Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience

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Objective

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

Study design

Using multicenter data from the Society of Pediatric Liver Transplantation, Kaplan-Meier
and Cox regression analyses were performed on first-time pediatric (aged <18 years)
liver transplant recipients (n = 3801) in the US and Canada between 1995 and 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 retransplanted, 20.7%
developed recurrent HAT. Prolonged warm ischemia times increased the odds of developing
HAT (OR, 1.11;
P = .02). Adolescents aged 11-17 years (OR, 0.53;
P = .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 (adjusted hazard ratio,
11.87; 95% CI, 9.02-15.62) and had a significantly higher post-transplant mortality
within the first 90 days after transplantation (adjusted hazard ratio, 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.

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