Long Graft Artery and Arterial Anomalies Are Associated with Hepatic Artery Thrombosis after Orthotopic Liver Transplantation

Abstract

Introduction: Hepatic artery thrombosis is one of the most feared surgical complications after orthotopic liver transplantation (OLT). The aim of this study was to analyse factors involved in global, early (less than a month) and late (more than a month) hepatic artery thrombosis (HAT) after OLT. Methods: Inclusion criteria: patients who underwent OLT between November 2001 and December 2018. Exclusion criteria: liver retransplantation. Several preoperative and intraoperative variables were analysed. Graft artery was classified as long or short when the section was located distal or proximal to the proper/common hepatic artery bifurcation. In the same way, recipient patch for arterial anastomosis was classified as distal or proximal to the proper/common hepatic artery bifurcation. Student's T for continuous variables and Chi-Square for discrete variables were used for univariate analysis. Logistic regression was used for multivariate analysis (MVA). Results: Finally, 588 patients were eligible for statistical analysis. Global, early and late HAT appeared in 53 (9.01%), 35 (5.95%) and 18 (3,06%) patients, respectively. For global HAT, two variables proved to be significant after MVA: hepatocellular carcinoma as indication for OLT (p=0.035) and long graft artery (p=0.007). For early HAT, two variables turned out to be significant after MVA: hepatocellular carcinoma as indication for OLT (p=0.012) and arterial anomalies (p=0.036). For late HAT, only long graft artery reached statistical significance after MVA (p=0.026). Conclusion: Technical factors involving arterial anastomosis, as the presence of arterial anomalies and the length of the graft artery, seem to be essential risk factors for HAT after OLT.