Interventional Radiology Management After Early Hepatic Artery Thrombosis Following Pediatric Liver Transplantation

Hepatic artery complications are a major cause of early graft loss after liver transplantation (LT), especially in pediatric patients. Traditionally, these complications have been managed with surgical reintervention. This study presents the outcomes of early radiological intervention in pediatric LT patients with early hepatic artery thrombosis (HAT).

A retrospective analysis was conducted by reviewing the prospectively collected database in our center. Patients between 0 to 18 years of age who had received an LT between 2003 and 2024 and had presented HAT in the first month after LT were included.

Out of 340 LTs, 13 patients (3.8%) presented early HAT and underwent an interventional radiology procedure (IRP) with balloon dilation and local infusion of vasodilators and/or fibrinolytic drugs. Five patients also required stent placement. The median time from LT to IRP was 1 day (0-6.5). IRP primary technical success was achieved in 11 of 13 patients (84.6%). Hepatic artery patency at three months was achieved in 10/13 (76.9%) of our patients, whilst long-term hepatic artery patency was achieved in 8/13 (61.5%) patients. Two patients ultimately required retransplantation.

An early and proactive interventional radiology approach may represent a feasible option for managing early HAT after pediatric LT. When performed promptly after diagnosis, it can help preserve hepatic artery patency and potentially reduce the need for surgical intervention and retransplantation.