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Feasibility and Effectiveness of a New Algorithm in Preventing Hepatic Artery Thrombosis after Liver Transplantation

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Journal of Gastrointestinal Surgery

Abstract

Introduction

The incidence of hepatic artery thrombosis (HAT) after liver transplantation (LTx) is up to 9% in adult recipients.

Material and Methods

To minimize HAT, we developed an algorithm that we have routinely applied since 2001. The algorithm is a cascade of potentially necessary procedures to improve hepatic artery blood flow before proceeding with LTx when arterial blood flow is impaired. Incidence, outcome, and possible therapeutic approaches of HAT were analyzed in prospectively non-controlled collected data during a 5-year period. There were 335 LTx in 299 adults (199 male, 100 female) with a median age of 49.7 years.

Results

HAT was defined as early and late HAT (diagnosis within or after 30 days following LTx). After a mean follow-up of 17 months, nine HAT were documented (2.7%; five early and four late HAT). Treatment consisted of thrombolysis (n = 1), surgical thrombectomy (n = 4), and re-transplantation (n = 4). Five HAT patients died during follow-up.

Discussion

Complex arterial reconstruction was associated with HAT compared to branch-patch anastomoses (P = 0.0193). Median arterial intraoperative blood flow was no risk factor for HAT. One-year patient survival after HAT was 31%. Once HAT occurs, complication rates are high and long-term results are devastating.

Conclusion

Therefore, we have implemented the presented algorithm, which showed an acceptable HAT rate.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany

    Sascha A. Müller, Bruno M. Schmied, Arianeb Mehrabi, Thilo Welsch, Peter Schemmer, Jürgen Weitz, Jens Werner, Markus W. Büchler & Jan Schmidt

  2. Unit for Documentation and Statistics, Department of Surgery, University of Heidelberg, Heidelberg, Germany

    Ulf Hinz

  3. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Jan Schmidt

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  1. Sascha A. Müller
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Correspondence to Jan Schmidt.

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S. A. Müller and B. M. Schmied contributed equally to this manuscript.

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Müller, S.A., Schmied, B.M., Mehrabi, A. et al. Feasibility and Effectiveness of a New Algorithm in Preventing Hepatic Artery Thrombosis after Liver Transplantation. J Gastrointest Surg 13, 702–712 (2009). https://doi.org/10.1007/s11605-008-0753-y

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