Does retransplantation improve long-term survival after a liver artery clot?

Details

Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) can complicate orthotopic liver transplantation (OLT), potentially causing graft loss and death. Revision and retransplantation are treatment options, but their long-term outcomes had remained undefined. The study aimed to assess major vascular complication rates after OLT, treatment effectiveness, and factors affecting long-term outcomes.

Researchers evaluated all patients who underwent OLT from 1984 to 2007. They used Kaplan-Meier analysis to assess the effects of vascular complications on survival after transplantation. For HAT, they compared anastomotic revision and arterial thrombolysis with retransplantation. After 2002, dissection at the porta hepatis began with early occlusion of common hepatic artery (CHA) inflow, and the researchers assessed its impact on HAT incidence.

During 1984–2007, 4,234 OLTs were performed. HAT occurred in 203 patients (5%) and PVT in 84 (2%). Both HAT and PVT significantly reduced graft survival, while only PVT reduced patient survival. For HAT, retransplantation improved patient survival over revision or thrombolysis in the first year, but offered no long-term survival advantage: five-year survival was 56% versus 56% (p=0.53). Anastomotic revision or thrombolysis salvaged only 10% of grafts in patients with HAT. HAT was significantly less frequent with early CHA inflow occlusion: 1.1% versus 3.7% (p=0.002). Factors associated with increased HAT risk included pediatric recipients, liver cancer, and aberrant arterial anatomy requiring complex reconstruction.

The authors concluded that both HAT and PVT significantly reduce graft survival, with PVT having a more adverse effect on patient survival. Revision and thrombolysis rarely salvage grafts after HAT, while retransplantation offers better short-term but not long-term survival. They emphasized that preventing vascular complications is critical, especially given the scarcity of donor livers. They concluded that early atraumatic CHA occlusion significantly reduces HAT incidence.