Retrospective Study
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World J Gastroenterol. Aug 14, 2014; 20(30): 10545-10552
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10545
Risk factors associated with early and late HAT after adult liver transplantation
Yi Yang, Ji-Chun Zhao, Lu-Nan Yan, Yu-Kui Ma, Bin Huang, Ding Yuan, Bo Li, Tian-Fu Wen, Wen-Tao Wang, Ming-Qing Xu, Jia-Yin Yang
Yi Yang, Ji-Chun Zhao, Yu-Kui Ma, Bin Huang, Ding Yuan, Department of Vascular Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Lu-Nan Yan, Bo Li, Tian-Fu Wen, Wen-Tao Wang, Ming-Qing Xu, Jia-Yin Yang, Liver Transplantation Center, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Yan LN and Zhao JC contributed equally to this work; Yan LN, Zhao JC and Yang Y designed the research; Zhao JC, Ma YK, Huang B, Yuan D and Yang Y contributed to the reconstruction of the hepatic artery; Li B, Wen TF, Wang WT, Xu MQ and Yang JY contributed to the clinical LT work; Yang Y wrote the manuscript; Zhao JC and Yan LN reviewed the manuscript.
Supported by Grants from the National Science and Technology Major Project of China, No. 2008ZX10002-026; and the National Science Foundation for Young Scientists of China, No. 81200226
Correspondence to: Ji-Chun Zhao, MD, PhD, Department of Vascular Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu 610041, Sichuan Province, China. zhao_jc120@126.com
Telephone: +86-28-85422473 Fax: +86-28-85422473
Received: January 1, 2014
Revised: March 9, 2014
Accepted: April 15, 2014
Published online: August 14, 2014
Abstract

AIM: To identify risk factors that might contribute to hepatic artery thrombosis (HAT) after liver transplantation (LT).

METHODS: The perioperative and follow-up data of a total of 744 liver transplants, performed from February 1999 to July 2010, were retrospectively reviewed. HAT developed in 20 patients (2.7%). HAT was classified as early (occurring in fewer than 30 d post LT) or late (occurring more than 30 d post LT). Early HAT developed in 14 patients (1.9%). Late HAT developed in 6 patients (0.8%). Risk factors associated with HAT were analysed using the χ2 test for univariate analysis and logistic regression for multivariate analysis.

RESULTS: Lack of ABO compatibility, recipient/donor weight ratio ≥ 1.15, complex arterial reconstruction, duration time of hepatic artery anastomosis > 80 min, duration time of operation > 10 h, dual grafts, number of units of blood received intraoperatively ≥ 7, number of units of fresh frozen plasma (FFP) received intraoperatively ≥ 6, postoperative blood transfusion and postoperative FFP use were significantly associated with early HAT in the univariate analysis (P < 0.1). After logistic regression, independent risk factors associated with early HAT were recipient/donor weight ratio ≥ 1.15 (OR = 4.499), duration of hepatic artery anastomosis > 80 min (OR = 5.429), number of units of blood received intraoperatively ≥ 7 (OR = 4.059) and postoperative blood transfusion (OR = 6.898). Graft type (whole/living-donor/split), duration of operation > 10 h, retransplantation, rejection reaction, recipients with diabetes preoperatively and recipients with a high level of blood glucose or diabetes postoperatively were significantly associated with late HAT in the univariate analysis (P < 0.1). After logistic regression, the independent risk factors associated with early HAT were duration of operation > 10 h (OR = 6.394), retransplantation (OR = 21.793) and rejection reactions (OR = 16.936).

CONCLUSION: Early detection of these risk factors, strict surveillance protocols by Doppler ultrasound and prophylactic anticoagulation for recipients at risk might be determined prospectively.

Keywords: Liver transplantation, Hepatic artery thrombosis, Risk factors, Complication, Blood transfusion

Core tip: By analysing in detail the risk factors associated with early and late hepatic artery thrombosis (HAT) after adult liver transplantation (LT), we found factors that increased the risk for early and late HAT after LT, as well as some independent predictors of early and late HAT, particularly the postoperative use of blood transfusion which has not been mentioned in previous publications. For patients at increased risk for early and late HAT as described above, prophylactic anticoagulant treatment or daily surveillance by Doppler ultrasound could be considered for the possible prevention or early detection of HAT after LT.