Heffron Thomas G, Welch David, Pillen Todd, Fasola Carlos, Redd Doug, Smallwood Gregory A, Martinez Enrique, Atkinson George, Guy Mark, Nam Changwoo, Henry Stuart, Romero Rene
Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
Pediatr Transplant. 2005 Aug;9(4):486-90. doi: 10.1111/j.1399-3046.2005.00327.x.
The risk of hepatic artery thrombosis (HAT) after pediatric liver transplantation (PLT) has been reported to range from 0 to 25%. We report our experience focusing on the interrelationships between risk factors, surgical technique and the incidence of HAT after liver transplantation in the pediatric age group. From February 18, 1997 to December 31, 2003, 150 consecutive liver transplants were performed in 132 pediatric patients. There were similar numbers of whole grafts when compared with partial grafts, 80 (53.3%) vs. 70 (46.7%), p = 0.30. Four grafts (2.7%) developed HAT. Of the grafts with HAT, three were successfully revascularized within the first 24 h. Only one graft (0.66%) was lost to HAT. A single surgeon utilizing 3.5-6.0 magnification loupes performed all but one hepatic arterial anastomoses. All patients were followed postoperatively by a daily ultrasound protocol and with anticoagulation of aspirin and alprostadil only. Living and deceased donor left lateral segment grafts had an increased rate of HAT when compared with whole liver grafts. HAT with subsequent graft loss may be minimized in PLT with the use of surgical loupes only, anticoagulation utilizing aspirin, alprostadil, and daily ultrasounds.
据报道，儿童肝移植（PLT）后肝动脉血栓形成（HAT）的风险为0%至25%。我们报告了我们的经验，重点关注小儿肝移植中危险因素、手术技术与HAT发生率之间的相互关系。从1997年2月18日至2003年12月31日，132例小儿患者连续进行了150例肝移植。与部分肝移植相比，全肝移植数量相似，分别为80例（53.3%）和70例（46.7%），p = 0.30。4例移植肝（2.7%）发生了HAT。在发生HAT的移植肝中，3例在最初24小时内成功实现了血管再通。仅1例移植肝（0.66%）因HAT丢失。除1例肝动脉吻合术外，其余均由一名使用3.5 - 6.0倍放大率放大镜的外科医生完成。所有患者术后均采用每日超声检查方案，仅使用阿司匹林和前列地尔进行抗凝治疗。与全肝移植相比，活体和尸体供体的左外侧叶移植肝HAT发生率增加。在小儿肝移植中，仅使用手术放大镜、采用阿司匹林和前列地尔进行抗凝治疗以及每日超声检查，可将HAT及随后的移植肝丢失风险降至最低。
