Hepatic Artery Thrombosis

Vascular complications are a major cause of morbidity and mortality after liver transplantation. Hepatic artery thrombosis is the most severe, requiring early diagnosis with prompt intervention to avoid urgent retransplantation.
Hepatic artery thrombosis has been reported with an incidence of 2 to 20%, significantly higher than in the adult population, and with an overall mortality rate of 0 to 50% &. Clinical manifestation varies upon time after transplant, and four different syndromes have been described. Diagnosis of hepatic artery thrombosis is confirmed by angiographic evaluation $. Duplex Doppler examination and dynamic (spiral) computed tomography may be helpful for screening purposes. For pediatric patients several risk factors have been proposed. A reduced incidence of hepatic artery thrombosis has been documented with the use of cadaveric left lateral segments grafts compared with whole organ grafts &.
In our experience of 97 pediatric liver transplants, 7 patients (7%) developed hepatic artery thrombosis. In all cases the complication had an early and acute onset with fulminant hepatic necrosis. No left lateral segment graft recipient experienced hepatic artery thrombosis, while this was diagnosed in 5 children transplanted with a whole liver, in one with a left hemiliver and in one with a right graft (segments I, IV-VIII). Clearly, the incidence of the complication was higher for whole liver recipients (20%) compared to left lateral segments recipients (no thrombosis).