.