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Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy
Published on: April 8, 2018
Hepatic artery thrombosis in pediatric liver transplantation
T G Heffron1, T Pillen, D Welch
1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Insights
Pediatric liver transplant recipients experienced a low rate of hepatic artery thrombosis (HAT) using aspirin and alprostadil without microsurgery. Prompt surgical intervention and ultrasound monitoring are key to successful graft salvage and patient survival.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Surgery
Background:
- Pediatric liver transplant recipients face a higher risk of hepatic artery thrombosis (HAT) due to factors like smaller arterial size and postoperative hypercoagulability.
- Traditional approaches often involve microsurgery, but its necessity in preventing HAT is debated.
Purpose of the Study:
- To evaluate the incidence of HAT in pediatric liver transplant patients.
- To assess the efficacy of anticoagulation with aspirin (ASA) and alprostadil (PGE) in preventing HAT.
- To determine the role of intraoperative magnification and ultrasound in managing hepatic artery complications.
Main Methods:
- Retrospective analysis of 74 pediatric liver transplants, examining anastomosis type, intraoperative magnification, and HAT management.
- All patients received ultrasound surveillance and anticoagulation with daily aspirin; 35 received alprostadil for 7 days post-transplant.
- No patients received intravenous heparin post-liver transplantation.
Main Results:
- A low incidence of HAT (1.35%, 1 of 74 transplants) was observed in the pediatric cohort.
- The single case of HAT occurred on postoperative day 7 in a patient with biliary atresia, attributed to intimal plaque dissection.
- The patient with HAT underwent emergent graft revision and achieved a survival time of 426 days post-transplant.
Conclusions:
- Hepatic artery thrombosis can be minimized in pediatric liver transplantation without mandatory microsurgery.
- Anticoagulation with aspirin and alprostadil appears sufficient for HAT prevention.
- Accurate ultrasound use and timely surgical intervention are crucial for graft and patient salvage.
Purpose:
Children have been reported to be at greater risk for hepatic artery thrombosis when compared to adults due to small arterial size, nonuse of intraoperative microscope, and postoperative hypercoagulable state.
Methods:
We evaluated arterial anastomosis type, intraoperative field magnification, and hepatic artery complications and how they were managed. All patients underwent ultrasound, anticoagulation consisted of 41 mg aspirin once a day, and 35 patients received alprostadil (PGE) for the first 7 days after transplantation. No patients were administered intravenous heparin following liver transplantation.
Results:
Of the 74 livers transplanted, 36 grafts (48.6%) were whole organ transplants and 38 grafts (51.4%) were partial livers. We observed HAT in 1 of 74 (1.35%) transplants in our pediatric liver transplant population. The only patient with HAT was a young girl with a history of biliary atresia. The occurrence of a hepatic artery thrombosis on day 7 was caused by the migration of an intimal plaque dissection within the artery graft. She was emergently taken back into the operating room for graft revision. This individual currently has a survival time of 426 days following her last transplant.
Conclusions:
Hepatic artery thrombosis may be minimized in pediatric liver transplantation without the use of microsurgery. Anticoagulation utilizing ASA and alprostadil is sufficient to avoid HAT. Accurate use of ultrasound is crucial to avoid this complication. Graft and patient salvage is possible with expedient surgical treatment; microsurgery, anticoagulant therapy, site of arterial inflow, and recipient size and weight.
