PROLONGED PRESERVATION IN UNIVERSITY-OF-WISCONSIN SOLUTION ASSOCIATEDWITH HEPATIC-ARTERY THROMBOSIS AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Hepatic artery thrombosis (HAT) after liver transplantation (LTx) usua lly mandates retransplantation. Prolonged preservation with Eurocollin s solution has been associated with HAT. We reviewed our experience wi th 359 LTx patients to identify risk factors for HAT. All grafts were preserved in University of Wisconsin solution. HAT developed in 12 pat ients (3%) within 50 days. Seven patients were asymptomatic; four pres ented with biliary sepsis and 1 with poor graft function. Two patients had suffered acute rejection; another 2 had severe preservation injur y. Technical problems accounted for 4 cases; in the remaining 8, no et iology was found. Diagnosis was at a mean 14.7 days after LTx. One pat ient maintains normal graft function 3 years after LTx without interve ntion. Eight underwent re-LTx, 3 of whom died. Routine surveillance vi a duplex enabled early diagnosis and revascularization in 3 patients; in all 3, no biliary complications occurred between 6 and 20 months. O verall graft and patient survival after HAT were 33.3% and 75%, respec tively. Cold ischemic time (CIT) averaged 813 min in patients with HAT and 669 min in those without HAT (P<.05). HAT occurred in 7/165 patie nts with CIT > 12 hr, and in 3/ 234 patients with CIT < 12 hr (P=0.069 9). By avoiding CIT > 12 hr, we have recently avoided HAT in 78 consec utive patients. We conclude that CIT > 12 hr may increase the risk of HAT. When HAT is diagnosed before biliary sepsis develops, flow can of ten be restored and retransplantation averted.