ETIOLOGY AND MANAGEMENT OF SYMPTOMATIC ADULT HEPATIC-ARTERY THROMBOSIS AFTER ORTHOTOPIC LIVER-TRANSPLANTATION (OLT)

Hepatic artery thrombosis (HAT) after adult orthotopic liver transplan tation (OLT) is associated with fulminant sepsis and irretrievable los s of the graft. The purpose of this study was 1) to identify recipient s at risk for the development of HAT; 2) to define early signs and met hods for diagnosis; 3) to determine surgical treatment strategies foll owing diagnosis of HAT. The charts of 680 adults who underwent primary OLT were reviewed. Eleven patients were symptomatic from HAT. Operati ve data revealed problematic arterial reconstruction in 9/11, and were related to inadequate recipient inflow, necessitating an interpositio n allogeneic iliac graft in seven patients, or anastomosis to aberrant right hepatic artery in two recipients. Early HAT in 4/11 occurred wi thin 4 weeks after transplantation, whereas late thrombosis in 7/11 wa s identified 30 days to 1 year after OLT. The postthrombosis course wa s manifested by elevated liver transaminases (7/11), sepsis and recurr ent cholangitis (9/11), or gas gangrene of the liver (4/11). The treat ment modalities included thrombectomy and revision of the arterial ana stomosis (1/11), emergency hepatectomy with temporary portocaval shunt (2/11), and urgent retransplantation (5/11). Antibiotic therapy and e lective retransplantation was the treatment in 4/11. Overall 1-year pa tient survival and satisfactory graft function was 45 per cent.