Late Hepatic Artery Thrombosis After Liver Transplant in Adults Associated With High Mortality.

Abstract

Introduction: Hepatic artery thrombosis (HAT) following liver transplant (LT) has been divided into early HAT (<30 days after transplant) and late HAT (>30 days). Methods: This is a retrospective study of all adult LT recipients (N=2931) performed at University of Pittsburgh Medical Center from 1995 to March 2013. Patients with late HAT were identified and their demographics, treatment and outcomes were reviewed.Graft survival and patient survival were analyzed using Kaplan-Meier curves. Results: Out of 2931 LT recipients, 76 (2.5%) developed late HAT. The mean time of LT to presentation of late HAT was 38.2 months (range 1.13 - 182.7 months). Thirty-eight (50.0%) patients died with a mean time from presentation to death of 10.5 months (range 0.1 - 90 months). Twenty eight (36.8%) patients underwent retransplantion with mean time from presentation to retransplant of 6.7 months (range 0.03 - 36 months). Of those undergoing retransplant, 17 patients (50.0% of retransplanted) died due to sepsis after retransplant. Median time from retransplant to death is 1.85 months (range 0.3 - 71 months).Final outcome of all late HAT patients are summarized in Table 1. Mean graft survival and patient survival in two groups is summarized in Table 2. Kaplan - Meier graft survival curve are shown in Figure 1.Table: No Caption available.Table: No Caption available.Conclusion: Late HAT remains a significant source of mortality resulting in death in approximately 50% of patients with biliary sepsis as main cause of death. Retransplant in this cohort of patients is associated with a significant risk for death as well.Figure: No Caption available.