VASCULAR COMPLICATIONS AFTER PEDIATRIC LIVER-TRANSPLANTATION

From February 1986 to July 1994, 81 hepatic transplantations were perf ormed in 73 children, with an overall patient survival rate of 83%. Fo rty-two patients received whole-liver grafts (WLG) and 39 had reduced- size grafts (RSG). The mean patient weight was 19.7 kg, with 29 patien ts weighing less than 10 kg. Seventeen vascular complications (21%) oc curred in 13 children: 8 (10%) had hepatic artery thrombosis (HAT), 5 (6%) had portal vein thrombosis (PVT), 1 had both HAT and PVT(1%), and 3 (4%) had aortic conduit perforation (ACP). There was no significant difference in the incidence of HAT between RSG (5%) and WLG (14%) or between children weighing less than 10 kg (10%) and those weighing mor e than 10 kg (10%). The site of arterial reconstruction, end-to-end to the recipient common hepatic artery or end-to-side to the infrarenal aorta, had no significant effect on the occurrence of HAT (7% v 8%), b ut HAT occurred in 2 of 6 cases (33%) in which an aortic conduit was u sed. PVT documented in 5 cases (6%) was associated with technical comp lications (2), preduodenal portal vein (2), and a circulating cardioli pid antibody (1), and required thrombectomy, with no graft loss. Combi ned HAT and PVT was found in one patient 2 years postretransplantation for HAT. Although graft function is normal, portal hypertension persi sts. The aortic conduit, used in six patients, led to arterial perfora tion (3), HAT (2), and death (2). Of the 8 cases of HAT, 1 was diagnos ed during autopsy and 7 occurred within 30 days and required retranspl antation (6) or thrombectomy with rearterialization (1). Anomalous art erial supply, found in 14 donor grafts (17%), was associated with 4 oc currences of HAT (29%) and 6 deaths. Vascular complications, particula rly in children weighing less than 10 kg, have decreased with the libe ral use of RSG in pediatric liver transplantation, but aortic conduit, anomalous arterial supply in the donor graft, and technical complicat ions remained significant causes of graft loss and patient death. Copy right (C) 1995 by W.B. Saunders Company