The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver Transplantations
The aim of our study was to assess risk factors for hepatic artery thrombosis (HAT) and to evaluate the impact of HAT management on long-term outcomes after pediatric living donor liver transplantation (LDLT). We retrospectively analyzed 400 patients who underwent primary LDLT between 1999 and 2020....
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| Format: | Article |
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MDPI AG
2023-02-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/10/2/340 |
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| author | Marek Stefanowicz Piotr Kaliciński Grzegorz Kowalewski Adam Kowalski Mateusz Ciopiński Marek Szymczak Agnieszka Kwiecińska Waldemar Patkowski Krzysztof Zieniewicz Ireneusz Grzelak Diana Kamińska Hor Ismail |
| author_facet | Marek Stefanowicz Piotr Kaliciński Grzegorz Kowalewski Adam Kowalski Mateusz Ciopiński Marek Szymczak Agnieszka Kwiecińska Waldemar Patkowski Krzysztof Zieniewicz Ireneusz Grzelak Diana Kamińska Hor Ismail |
| author_sort | Marek Stefanowicz |
| collection | DOAJ |
| description | The aim of our study was to assess risk factors for hepatic artery thrombosis (HAT) and to evaluate the impact of HAT management on long-term outcomes after pediatric living donor liver transplantation (LDLT). We retrospectively analyzed 400 patients who underwent primary LDLT between 1999 and 2020. We compared preoperative data, surgical factors, complications, and patient and graft survivals in patients with HAT (HAT Group) and without HAT (non-HAT Group). A total of 27 patients (6.75%) developed HAT. Acute liver failure, a hepatic artery (HA) anastomosis diameter below 2 mm, and intraoperative HA flow dysfunction were significantly more common in the HAT Group (<i>p</i> < 0.05, <i>p</i> = 0.02026, and <i>p</i> = 0.0019, respectively). In the HAT Group, 21 patients (77.8%) underwent urgent surgical revision. The incidence of biliary stenosis and retransplantation was significantly higher in the HAT Group (<i>p</i> = 0.00002 and <i>p</i> < 0.0001, respectively). Patient and graft survivals were significantly worse in the HAT Group (<i>p</i> < 0.05). The close monitoring of HA flow with Doppler ultrasound during the critical period of 2 to 3 weeks after LDLT and the immediate attempt of surgical revascularization may attenuate the elevated risk of biliary stenosis, graft loss, and the need for retransplantation due to HAT. |
| first_indexed | 2024-03-11T08:59:48Z |
| format | Article |
| id | doaj.art-4359946cbd24481a936f703b84ed03c0 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-11T08:59:48Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-4359946cbd24481a936f703b84ed03c02023-11-16T19:49:23ZengMDPI AGChildren2227-90672023-02-0110234010.3390/children10020340The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver TransplantationsMarek Stefanowicz0Piotr Kaliciński1Grzegorz Kowalewski2Adam Kowalski3Mateusz Ciopiński4Marek Szymczak5Agnieszka Kwiecińska6Waldemar Patkowski7Krzysztof Zieniewicz8Ireneusz Grzelak9Diana Kamińska10Hor Ismail11Department of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandDepartment of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandDepartment of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandDepartment of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandDepartment of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandDepartment of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandDepartment of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandDepartment of General Surgery, Transplantation and Liver Surgery, Warsaw Medical University, 02-091 Warsaw, PolandDepartment of General Surgery, Transplantation and Liver Surgery, Warsaw Medical University, 02-091 Warsaw, PolandDepartment of General Surgery, Transplantation and Liver Surgery, Warsaw Medical University, 02-091 Warsaw, PolandDepartment of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandDepartment of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, 04-730 Warsaw, PolandThe aim of our study was to assess risk factors for hepatic artery thrombosis (HAT) and to evaluate the impact of HAT management on long-term outcomes after pediatric living donor liver transplantation (LDLT). We retrospectively analyzed 400 patients who underwent primary LDLT between 1999 and 2020. We compared preoperative data, surgical factors, complications, and patient and graft survivals in patients with HAT (HAT Group) and without HAT (non-HAT Group). A total of 27 patients (6.75%) developed HAT. Acute liver failure, a hepatic artery (HA) anastomosis diameter below 2 mm, and intraoperative HA flow dysfunction were significantly more common in the HAT Group (<i>p</i> < 0.05, <i>p</i> = 0.02026, and <i>p</i> = 0.0019, respectively). In the HAT Group, 21 patients (77.8%) underwent urgent surgical revision. The incidence of biliary stenosis and retransplantation was significantly higher in the HAT Group (<i>p</i> = 0.00002 and <i>p</i> < 0.0001, respectively). Patient and graft survivals were significantly worse in the HAT Group (<i>p</i> < 0.05). The close monitoring of HA flow with Doppler ultrasound during the critical period of 2 to 3 weeks after LDLT and the immediate attempt of surgical revascularization may attenuate the elevated risk of biliary stenosis, graft loss, and the need for retransplantation due to HAT.https://www.mdpi.com/2227-9067/10/2/340hepatic artery thrombosisliver transplantationliving donor |
| spellingShingle | Marek Stefanowicz Piotr Kaliciński Grzegorz Kowalewski Adam Kowalski Mateusz Ciopiński Marek Szymczak Agnieszka Kwiecińska Waldemar Patkowski Krzysztof Zieniewicz Ireneusz Grzelak Diana Kamińska Hor Ismail The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver Transplantations Children hepatic artery thrombosis liver transplantation living donor |
| title | The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver Transplantations |
| title_full | The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver Transplantations |
| title_fullStr | The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver Transplantations |
| title_full_unstemmed | The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver Transplantations |
| title_short | The Impact of Hepatic Artery Thrombosis on the Outcome of Pediatric Living Donor Liver Transplantations |
| title_sort | impact of hepatic artery thrombosis on the outcome of pediatric living donor liver transplantations |
| topic | hepatic artery thrombosis liver transplantation living donor |
| url | https://www.mdpi.com/2227-9067/10/2/340 |
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