Minciuna Iulia, De Jonge Jeroen, Den Hoed Caroline, Maan Raoel, Polak Wojciech G, Porte Robert J, Janssen Harry L A, Procopet Bogdan, Darwish Murad Sarwa
Erasmus Medical Center Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.
Transpl Int. 2024 Dec 18;37:13440. doi: 10.3389/ti.2024.13440. eCollection 2024.
The prevention of hepatic artery thrombosis (HAT) is pivotal for graft survival immediately after liver transplantation (LT). This study aimed to identify risk factors (RF) for early HAT (eHAT) and assess the benefit of antiplatelet prophylaxis (AP). This retrospective single-center study included 836 adult patients who underwent LT between 2007 and 2022. AP was administered for 3 months in N = 127 patients for surgical reasons. In total, 836 patients underwent LT, of whom 5.5% developed eHAT. In multivariable analysis, arterial anastomotic redo (aHR = 4.33), arterial reconstruction (aHR = 3.72) and cryptogenic liver cirrhosis (aHR = 4.25) were independent RFs for eHAT and AP appeared to be protective (aHR = 0.18). Indeed, in patients with at least one RF who received AP (RF+AP+, n = 94), the eHAT rate was significantly lower (3.2% vs. 21.3%, < 0.001) than in those with RF who did not receive AP (RF+AP-, n = 89). The effect was even more pronounced when focusing on surgical RF alone (i.e., redo and/or reconstruction) with an additional improvement in 1 year graft survival of 85.3% vs. 70.4%, = 0.02. AP did not pose an increased risk of bleeding. In conclusion, the main RFs for eHAT include arterial anastomotic redo, arterial reconstruction and cryptogenic liver cirrhosis as LT indications. Our results suggest that AP may protect against eHAT development in these high-risk patients.
肝动脉血栓形成（HAT）的预防对于肝移植（LT）术后即刻的移植物存活至关重要。本研究旨在确定早期HAT（eHAT）的危险因素（RF）并评估抗血小板预防（AP）的益处。这项回顾性单中心研究纳入了2007年至2022年间接受LT的836例成年患者。因手术原因，127例患者接受了3个月的AP治疗。总共836例患者接受了LT，其中5.5%发生了eHAT。在多变量分析中，动脉吻合口再次手术（aHR = 4.33）、动脉重建（aHR = 3.72）和隐源性肝硬化（aHR = 4.25）是eHAT的独立危险因素，而AP似乎具有保护作用（aHR = 0.18）。事实上，在至少有一个危险因素且接受AP的患者（RF+AP+，n = 94）中，eHAT发生率显著低于未接受AP的有危险因素患者（RF+AP-，n = 89）（3.2%对21.3%，<0.001）。仅关注手术危险因素（即再次手术和/或重建）时，这种效果更为明显，1年移植物存活率额外提高，分别为85.3%对70.4%，P = 0.02。AP并未增加出血风险。总之，eHAT的主要危险因素包括动脉吻合口再次手术、动脉重建和作为LT适应证的隐源性肝硬化。我们的数据表明，AP可能对这些高危患者预防eHAT的发生具有保护作用。
