CLINICAL-FEATURES OF HEPATIC-ARTERY THROMBOSIS AFTER PEDIATRIC LIVER-TRANSPLANTATION

Thrombosis of the hepatic artery (HAT) is a severe complication of liv er transplantation, and most cases need regrafting. The aim of this st udy was to review our experience with this complication. From January 1986 through January 1992, 76 liver transplants were performed in 59 p ediatric patients at the Children's Hospital ''La Paz'', Madrid. The d iagnosis of HAT was made in 12 cases (15.7%). The common patterns of c linical presentation were: fulminant liver necrosis (5), bile leak due to necrosis of the bile duct (4), and relapsing bacteremia (3). Clini cal symptoms of fulminant liver necrosis started within the first 2 we eks after transplantation, with rapid deterioration and steep rises in SGOT and SGPT levels. All these patients were retransplanted on an ur gent basis, but only 1 is alive 4 years later. Four patients developed bile leaks 13 to 60 days after transplantation; SGOT, SGPT, and total bilirubin were only slightly increased. Three children were retranspl anted electively and are alive with a mean followup of 3 years. One ex ceptional patient had a Roux-en-Y jejunostomy and is doing well 30 mon ths later with his original graft. The 3 remaining children had episod es of septicemia with hepatic abscess, liver infarction, and pleural e ffusion. Liver function tests were normal, with bilirubin levels below 2 mg/dl. All patients were retransplanted, but only 1 is alive and we ll 13 months later. In the present series, we found that early HAT pro duces fulminant clinical deterioration requiring an urgent regraft. La te HAT presenting with either infection or bile leak allows time for t reatment by elective retransplantation. The best survival was obtained in the latter group.