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Management and outcome of hepatic artery thrombosis after pediatric liver transplantation.

Management and outcome of hepatic artery thrombosis after pediatric liver transplantation.

Authors :
Channaoui A
Tambucci R
Pire A
de Magnée C
Sokal E
Smets F
Stephenne X
Scheers I
Reding R
Source :
Pediatric transplantation [Pediatr Transplant] 2021 Aug; Vol. 25 (5), pp. e13938. Date of Electronic Publication: 2020 Dec 12.
Publication Year :
2021

Abstract

Background: Pediatric LT are at particular risk of HAT, and its management still constitutes a matter of debate. Our purpose was to study predisposing factors and outcome of HAT post-LT, including the impact of surgical revisions on survival and biliary complications.<br />Methods: Among 882 primary pediatric LT performed between 1993 and 2015, 36 HAT were encountered (4.1%, 35 fully documented). Each HAT case was retrospectively paired with a LT recipient without HAT, according to diagnosis, age at LT, type of graft, and era.<br />Results: Five-year patient survivals were 77.0% versus 83.9% in HAT and non-HAT paired groups, respectively (P = .321). Corresponding graft survivals were 20.0% versus 80.5% (P < .001), and retransplantation rates 77.7% versus 10.7%, respectively (P < .001). One-year biliary complication-free survivals were 16.6% versus 83.8% in the HAT and non-HAT groups, respectively (P < .001). Regarding chronology of surgical re-exploration, only HAT cases that occurred within 14 days post-LT were re-operated, fourteen of them being explored within 7 days post-LT (revascularization rate: 6/14), versus two beyond 7 days (no revascularization). When revascularization was achieved, graft and biliary complication-free survival rates at 1 year were 33.3% and 22.2%, respectively, both rates being 0.0% in case of failure.<br />Conclusions: The pejorative prognosis associated with HAT in terms of graft survival is confirmed, whereas patient survival could be preserved through retransplantation. Results suggest that HAT should be re-operated if occurring within 7 days post-LT, but not beyond.<br /> (© 2020 Wiley Periodicals LLC.)

Details

Language :
English
ISSN :
1399-3046
Volume :
25
Issue :
5
Database :
MEDLINE
Journal :
Pediatric transplantation
Publication Type :
Academic Journal
Accession number :
33314551
Full Text :
https://doi.org/10.1111/petr.13938