Transplantation 1993 Dec;56(6):1399-402

Prolonged preservation in University of Wisconsin solution associated wit
hepatic artery thrombosis after orthotopic liver transplantation

Mor E, Schwartz ME, Sheiner PA, Menesses P, Hytiroglou P, Emre S, Kishikawa K,
Chiodini S, Miller CM
Department of Surgery, Mount Sinai Medical Center, New York, New York
10029-6574
Abstract
Hepatic artery thrombosis (HAT) after liver transplantation (LTx) usually
mandates retransplantation. Prolonged preservation with Eurocollins solution has
been associated with HAT. We reviewed our experience with 359 LTx patients to
identify risk factors for HAT. All grafts were preserved in University of
Wisconsin solution. HAT developed in 12 patients (3%) within 50 days. Seven
patients were asymptomatic; four presented with biliary sepsis and 1 with poor
graft function. Two patients had suffered acute rejection; another 2 had severe
preservation injury. Technical problems accounted for 4 cases; in the remaining
8, no etiology was found. Diagnosis was at a mean 14.7 days after LTx. One
patient maintains normal graft function 3 years after LTx without intervention.
Eight underwent re-LTx, 3 of whom died. Routine surveillance via duplex enabled
early diagnosis and revascularization in 3 patients; in all 3, no biliary
complications occurred between 6 and 20 months. Overall graft and patient
survival after HAT were 33.3% and 75%, respectively. Cold ischemic time (CIT)
averaged 813 min in patients with HAT and 669 min in those without HAT (P <
.05). HAT occurred in 7/165 patients with CIT > 12 hr, and in 3/234 patients
with CIT < 12 hr (P = 0.0699). By avoiding CIT > 12 hr, we have recently avoided
HAT in 78 consecutive patients. We conclude that CIT > 12 hr may increase the
risk of HAT. When HAT is diagnosed before biliary sepsis develops, flow can
often be restored and retransplantation averted