Abstract
Background
Hepatic artery–related complications (HARC) after live donor liver transplantation (LDLT) is associated with high morbidity and mortality rate.
Methods
Prospectively maintained data from July 2011 to September 2020 was analyzed for etiology, detection, management, and outcome of HARC.
Results
Six hundred fifty-seven LDLT (adult 572/pediatrics 85) were performed during the study period. Twenty-one (3.2%) patient developed HARC; 16 (2.4%) hepatic artery thrombosis (HAT) and 5 (0.76%) non-thrombotic hepatic artery complication (NTHAC). Ninety percent (19/21) HARC were asymptomatic and detected on protocol Doppler. Median time to detection was day 4 (range − 1 to 35), which included 18 early (within 7 days) vs 3 late incidents. Only one pediatric patient had HAT. Seven patients underwent surgical revascularization, 11 had endovascular intervention and 3 with attenuated flow required only systemic anticoagulation. All NTHAC survived without any sequelae. Revascularization was successful in 81% (13/16) with HAT. Biliary complications were seen in 5 (23.8%); four were managed successfully. Overall mortality was 14.8% (3/21). The 1-year and 5-year survival were similar to those who did not develop HARC (80.9% vs 84.2%, p = 0.27 and 71.4% vs 75.19%, p = 0.36 respectively) but biliary complications were significantly higher (23.8% vs 14.2%, p = 0.03). On multivariate analysis, clockwise technique of arterial reconstruction was associated with decreased risk of HAT (1.7% vs 4.1% (p value − 0.003)).
Conclusion
Technical refinement, early detection, and revascularization can achieve good outcome in patients with HARC after LDLT.
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Data Availability
The data that support the findings of the present study are available within the article.
Change history
16 February 2023
A Correction to this paper has been published: https://doi.org/10.1007/s00423-023-02824-5
Abbreviations
- ACLF:
-
Acute on chronic liver failure
- ALF:
-
Acute liver failure
- AST:
-
Aspartate aminotransferase
- ALT:
-
Alanine aminotransferase
- CD:
-
Clavien-Dindo grading
- CLD:
-
Chronic liver disease
- DDLT:
-
Deceased donor liver transplantation
- DSA:
-
Digital subtraction angiography
- ERCP:
-
Endoscopic retrograde cholangio-pancreatography
- GDA:
-
Gastro-duodenal artery
- GRWR:
-
Graft recipient weight ratio
- HARC:
-
Hepatic artery–related complications
- HAT:
-
Hepatic artery thrombosis
- HJ:
-
Hepatico-jejunostomy
- HTK:
-
Histidine-Tryptophan-Ketoglutarate
- LAI:
-
Liver attenuation index
- LT:
-
Liver transplantation
- LDLT:
-
Living donor liver transplantation
- NTHAC:
-
Non-thrombotic hepatic artery complications
- PTBD:
-
Percutaneous trans-hepatic biliary drainage
- RGE:
-
Right gastro epiploic artery
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Participated in research design: Viniyendra Pamecha. Participated in data collection: Viniyendra Pamecha, Piyush Kumar Sinha, Amar Mukund, Nilesh Patil, Nihar Mohapatra, Anubhav Kumar, Sahil Gupta. Participated in data analysis: Viniyendra Pamecha, Piyush Kumar Sinha, Sahil Gupta. Participated in the writing of the paper: Viniyendra Pamecha, Piyush Kumar Sinha, Sahil Gupta. Participated in the performance of the research: Viniyendra Pamecha, Piyush Kumar Sinha, Amar Mukund, Nilesh Patil, Nihar Mohapatra, Anubhav Kumar, Sahil Gupta, Shalini Thapar, Ashok Choudhury. Participated in critical analysis of paper: Viniyendra Pamecha, Piyush Kumar Sinha.
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Pamecha, V., Sinha, P.K., Mukund, A. et al. Hepatic artery–related complications after live donor liver transplantation. Langenbecks Arch Surg 408, 24 (2023). https://doi.org/10.1007/s00423-023-02759-x
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DOI: https://doi.org/10.1007/s00423-023-02759-x