Hepatic Artery Thrombosis in Liver Transplantation Recipients after Neoadjuvant Therapy with Transarterial Chemoembolization

Abstract

Introduction: Transarterial chemoembolization (TACE) prior to liver transplantation for patients with hepatocellular carcinoma may increase the risk of arterial complications after transplantation. The aim of this study was to evaluate the impact of neoadjuvant treatment with TACE on the risk of post transplant hepatic artery thrombosis (HAT). Methods: It was a retrospective, observational study performed on 228 patients with hepatocellular carcinoma who underwent liver transplantation. The diagnosis of post transplant HAT was based on computed tomography. Factors such as treatment with TACE, number of TACE sessions, time between TACE and liver transplantation, donor age, total ischemic time, diameter of common hepatic artery in recipient, arterial reconstruction, intraoperative macroscopic artery assessment and type of arterial anastomosis were evaluated in univariate and multivariate analysis. Results: HAT was observed in 13 (5,7%) patients. The incidence rate of HAT was 5.5% for patients after TACE and 5.9% for the rest of a group (p=0.876). The only independent risk factor for HAT was poor intraoperative macroscopic artery assessment but there was no significant intercorrelation with TACE prior to liver transplantation (0.117; p=0.116). Despite the analysis did not reveal the time between TACE and liver transplantation as an independent risk factor for HAT (OR=1.001; 95%CI 0.997-1.005; p=0.476), there was a difference in median time for patient with HAT (Me=12.0 days) and the rest of a group (Me=88.5 days; p=0.040). Conclusion: Neoadjuvant treatment with TACE does not increase the risk of HAT, however special caution should be taken when selecting the moment of liver transplantation after TACE.