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Multicenter Study
. 2020 Nov:226:195-201.e1.
doi: 10.1016/j.jpeds.2020.06.053. Epub 2020 Jun 22.

Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience

Noelle H Ebel  1 , Evelyn K Hsu  2 , André A S Dick  3 , Michele L Shaffer  4 , Kristen Carlin  5 , Simon P Horslen  2
Affiliations
Multicenter Study

Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience

Noelle H Ebel et al. J Pediatr. 2020 Nov.

Abstract

Objective: To evaluate risk factors for hepatic artery thrombosis (HAT) and examine the long-term outcomes of graft and patient survival after HAT in pediatric recipients of liver transplantation.

Study design: Using multicenter data from the Society of Pediatric Liver Transplantation, Kaplan-Meier and Cox regression analyses were performed on first-time pediatric (aged <18 years) liver transplant recipients (n = 3801) in the US and Canada between 1995 and 2016.

Results: Of children undergoing their first liver transplantation, 7.4% developed HAT within the first 90 days of transplantation and, of those who were retransplanted, 20.7% developed recurrent HAT. Prolonged warm ischemia times increased the odds of developing HAT (OR, 1.11; P = .02). Adolescents aged 11-17 years (OR, 0.53; P = .03) and recipients with split, reduced, or living donor grafts had decreased odds of HAT (OR, 0.59; P < .001 compared with whole grafts). Fifty percent of children who developed HAT developed graft failure within the first 90 days of transplantation (adjusted hazard ratio, 11.87; 95% CI, 9.02-15.62) and had a significantly higher post-transplant mortality within the first 90 days after transplantation (adjusted hazard ratio, 6.18; 95% CI, 4.01-9.53).

Conclusions: These data from an international registry demonstrate poorer long-term graft and patient survival in pediatric recipients whose post-transplant course is complicated by HAT. Notably, recipients of technical variant grafts had lower odds of HAT compared with whole liver grafts.

Keywords: anticoagulation; hepatology; liver transplant outcomes; living donor; recurrent hepatic artery thrombosis; reduced liver; split liver; transplant surgery; warm ischemia time; whole liver.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier curve of A, graft survival and B, patient survival in liver transplant recipients with and without HAT.
See this image and copyright information in PMC

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