Shackleton C R, Goss J A, Swenson K, Colquhoun S D, Seu P, Kinkhabwala M M, Rudich S M, Markowitz J S, McDiarmid S V, Busuttil R W
Department of Surgery, Dumont-UCLA Transplant Center, UCLA School of Medicine, Los Angeles, California 90095, USA.
Am J Surg. 1997 May;173(5):431-5. doi: 10.1016/S0002-9610(97)00066-4.
Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival.
A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR.
Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71%, 61%, and 57% versus 85%, 85%, and 85%, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19%), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81% in group 1 and 100% in group 2 (P = 0.02).
In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.
胆道闭锁（BA）肝移植术后肝动脉血栓形成（HAT）是一种严重并发症，常导致再次移植（再次肝移植，re-OLT）。本研究的目的是：（1）确定与HAT相关的危险因素；（2）分析近期引入的显微外科肝动脉重建术（MHR）对HAT发生率、随后再次肝移植的需求以及患者生存率的影响。
对194例因BA接受移植的患者进行回顾性研究。166例患者（第1组）接受传统动脉重建，28例（第2组）接受MHR。
HAT患者1年、2年和5年的精算生存率显著低于无HAT患者（分别为71%、61%和57%，对比85%、85%和85%，P = 0.0007）。逐步逻辑回归分析显示，HAT风险与动脉重建类型相关性最强（P = 0.007），其次是移植前胆红素浓度（P = 0.04）和急性排斥反应发作次数（P = 0.03）。在第1组中，32例患者发生HAT（19%），其中18例因HAT接受再次肝移植。第2组无患者发生HAT（与第1组相比，P = 0.006）。第1组患者1年精算生存率为81%，第2组为100%（P = 0.02）。
在BA的肝移植中，（1）HAT的主要危险因素是动脉重建技术；（2）MHR可显著降低HAT发生率和再次肝移植的需求，同时提高患者生存率。
