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World Journal of Surgery

, Volume 41, Issue 8, pp 2101–2110 | Cite as

Early Hepatic Artery Thrombosis After Liver Transplantation: What is the Impact of the Arterial Reconstruction Type?

  • Astrid HerreroEmail author
  • Regis Souche
  • Emmanuel Joly
  • Gildas Boisset
  • Hussein Habibeh
  • Hassan Bouyabrine
  • Fabrizio Panaro
  • Jose Ursic-Bedoya
  • Samir Jaber
  • Boris Guiu
  • Georges Philippe Pageaux
  • Francis Navarro
Original Scientific Report

Abstract

Objective

Hepatic artery thrombosis (HAT) is the most severe vascular complication occurring after liver transplantation, with an incidence ranging from 2 to 9% in adults. Although the ideal arterial reconstruction is often described as a short and non-redundant anastomosis fashioned between the recipient and donor hepatic arteries, there is no strong evidence about this ideal reconstruction in the literature. The aim of this study was to assess the impact of the type of arterial reconstruction on early HAT after primary liver transplantation.

Methods

We retrospectively reviewed a contemporary MELD era cohort of 282 patients who underwent deceased donor primary liver transplantation from 2007 to 2012. Graft artery was classified as “short” when the section was located at the proper/common hepatic artery or “long” when the celiac trunk was used for anastomosis. Recipient arterial sites for arterial anastomosis were classified in three sites: (1) “distal” (proper hepatic artery or common hepatic artery/gastro-duodenal bifurcation), (2) “intermediate” (common hepatic artery) and (3) “proximal” (celiac trunk–splenic artery–aorta). We used univariate and multivariate analyses to assess the impact of different types of arterial reconstruction on early HAT.

Results

Of 282 primary liver transplantations, 17 patients (6%) developed early HAT. Patients with and without early HAT had comparable demographic and operative data. The main anastomotic combination was short graft artery on the recipient-common hepatic artery (n = 111, 39%). A long graft artery was used in 91 patients (32%) and was associated with hepatic artery variations (56%; n = 51; p = 0.001). Arterial reconstructions using a long graft artery (p = 0.003), a recipient proximal site as celiac trunk–splenic artery–aorta (p = 0.02) and the combination of a long graft artery on the recipient distal hepatic artery (p = 0.02) were significantly associated with early HAT. The early HAT rate in patients with a long graft artery was not significantly different between patients with or without donor arterial variation (respectively, 12% (n = 6/51) vs. 12% (n = 5/40); p = 1). In multivariate analysis, the use of a long graft artery, whatever the recipient anastomosis site, was an independent risk factor of early HAT (OR 3.2; 95% CI 1.2–9; p = 0.02).

Conclusion

The type of arterial reconstruction used for arterial anastomosis during primary liver transplantation has an impact on the occurrence of early HAT. The use of a long graft artery is an independent risk factor of early HAT. Thereby, we recommend the use of a short graft artery with a direct path when feasible to reduce the occurrence of early HAT after primary liver transplantation.

Keywords

Splenic Artery Deceased Donor Celiac Trunk Common Hepatic Artery Proper Hepatic Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

A

Aorta

AA

Arterial anastomosis

CHA

Common hepatic artery

CT

Celiac trunk

CT scan

Computed tomography scan

GDA

Gastroduodenal artery

GS

Graft survival

HA

Hepatic artery

HAT

Hepatic artery thrombosis

ICU

Intensive care unit

LT

Liver transplantation

MELD

Model for end-stage liver disease

OS

Overall survival

PHA

Proper hepatic artery

RRHA

Replaced right hepatic artery

SA

Splenic artery

SMA

Superior mesenteric artery

TACE

Transarterial chemoembolization

POD

Postoperative day

Notes

Authors’ contribution

AH, RS, EJ and FN designed the paper, reviewed the literature, collected data, wrote the paper and contributed important ideas. GB, HH, HB, FP, JUB, SJ, BG, GPP designed the paper, collected data and contributed important ideas.

Compliance with ethical standards

Conflicts of interest

The authors declare no conflicts of interest.

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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Astrid Herrero
    • 1
    Email author
  • Regis Souche
    • 1
  • Emmanuel Joly
    • 1
  • Gildas Boisset
    • 1
  • Hussein Habibeh
    • 1
  • Hassan Bouyabrine
    • 1
  • Fabrizio Panaro
    • 1
  • Jose Ursic-Bedoya
    • 2
  • Samir Jaber
    • 3
  • Boris Guiu
    • 4
  • Georges Philippe Pageaux
    • 2
  • Francis Navarro
    • 1
  1. 1.Liver Transplant Unit, Department of Digestive Surgery and Liver Transplantation, Hopital Saint Eloi - Hopitaux Universitaires de MontpellierUniversity of MontpellierMontpellier Cedex 5France
  2. 2.Liver Transplant Unit, Department of Hepatology and Liver Transplantation, Hopital Saint Eloi - Hopitaux Universitaires de MontpellierUniversity of MontpellierMontpellier Cedex 5France
  3. 3.Liver Transplant Unit, Department of Anesthesiology, Intensive Care and Transplantation Unit, Hopital Saint Eloi - Hopitaux Universitaires de MontpellierUniversity of MontpellierMontpellier Cedex 5France
  4. 4.Liver Transplant Unit, Department of Radiology, Hopital Saint Eloi - Hopitaux Universitaires de MontpellierUniversity of MontpellierMontpellier Cedex 5France

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