https://pubmed.ncbi.nlm.nih.gov/32585237/ liver transplant
J Pediatr. 2020 Jun 22;S0022-3476(20)30756-3.
doi: 10.1016/j.jpeds.2020.06.053.Online ahead of print.

Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Utilizing Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation (SPLIT) Experience

Noelle H Ebel 1, Evelyn K Hsu 2, André A S Dick 3, Michele L Shaffer 4, Kristen Carlin 5, Simon P Horslen 2
PMID: 32585237
DOI: 10.1016/j.jpeds.2020.06.053

Abstract

Objective: To evaluate risk factors for hepatic artery thrombosis (HAT) and examine the long-term outcomes of graft and patient survival following HAT in pediatric recipients of liver transplantation.

Study design: Utilizing multicenter data from the Society of Pediatric Liver Transplantation (SPLIT), Kaplan-Meier and Cox regression analyses were performed on first-time pediatric (aged <18 years) liver transplant recipients (n=3801) in the United States and Canada between 1995 to 2016.
Results: Of children undergoing their first liver transplantation, 7.4% developed HAT within the first 90 days of transplantation and of those who were re-transplanted, 20.7% developed recurrent HAT. Prolonged warm ischemia times increased the odds of developing HAT (OR 1.11, p=0.02). Adolescents aged 11-17 years (OR 0.53, p=0.03) and recipients with split, reduced or living donor grafts had decreased odds of HAT (OR 0.59, P < .001 compared with whole grafts). Fifty percent of children who developed HAT developed graft failure within the first 90 days of transplantation (AHR 11.87, 95% CI 9.02,15.62) and had a significantly higher post-transplant mortality within the first 90 days of transplantation (AHR 6.18, 95% CI 4.01,9.53).
Conclusions: These data from an international registry demonstrate poorer long-term graft and patient survival in pediatric recipients whose post-transplant course is complicated by HAT. Notably, recipients of technical variant grafts had lower odds of HAT compared with whole liver grafts.
Keywords: anticoagulation; hepatology; liver transplant outcomes; living donor; recurrent hepatic artery thrombosis; reduced liver; split liver; transplant surgery; warm ischemia time; whole liver.