Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

Weihao Li¹, Reinoud P H Bokkers¹, Barbara E Wildhaber², Ana M Calinescu², Alexis Ricoeur³, Paolo Marra⁴, Michela Bravi⁵, Domenico Pinelli⁶, Julia Minetto⁷, Marcelo Dip⁷, Sergio Sierre⁸, Martín de Santibañes⁹, Victoria Ardiles⁹, Jimmy Walker Uno⁹, Winita Hardikar¹⁰, Sue Bates¹⁰, Lynette Goh¹⁰, Denise Aldrian¹¹, Jonathan Seisenbacher¹¹, Georg F Vogel^{11

12}, João Seda Neto¹³, Eduardo Antunes da Fonseca¹³, Carolina Magalhães Costa¹³, Cristina T Ferreira¹⁴, Luiza S Nader¹⁴, Marco A Farina¹⁴, Khaled Z Dajani¹⁵, Alessandro Parente¹⁵, David L Bigam¹⁵, Tingbo Liang¹⁶, Xueli Bai¹⁶, Jie Xiang¹⁶, Lucie Gonsorčíková¹⁷, Jiří Froněk¹⁸, Šimon Bohuš¹⁷, Stéphanie Franchi-Abella¹⁹, Emmanuel Gonzales²⁰, Florent Guérin²¹, Norman Junge²², Ulrich Baumann²², Nicolas Richter²³, Steffen Hartleif²⁴, Ekkehard Sturm²⁴, Muthukumarassamy Rajakannu²⁵, Kumar Palaniappan²⁵, Mohamed Rela²⁵, Arti Pawaria²⁶, Haritha Rajakrishnan²⁷, Sudhindran Surendran²⁷, Mukesh Kumar²⁸, Shaleen Agarwal²⁸, Subhash Gupta²⁸, Sonal Asthana²⁹, Mallikarjun Sakpal²⁹, Ashritha Avalareddy²⁹, Marco Spada³⁰, Lidia Monti³¹, Tommaso Alterio³², Yusuke Yanagi³³, Hajime Uchida³³, Ryuji Komine³³, Helen Evans³⁴, Peter Carr-Boyd³⁵, David Duncan³⁶, Marek Stefanowicz³⁷, Julita Latka-Grot³⁷, Adam Koleśnik³⁸, Dieter C Broering³⁹, Dimitri A Raptis³⁹, Kris Ann H Marquez³⁹, Vidyadhar Mali⁴⁰, Marion Aw⁴¹, Marisa Beretta⁴², Francisca Van der Schyff⁴³, Jesús Quintero⁴⁴, Maria Mercadal-Hally⁴⁴, Jose Andrés Molino-Gahete⁴⁴, Ane M Andres⁴⁵, Francisco Hernandez-Oliveros⁴⁵, Esteban Frauca Remacha⁴⁶, Thomas Casswall⁴⁷, Carl Jorns⁴⁸, Martin Delle⁴⁹, Girish L Gupte⁵⁰, Khalid Sharif⁵⁰, Simon P McGuirk⁵¹, Riccardo Superina⁵², Juan Carlos Caicedo^{52

53}, Catalina Jaramillo⁵⁴, Leandra Bitterfeld⁵⁵, Zachary Kastenberg⁵⁶, Amit A Shah^{57

58}, Bryanna Domenick⁵⁷, Michael R Acord^{58

59}, George Mazariegos⁶⁰, Kyle Soltys⁶⁰, Joseph DiNorcia⁶¹, Puja Patel⁶¹, Sander Florman⁶¹, Bettina M Buchholz⁶², Uta Herden⁶², Lutz Fischer⁶², Rudi A J O Dierckx⁶³, Hermien Hartog⁶⁴, Hubert P J Van der Doef⁶⁵

Affiliations

¹ Department of Radiology, Medical Imaging Centre, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
² Swiss Pediatric Liver Center, Division of Child and Adolescent Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
³ Swiss Pediatric Liver Center, Division of Interventional Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
⁴ Department of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano-Bicocca, Bergamo, Italy.
⁵ Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
⁶ Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
⁷ Division of Liver Transplant, J. P. Garrahan Hospital, Buenos Aires, Argentina.
⁸ Division of Interventional Radiology, J. P. Garrahan Hospital, Buenos Aires, Argentina.
⁹ HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
¹⁰ Department of Gastroenterology, Royal Children's Hospital, Melbourne, Australia.
¹¹ Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria.
¹² Institute of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria.
¹³ Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil.
¹⁴ Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil.
¹⁵ Department of Surgery, Division of Transplantation Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Department of Hepatobiliary and Pancreatic Surgery, Liver Transplant Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹⁷ Department of Pediatrics, First Faculty of Medicine, Charles University, Prague and Thomayer University Hospital, Prague, Czech Republic.
¹⁸ Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
¹⁹ Department of Paediatric Radiology, Paris-Saclay University, AP-HP, Hôpital Bicêtre, National Reference Centre for Rare Paediatric Liver Diseases and FILFOIE, Le Kremlin-Bicêtre, France.
²⁰ Paediatric Hepatology and Paediatric Liver Transplantation Unit, Paris-Saclay University, AP-HP, Hôpital Bicêtre, National Reference Centre for Rare Paediatric Liver Diseases and FILFOIE, Le Kremlin-Bicêtre, France.
²¹ Paediatric Surgery and Paediatric Liver Transplantation Unit, Paris-Saclay University, AP-HP, Hôpital Bicêtre, National Reference Centre for Rare Paediatric Liver Diseases and FILFOIE, Le Kremlin-Bicêtre, France.
²² Division for Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
²³ Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
²⁴ Paediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany.
²⁵ Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chromepet, Chennai, India.
²⁶ Department of Pediatric Hepatology and Gastroenterology, Amrita Institute of Medical Sciences and Research Centre, New Delhi, India.
²⁷ Department of Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India.
²⁸ Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India.
²⁹ Integrated Liver Care Department, Aster CMI Hospital, Bengaluru, India.
³⁰ Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
³¹ Gastrointestinal and Transplant Liver Imaging Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
³² Hepatology and Liver Transplant Unit, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy.
³³ Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
³⁴ Department of Paediatric Gastroenterology, Starship Children's Health, Auckland, New Zealand.
³⁵ New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
³⁶ Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand.
³⁷ Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland.
³⁸ Cardiovascular Interventions Laboratory, Childrens Memorial Health Institute, Warsaw, Poland, Warsaw, Poland.
³⁹ Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
⁴⁰ Department of Paediatric Surgery, National University Hospital, Singapore City, Singapore.
⁴¹ Department of Paediatrics, National University Hospital, Singapore City, Singapore.
⁴² Department of Paediatrics, Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
⁴³ Department of Surgery, Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
⁴⁴ Pediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁴⁵ Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain.
⁴⁶ Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain.
⁴⁷ Division for Paediatrics, Department of Clinical Interventions and Technology CLINTEC, Karolinska Institutet, Stockholm, Sweden.
⁴⁸ Department of Transplantation Surgery, F82, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology CLINTEC, Karolinska Institutet, Stockholm, Sweden.
⁴⁹ Department of Radiology, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology CLINTEC, Karolinska Institutet, Stockholm, Sweden.
⁵⁰ Liver Unit (including small bowel transplantation), Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
⁵¹ Department of Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
⁵² Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
⁵³ Division of Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁵⁴ Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA.
⁵⁵ Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA.
⁵⁶ Department of Surgery, Division of Paediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA.
⁵⁷ Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁵⁸ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵⁹ Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁶⁰ University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁶¹ Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA.
⁶² Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁶³ Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁶⁴ Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
⁶⁵ Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 40586698
DOI: 10.1097/LVT.0000000000000671

Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

Weihao Li et al. Liver Transpl. 2025.

. 2025 Jul 1.

doi: 10.1097/LVT.0000000000000671. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology, Medical Imaging Centre, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
² Swiss Pediatric Liver Center, Division of Child and Adolescent Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
³ Swiss Pediatric Liver Center, Division of Interventional Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
⁴ Department of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano-Bicocca, Bergamo, Italy.
⁵ Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
⁶ Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
⁷ Division of Liver Transplant, J. P. Garrahan Hospital, Buenos Aires, Argentina.
⁸ Division of Interventional Radiology, J. P. Garrahan Hospital, Buenos Aires, Argentina.
⁹ HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
¹⁰ Department of Gastroenterology, Royal Children's Hospital, Melbourne, Australia.
¹¹ Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria.
¹² Institute of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria.
¹³ Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil.
¹⁴ Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil.
¹⁵ Department of Surgery, Division of Transplantation Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Department of Hepatobiliary and Pancreatic Surgery, Liver Transplant Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹⁷ Department of Pediatrics, First Faculty of Medicine, Charles University, Prague and Thomayer University Hospital, Prague, Czech Republic.
¹⁸ Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
¹⁹ Department of Paediatric Radiology, Paris-Saclay University, AP-HP, Hôpital Bicêtre, National Reference Centre for Rare Paediatric Liver Diseases and FILFOIE, Le Kremlin-Bicêtre, France.
²⁰ Paediatric Hepatology and Paediatric Liver Transplantation Unit, Paris-Saclay University, AP-HP, Hôpital Bicêtre, National Reference Centre for Rare Paediatric Liver Diseases and FILFOIE, Le Kremlin-Bicêtre, France.
²¹ Paediatric Surgery and Paediatric Liver Transplantation Unit, Paris-Saclay University, AP-HP, Hôpital Bicêtre, National Reference Centre for Rare Paediatric Liver Diseases and FILFOIE, Le Kremlin-Bicêtre, France.
²² Division for Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
²³ Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
²⁴ Paediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany.
²⁵ Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chromepet, Chennai, India.
²⁶ Department of Pediatric Hepatology and Gastroenterology, Amrita Institute of Medical Sciences and Research Centre, New Delhi, India.
²⁷ Department of Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, India.
²⁸ Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India.
²⁹ Integrated Liver Care Department, Aster CMI Hospital, Bengaluru, India.
³⁰ Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
³¹ Gastrointestinal and Transplant Liver Imaging Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
³² Hepatology and Liver Transplant Unit, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy.
³³ Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
³⁴ Department of Paediatric Gastroenterology, Starship Children's Health, Auckland, New Zealand.
³⁵ New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
³⁶ Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand.
³⁷ Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland.
³⁸ Cardiovascular Interventions Laboratory, Childrens Memorial Health Institute, Warsaw, Poland, Warsaw, Poland.
³⁹ Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
⁴⁰ Department of Paediatric Surgery, National University Hospital, Singapore City, Singapore.
⁴¹ Department of Paediatrics, National University Hospital, Singapore City, Singapore.
⁴² Department of Paediatrics, Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
⁴³ Department of Surgery, Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
⁴⁴ Pediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁴⁵ Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain.
⁴⁶ Pediatric Hepatology Department, La Paz University Hospital, Madrid, Spain.
⁴⁷ Division for Paediatrics, Department of Clinical Interventions and Technology CLINTEC, Karolinska Institutet, Stockholm, Sweden.
⁴⁸ Department of Transplantation Surgery, F82, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology CLINTEC, Karolinska Institutet, Stockholm, Sweden.
⁴⁹ Department of Radiology, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology CLINTEC, Karolinska Institutet, Stockholm, Sweden.
⁵⁰ Liver Unit (including small bowel transplantation), Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
⁵¹ Department of Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
⁵² Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
⁵³ Division of Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁵⁴ Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA.
⁵⁵ Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA.
⁵⁶ Department of Surgery, Division of Paediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA.
⁵⁷ Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁵⁸ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵⁹ Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁶⁰ University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁶¹ Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA.
⁶² Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁶³ Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁶⁴ Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
⁶⁵ Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 40586698
DOI: 10.1097/LVT.0000000000000671

Abstract

Guidelines for managing hepatic artery thrombosis (HAT) and stenosis (HAS) after pediatric liver transplantation (pLT) are lacking, with heterogeneous local practices. This study aims to evaluate management practices for HAT and HAS after pLT. An online and paper-based survey was sent to 36 international pLT centers. The survey included 36 questions covering center experience, screening protocols, diagnostic criteria, preventive management, post-procedural care, and follow-up. Treatment strategies were explored through hypothetical case scenarios categorized by early (≤14 d after pLT) and late onset complications (>14 d after pLT). Responses from 36 centers showed that 60% applied interrupted sutures and 76% used a surgical loupe during transplantation. In addition, 89% followed a specific anticoagulation protocol after uncomplicated pLT. All centers initiated Doppler ultrasound (DUS) within 24 hours after pLT, with 60% conducting it daily during the first week. Immediate re-transplantation was preferred for early HAT with pediatric acute liver failure (PALF) (61% vs. 11% for non-PALF, p <0.001), and surgical revascularization was more frequently chosen for non-PALF cases (51% vs. 24% for PALF, p <0.001). Endovascular therapy was selected in 35% of cases for both late HAT and HAS, with conservative management chosen in 51% for late HAT and 61% for late HAS (all p <0.001, compared to early cases). Internationally, there is agreement on the importance of early DUS screening in current management practices. Immediate re-transplantation was preferred for early HAT with PALF, while surgical revascularization was favored for non-PALF cases. Conservative management and endovascular therapy emerged as potential strategies for late-onset cases. This worldwide survey on real-world practice provides a basis for developing and implementing guidelines.

Keywords: hepatic artery stenosis; hepatic artery thrombosis; management; pediatric liver transplantation; survey.

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References

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Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

Affiliations

Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

Authors

Affiliations

Abstract

References

LinkOut - more resources

Full Text Sources