Incidence and Risk Factors of Hepatic Artery Thrombosis and Stenosis After Pediatric Liver Transplantation: Results From the HEPATIC Registry
Weihao Li, Hermien Hartog, Julia Minetto, Marcelo Dip, Sergio Sierre, Florent Guérin, Stéphanie Franchi-Abella, Emmanuel Gonzales, Ane M. Andres, Francisco Hernandez-Oliveros, Esteban Frauca Remacha, Catalina Jaramillo, Leandra Bitterfeld, Arielle Melen, Norman Junge, Ulrich Baumann, Nicolas Richter, Joseph DiNorcia, Sander Florman, João Seda Neto, Eduardo Antunes da Fonseca, Carolina Magalhães Costa, George Mazariegos, Kyle Soltys, Renana Yemini, Martín de Santibañes, Victoria Ardiles, Jimmy Walker Uno, Lucie Gonsorčíková, Jiří Froněk, Šimon Bohuš, Girish L. Gupte, Khalid Sharif, Simon P. McGuirk, Denise Aldrian, Jonathan Seisenbacher, Georg F. Vogel, Barbara E. Wildhaber, Ana M. Calinescu, Alexis Ricoeur, Mukesh Kumar, Shaleen Agarwal, Subhash Gupta, Tingbo Liang, Xueli Bai, Jie Xiang, Paolo Marra, Lorenzo D’Antiga, Domenico Pinelli, Marisa Beretta, Francisca Van der Schyff, Cristina T. Ferreira, Luiza S. Nader, Marco A. Farina, Jesús Quintero, Maria Mercadal-Hally, Jose Andrés Molino, Winita Hardikar, Sue Bates, Lynette Goh, Dieter C. Broering, Dimitri A. Raptis, Kris Ann H. Marquez, Amit A. Shah, Bryanna Domenick, Michael R. Acord, Arti Pawaria, Haritha Rajakrishnan, Sudhindran Surendran, Marco Spada, Lidia Monti, Tommaso Alterio, Thomas Casswall, Carl Jorns, Martin Delle, Muthukumarassamy Rajakannu, Kumar Palaniappan, Mohamed Rela, Riccardo Superina, Juan Carlos Caicedo, Khaled Z. Dajani, Alessandro Parente, David L. Bigam, Vidyadhar Mali, Marion M. Aw, Sonal Asthana, Vachan S. Hukkeri, Ashritha Avalareddy, Yusuke Yanagi, Hajime Uchida, Ryuji Komine, Rene Scheenstra, Rudi A. J. O. Dierckx, Reinoud P. H. Bokkers, Hubert P. J. van der DoefBackground.
The incidence and risk factors of hepatic artery complications (HACs), including thrombosis (HAT) and stenosis (HAS), after pediatric liver transplantation (pLT) are not well characterized. This study aimed to assess the incidence and risk factors of HACs after pLT and quantify the screening effort required to identify a single HAC.
Methods.
We performed a retrospective multicenter analysis using the HEPATIC registry, including pLTs from 32 centers over a 20-y period. HAC incidence was assessed across subgroups defined by pLT indication, recipient age, donor type, transplant era, and annual center volume. Timing of HAC occurrence and the number needed to screen were analyzed.
Results.
Among 11 443 pLTs, HACs occurred in 4.8% (HAT 3.6%; HAS 1.2%). Most HACs developed within the first-month posttransplant (82.4%), with HAT peaking in the first 2 wk, whereas HAS was more evenly distributed. The overall incidence increased in 2012–2021 (5.3%), with rising HAS and stable HAT rates. Modifiable factors included living donor transplantation (3.4%) and high-volume centers (3.8%), both associated with lower HAC rates, whereas whole grafts in infants <1 y with biliary atresia (15.3%) were associated with higher incidence (all
Conclusions.
HACs occurred in 4.8% of pLTs, with recent increases driven by HAS. Infants <1 with biliary atresia receiving whole grafts and patients undergoing retransplantation after prior HACs were at the highest risk.