Risk factors associated with early and late HAT after adult liver transplantation

Table 1 Indications for liver transplantation in those developing early and late hepatic artery thrombosis

Indication for LT	HAT	% HAT for indication	Early HAT	Late HAT
Malignancy	10	3.1% (10/327)	6	4
Hepatitis B cirrhosis	6	2.3% (6/265)	5	1
Acute liver failure	3	5% (3/60)	2	1
Hepatic echinococcosis	1	14.3% (1/7)	1	0

HAT: Hepatic artery thrombosis; LT: Liver transplantation.

Table 2 Univariate analysis for recipient and donor factors associated with early hepatic artery thrombosis n (%)

Variable	Patients	Early HAT	P value
Number of LTs	744	14 (1.9)	-
Recipient gender
Male	627 (84.3)	13 (2.1)
Female	117 (15.7)	1 (0.9)	0.370
Recipient age (yr)
> 60	63 (8.5)	2 (3.2)
≤ 60	681 (91.5)	12 (1.8)	0.460
Aetiology
Malignancy	327 (44)	6 (1.8)
Benign	417 (56)	8 (1.9)	0.930
Child-Pugh class
A	233 (31.3)	3 (1.3)
B	291 (39.1)	5 (1.7)
C	220 (29.6)	6 (2.7)	0.510
MELD score	14 (6-59)	12.5 (6-36)	0.538
Pre-LT abdominal operation
Yes	222 (29.8)	2 (0.9)
No	522 (70.2)	12 (2.3)	0.199
TACE history
Yes	67 (9.0)	2 (3.0)
No	677 (91.0)	12 (1.2)	0.490
Diabetes
Yes	40 (5.4)	1 (2.5)
No	744 (94.6)	13 (1.8)	0.770
Blood group
Match	649 (87.2)	12 (1.8)
Compatible	89 (12.0)	1 (1.1)
Incompatible	6 (0.8)	1 (16.7)	0.025
Recipient/donor wt. ratio
≥ 1.15	112 (15.1)	6 (5.4)
< 1.15	632 (84.9)	8 (1.3)	0.003
Donor gender
Female	113 (15.0)	3 (2.7)
Male	641 (85.0)	11 (1.7)	0.495
Donor age (yr)
≥ 60	4 (0.5)	0
< 60	750 (99.5)	14 (1.9)	0.780

LT: Liver transplantation; wt: Weight; TACE: Transcatheter arterial chemoembolization.

Table 3 Univariate analysis for potential intraoperative factors associated with early hepatic artery thrombosis n (%)

Variable	Patients	Early HAT	P value
Type of allograft
Whole size	544	10
LDLT	196	4
Split	4	0	0.948
Dual grafts
Yes	10 (1.3)	1 (10.0)
No	734 (98.7)	13 (1.8)	0.057
Complex arterial reconstruction
Yes	30 (4.0)	3 (10.0)
No	714 (96.0)	11 (1.5)	0.001
HA anastomosis time (min)
> 80	153 (20.6)	8 (5.2)
≤ 80	591 (79.4)	6 (1.0)	0.001
Biliary reconstruction
R-D	74 (9.9)	1 (1.4)
D-D	670 (90.1)	13 (1.9)	0.723
Operation time (h)
> 10	208 (28.0)	9 (4.3)
≤ 10	536 (72.0)	5 (0.9)	0.002
Blood (U)
≥ 7	383 (51.5)	12 (3.1)
< 7	361 (48.5)	2 (0.6)	0.010
FFP (U)
≥ 6	295 (39.7)	10 (3.4)
< 6	449 (60.3)	4 (0.9)	0.014
Platelets
Yes	223 (29.9)	2 (0.9)
No	521 (70.1)	12 (2.3)	0.199
WIT (min)	51 (36-105)	54 (38-82)	> 0.1
CIT (min)	359 (109-782)	341 (134-542)	> 0.1

LT: Liver transplantation; LDLT: Living donor liver transplantation; R-D: Roux-en-Y choledochojejunostomy biliary reconstruction; D-D: End to end choledochocholedochostomy; FFP: Fresh frozen plasma; WIT: Warm ischemia time; HAT: Hepatic artery (HA) thrombosis; CIT: Cold ischemia time.

Table 4 Univariate analysis for potential postoperative factors associated with early hepatic artery thrombosis n (%)

Variable	Patients	Early HAT	P value
Episode of rejection
Yes	42 (5.6)	1 (2.4)
No	702 (94.4)	13 (1.9)	0.806
Retransplantation
Yes	18 (2.4)	0
No	726 (97.6)	14 (1.9)	0.708
Infection
Yes	126 (16.9)	3 (2.4)
No	618 (83.1)	11 (1.8)	0.651
Blood
Yes	244 (32.8)	9 (3.7)
No	500 (67.2)	5 (1.0)	0.011
FFP
Yes	240 (32.3)	8 (3.3)
No	504 (67.7)	6 (1.2)	0.044
Platelets
Yes	60 (8.1)	1 (1.7)
No	684 (91.9)	13 (1.9)	0.898
Hyperglycemia/diabetes
Yes	268 (36.0)	5 (1.9)
No	476 (64.0)	9 (1.9)	0.981
PVT
Yes	9 (1.2)	0 (11.1)
No	735 (98.8)	14 (1.9)	0.679
Bile leak
Yes	17 (2.3)	0
No	727 (97.7)	14 (1.9)	0.721

FFP: Fresh frozen plasma; PVT: Portal vein thrombosis; HAT: Hepatic artery thrombosis

Table 5 Independent predictors of early hepatic artery thrombosis after liver transplantation

Variable	Pvalue	OR	95%CI
Recipient/donor wt. ratio ≥ 1.15	0.008	4.499	1.487-13.608
HA anastomosis time > 80 min	0.004	5.429	1.725-17.086
Intraoperative blood transfusion ≥ 7 U	0.017	4.059	1.290-12.770
Postoperative blood transfusion	0.015	6.898	1.463-32.526

HA: Hepatic artery; wt: Weight.

Table 6 Univariate analysis for risk factors associated with early hepatic artery thrombosis n (%)

Variable	Patients	Late HAT	P value
Diabetes pre-LT
Yes	40 (5.4)	2 (5.0)
No	704 (94.6)	4 (0.6)	0.037
Type of LT
Whole size	544 (73.1)	4 (0.7)
LDLT	196 (26.3)	1 (0.5)
Split	4 (0.5)	1 (25)	< 0.001
Operation time
> 10 h	208 (28.0)	4 (1.7)
≤ 10 h	536 (72.0)	2 (0.4)	0.034
Retransplantation
Yes	18	1
No	726	5	0.023
Hyperglycemia/post-LT diabetes
Yes	268 (36.0)	5 (1.9)
No	476 (64.0)	1 (0.2)	0.025
Episode of rejection
Yes	48 (6.5)	2 (4.2)
No	696 (93.5)	4 (0.6)	0.050

LT: Liver transplantation; LDLT: Living donor liver transplantation.

Table 7 Independent predictors of late hepatic artery thrombosis after liver transplantation

Variable	P value	OR	95%CI
Operation time > 10 h	0.050	6.394	0.998-40.977
Episode of rejection	0.004	16.936	2.424-118.317
Retransplantation	0.001	21.793	3.302-143.836