Early Hepatic Artery Thrombosis After Liver Transplantation: What is the Impact of the Arterial Reconstruction Type?

Objective Hepatic artery thrombosis (HAT) is the most severe vascular complication occurring after liver transplantation, with an incidence ranging from 2 to 9% in adults. Although the ideal arterial reconstruction is often described as a short and non-redundant anastomosis fashioned between the rec...

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Bibliographic Details
Published in:World journal of surgery 2017-08, Vol.41 (8), p.2101-2110
Main Authors: Herrero, Astrid, Souche, Regis, Joly, Emmanuel, Boisset, Gildas, Habibeh, Hussein, Bouyabrine, Hassan, Panaro, Fabrizio, Ursic-Bedoya, Jose, Jaber, Samir, Guiu, Boris, Pageaux, Georges Philippe, Navarro, Francis
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Adults
Anastomosis
Anastomosis, Surgical - adverse effects
Anastomosis, Surgical - methods
Aorta
Aorta - surgery
Arteries
Bifurcations
Blood Vessel Prosthesis - adverse effects
Cardiac Surgery
Celiac Artery - surgery
Celiac Trunk
Common Hepatic Artery
Coronary vessels
Deceased Donor
Demographics
Female
General Surgery
Grafting
Hepatic artery
Hepatic Artery - surgery
Human health and pathology
Humans
Incidence
Life Sciences
Liver
Liver transplantation
Liver Transplantation - adverse effects
Liver Transplantation - methods
Liver transplants
Male
Medicine
Medicine & Public Health
Middle Aged
Multivariate Analysis
Original Scientific Report
Patients
Proper Hepatic Artery
Retrospective Studies
Risk Factors
Spleen
Splenic Artery
Surgery
Thoracic Surgery
Thromboembolism
Thrombosis
Thrombosis - etiology
Transplantation
Vascular Surgery
Vascular Surgical Procedures - adverse effects
Vascular Surgical Procedures - methods
Veins & arteries
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Summary:Objective Hepatic artery thrombosis (HAT) is the most severe vascular complication occurring after liver transplantation, with an incidence ranging from 2 to 9% in adults. Although the ideal arterial reconstruction is often described as a short and non-redundant anastomosis fashioned between the recipient and donor hepatic arteries, there is no strong evidence about this ideal reconstruction in the literature. The aim of this study was to assess the impact of the type of arterial reconstruction on early HAT after primary liver transplantation. Methods We retrospectively reviewed a contemporary MELD era cohort of 282 patients who underwent deceased donor primary liver transplantation from 2007 to 2012. Graft artery was classified as “short” when the section was located at the proper/common hepatic artery or “long” when the celiac trunk was used for anastomosis. Recipient arterial sites for arterial anastomosis were classified in three sites: (1) “distal” (proper hepatic artery or common hepatic artery/gastro-duodenal bifurcation), (2) “intermediate” (common hepatic artery) and (3) “proximal” (celiac trunk–splenic artery–aorta). We used univariate and multivariate analyses to assess the impact of different types of arterial reconstruction on early HAT. Results Of 282 primary liver transplantations, 17 patients (6%) developed early HAT. Patients with and without early HAT had comparable demographic and operative data. The main anastomotic combination was short graft artery on the recipient-common hepatic artery ( n  = 111, 39%). A long graft artery was used in 91 patients (32%) and was associated with hepatic artery variations (56%; n  = 51; p  = 0.001). Arterial reconstructions using a long graft artery ( p  = 0.003), a recipient proximal site as celiac trunk–splenic artery–aorta ( p  = 0.02) and the combination of a long graft artery on the recipient distal hepatic artery ( p  = 0.02) were significantly associated with early HAT. The early HAT rate in patients with a long graft artery was not significantly different between patients with or without donor arterial variation (respectively, 12% ( n  = 6/51) vs. 12% ( n  = 5/40); p  = 1). In multivariate analysis, the use of a long graft artery, whatever the recipient anastomosis site, was an independent risk factor of early HAT (OR 3.2; 95% CI 1.2–9; p  = 0.02). Conclusion The type of arterial reconstruction used for arterial anastomosis during primary liver transplantation has an impact on the occurrence of e
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-017-3989-4