Hepatic artery thrombosis after orthotopic liver transplant: A review of the same institute 5 years later

Objectives: Summarize the experience of managing patients with hepatic artery thrombosis after orthotopic liver transplant in a single center. Materials and Methods: A total of 726 adult patients who received a liver transplant at the Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-Sen University, between January 2004 and December 2009, were selected. Fourteen patients had hepatic artery thrombosis after the operation, and the clinical data of these patients were analyzed retrospectively. Results: The incidence rate of hepatic artery thrombosis was 1.9% (14/726), and the mean time of onset was 10 days (range, 1 - 41 d) after surgery. Six patients had acute deterioration of liver function, 4 had bile leakage, 1 had hepatic abscess, and 3 had no symptoms. Three patients received urgent rearterialization, 2 received intra-arterial thrombolysis, 3 received combined urgent rearterialization and intra-arterial thrombolysis, and 6 patients received a retransplant. The mortality rate associated with hepatic artery thrombosis was 42.9% (6/14); 2 from biliary necrosis and secondary hepatic failure after urgent rearterialization; 1 from recurrent hepatic artery thrombosis and multiple organ failure after intra-arterial thrombolysis; 1 from renal failure and severe infection after combined urgent rearterialization and intra-arterial thrombolysis, and 2 from severe infection after retransplant. The other patients recovered and were followed for 18 to 66 months. Their liver grafts all functioned well with a patent artery. Two died from tumor recurrence at 18 and 29 months after transplant. Conclusions: Hepatic artery thrombosis is a severe complication after liver transplant, which leads to graft loss and recipient death. Rearterialization as early as possible before irreversible biliary and liver parenchyma damage can avoid retransplant.