Diagnosis and outcomes of collateral arterial formation after irreversible early hepatic artery thrombosis in pediatric liver recipients
Li-Hong Gu, Feng-Hua Li, Qiang Xia, Hua Fang, Shi-Jun Zhang and Long-Zhi Han
Shanghai, China
Author Affiliations: Department of Ultrasound (Gu LH, Li FH, Fang H and Zhang SJ) and Department of Liver Surgery (Xia Q and Han LZ), Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Corresponding Author: Feng-Hua Li, MD, Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China (Tel: +86-21-68383396; Fax: +86-21-50896639; Email: renjilfh@163.com)
Abstract：BACKGROUND: Early hepatic artery thrombosis (eHAT) has been recognized as an important cause of graft loss and mortality. However, the incidence, etiology and outcome are not clear, especially for children. The present study was to investigate the formation of collateral artery flow after irreversible eHAT and its impact on patient’s prognosis.
METHODS: We analyzed eHAT after liver transplantation in children from October 2006 to April 2015 in our center, illustrated the formation of collateral hepatic artery flow after irreversible eHAT and explored the diagnosis, complications, treatment and prognosis. The basic and follow-up ultrasonographic images were also compared.
RESULTS: Of the 330 pediatric liver recipients, 22 (6.67%) developed eHAT within 1 month. Revascularization attempts including surgical thrombectomy, interventional radiology and conservational treatment (thrombolysis) were successful in 5 patients. Among the 17 who had irreversible eHAT, follow-up ultrasonography revealed that collateral artery flow was developed as early as 2 weeks after eHAT. Liver abscess and bile duct complication occurred secondary to eHAT in variable time.
CONCLUSIONS: Collateral arterial formation is a compensatory adaptation to eHAT to supply blood to liver grafts. However, the severe bile duct damage secondary to eHAT is irreversible and retransplantation is unavoidable.
2017, Vol. 16 
