Hepatic artery thrombosis after pediatric liver transplantation : a medical or surgical event?

Hepatic artery thrombosis (HAT) is one of the most serious complications after orthotopic liver transplan¬tation, and is associated with a high morbidity and mor¬tality. This study retrospectively reviewed 66 liver transplants in children under the age of 10 years during1 a year-long period at a single institution.;A, total of 28 perioperative variables were analyzed to identify responsible factors of HAT. Of the 66 children, 18 (26%) developed HAT within 15 days after the transplant (HAT group); 29 (42%) had an uneventful postoperative course (control group). To avoid the possible influence of other complications 19 patients were excluded. Of the variables compared between the 2 study groups, three surgical factors (diameter of the hepatic artery-- greater or less than 3 mm; type of arterial anastomosis—end-to-end versus the use of an iliac graft or aortic conduit; and number of times the anastomosis was redone--one versus more than one), were found to be significantly different (P<.05) between HAT and control groups. Two medical factors also were significantly different: the use of intraoperative transfusion of fresh frozen plasma (FFP) and the administration of postoperative prophylactic anticoagulant treatment. A heparin and dextran-40 protocol appeared to be effective in preventing HAT (P<.02). Moreover, after multivariate analysis, anticoagulation therapy was demonstrated to with poor hepatic artery flow.