Hepatic artery thrombosis after orthotopic liver transplantation

Objective: Hepatic artery thrombosis after liver transplantation is uncommo n, but represents an important cause of morbidity and mortality. The aim of this study is to identify the possible risk factors for the development of hepatic artery thrombosis, and the impact of hepatic artery thrombosis on the patients and graft survival. Methods: Between January 1994 and June 1998, we reviewed retrospectively a series of 86 liver transplant procedures performed on 81 adult patients. Ar terial anomalies of the donor graft, rejection episodes, cold ischemia time , ABO matching, the use of blood/fresh frozen plasma during and after surge ry, and the use of heparin as prophylactic anticoagulation therapy were exa mined as a possible contributing risk factors for the development of hepati c artery thrombosis. Results: Hepatic artery thrombosis occurred in 7 procedures out of 86 (9%). Early cases of Hepatic artery thrombosis within 15 days after transplant o ccurred in 4 patients. Late thrombosis occurred in 3 patients. Analysis of potential risk factors for the development of hepatic artery thrombosis was carried out. Five out of 40 patients who did not received prophylactic hep arin had hepatic artery thrombosis (12.5%), while only 2 out of 46 patients who received prophylactic heparin had hepatic artery thrombosis 4%. On the other hand, 6 out of the 7 patients developed hepatic artery thrombosis re ceived more than 5 units of blood transfusion during the transplant procedu re (11%) while only one patient developed hepatic artery thrombosis who rec eived less than 5 units intra-operatively (3%). Management of hepatic arter y thrombosis cases were carried out in the form of: thrombectomy (n=1), thr ombectomy followed by retransplantation (n=2), and non-surgical or conserva tive treatment (n=4). The overall survival rate was (43%) (3 out of 7). Out of four deaths, 3 were directly related to hepatic artery thrombosis while the cause of death iin the remaining patients was attributed to pulmonary sepsis. Conclusion: Early hepatic artery thrombosis leads to death unless quick ret ransplantation follows. Conservative treatment for the late onset hepatic a rtery thrombosis on occasion has been useful, The use of postoperative prop hylactic anticoagulation therapy might be of benefit in the prevention of h epatic artery thrombosis after liver transplantation. Increased transfusion requirement for red blood cells during transplant procedure was independen tly associated with increase incidence of hepatic artery thrombosis.