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Donor Atheromatous Disease is a Risk Factor for Hepatic Artery Thrombosis After Liver Transplantation

Javier M Zamora-Olaya1,2, Rocío Tejero-Jurado1,2, Paloma E Alañón-Martínez1,2

  • 1Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, Córdoba, Spain.

Clinical Transplantation
|July 21, 2024
PubMed

Insights

Liver transplant recipients with donor hepatic artery (HA) atherosclerosis face a significantly higher risk of HA thrombosis. Evaluating donor HA vasculature may guide post-transplant antiplatelet therapy.

Area of Science:

  • Transplantation Surgery
  • Vascular Pathology
  • Graft Assessment

Background:

  • Increasing donor and recipient age, plus metabolic comorbidities, may elevate vascular complication risks post-liver transplant.
  • Hepatic artery (HA) atherosclerosis in donors and recipients is a potential risk factor for thrombosis after liver transplantation.

Purpose of the Study:

  • To investigate the association between hepatic artery atherosclerosis in liver donors and recipients and the occurrence of hepatic artery thrombosis post-transplant.
  • To identify risk factors for vascular complications, specifically HA thrombosis, in liver transplantation.

Main Methods:

  • A cohort of 443 adult liver transplant patients (2012-2021) underwent blinded pathological assessment of donor and recipient HA atherosclerosis.
  • Logistic regression and propensity score-matching were used to evaluate the relationship between HA atherosclerosis and HA thrombosis.
  • Exclusion criteria included partial/reduced grafts, retransplantation, and combined organ transplants.

Main Results:

  • Hepatic artery atheroma was found in 51.5% of donors and 11.4% of recipients.
  • Hepatic artery thrombosis occurred in 5.9% of patients, significantly higher in those receiving grafts from donors with HA atherosclerosis (10.7% vs. 0.8%).
  • Donor HA atherosclerosis was an independent risk factor for HA thrombosis (OR=17.79, p=0.008), a finding consistent in propensity-matched analysis (OR=19.29, p=0.007). Recipient atherosclerosis did not influence thrombosis risk (OR=1.70, p=0.55).

Conclusions:

  • Donor hepatic artery atherosclerosis is a significant independent risk factor for hepatic artery thrombosis following liver transplantation.
  • Recipient atherosclerosis does not appear to influence the risk of HA thrombosis.
  • Pre-transplant evaluation of donor graft vasculature for atherosclerosis may inform postoperative antiplatelet therapy strategies.

Keywords:
complicationliver allograft function/dysfunctionthrombosis and thromboembolism

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