Hyperbaric oxygen therapy for hepatic artery thrombosis after liver transplantation in children

Early hepatic artery thrombosis (HAT) after pediatric orthotopic liver tran splantation (OLT) can cause significant morbidity and mortality, leading to liver failure or septic complications requiring urgent retransplantation. Experimental evidence that hyperbaric oxygen (HBO) may ameliorate hepatic i schemic-reperfusion injury led to this study of HBO in pediatric liver tran splant recipients who developed HAT. Children undergoing OLT under primary tacrolimus immunosuppression and University of Wisconsin organ preservation between August 1, 1989, and December 31, 1998, who developed HAT were the basis for this study. Patients who developed HAT between March 1, 1994, and December 31, 1998, were treated with HBO therapy until signs of ischemia r esolved (absence of fever, normalizing liver injury test results) or for 2 weeks. The pediatric OLTs performed from August 1, 1989, to February 28, 19 94, who developed HAT served as a control group. Primary outcome measures w ere survival, retransplantation rate, time to retransplantation, incidence of hepatic gangrene, and days to collateral formation. Three hundred sevent y-five consecutive pediatric patients underwent 416 OLTs between August 1, 1989, and December 31, 1998. Thirty-one patients (7.5%) developed HAT at a mean time of 8.2 days (range, 1 to 52 days) post-OLT: In 17 patients, HBO t reatment was begun within 24 hours of HAT or immediately after the revascul arization attempt and performed twice daily for 90 minutes at 2.4 atmospher es pressure. Fourteen patients were treated without HBO. None of the HBO-tr eated patients developed hepatic gangrene. Eight HBO patients (47%) were br idged to retransplantation at a mean time of 157 days (range, 3 to 952 days ) after initial OLT and all survived. Mean time to retransplant in the cont rol group was 12.7 days (range, 1 to 64 days). HBO was well tolerated witho ut significant complications. Although there was no significant difference in survival or retransplantation rates, HBO significantly delayed retranspl antation, potentially by hastening the development of hepatic artery collat erals. Copyright (C) 1999 by the American Association for the Study of Live r Diseases.