Collateral formation after hepatic artery occlusion in infant recipients early after donation-after-cardiac-death liver transplantation

Abstract

Objective To summarize the clinical characteristics of collateral circulation after hepatic artery occlusion (HAO) during early postoperative stage in infant recipients undergoing donation-after-cardiac-death (DCD) liver transplantation and further discuss the potential factors associated with collateral formation. Methods A total of 49 infant recipients of DCD liver transplantation from December 2013 to December 2015 were recruited. Among them, 15 cases had HAO at early postoperative stage. Two cases dead within the first postoperative week were excluded. The clinical data of the other 13 cases were retrospectively collected by reviewing medical charts. Clinical features of collaterals after HAO were reviewed and their outcomes analyzed. Results Among 13 infant recipients, 9 patients had hepatic arterial branch occlusion (group HABO) while the other 4 patients main hepatic artery occlusion (group MHAO). The mean time of HAO detection was (4.7±1.8) days post-transplantation. Intrahepatic arterial branch flows were restored in all HABO patients at (9.7±5.3) days post-HABO. Additionally, for all of four MHAO patients, intrahepatic artery collaterals developed at (9.8±3.2) days post-MHAO and extrahepatic artery collaterals at (20.0±5.0) days post-MHAO. Two patients in each group had ischemia biliary complications. One patient of graft nonfunction in MHAO group received retransplantation while the remainder had percutaneous transhepatic cholangial drainage and balloon dilation. And nearly normal liver function maintained at the last follow-up. Conclusions Arterial branch occlusion is the major presentation of early postoperative HAO in infant recipients undergoing DCD liver transplantation. Rapid collateral formation appears in all patients with MHAO. However, the incidence of biliary complications remains high and close monitoring is required. And long-term outcomes need further evaluations. Key words: Tissue and organ procurement; Liver transplantation; Infant; Hepatic artery occlusion; Collateral circulation