DOI: 10.1097/lvt.0000000000000671 ISSN: 1527-6465

Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

Weihao Li, Reinoud P.H. Bokkers, Barbara E. Wildhaber, Ana M. Calinescu, Alexis Ricoeur, Paolo Marra, Michela Bravi, Domenico Pinelli, Julia Minetto, Marcelo Dip, Sergio Sierre, Martín de Santibañes, Victoria Ardiles, Jimmy Walker Uno, Winita Hardikar, Sue Bates, Lynette Goh, Denise Aldrian, Jonathan Seisenbacher, Georg F. Vogel, João Seda Neto, Eduardo Antunes da Fonseca, Carolina Magalhães Costa, Cristina T. Ferreira, Luiza S. Nader, Marco A. Farina, Khaled Z. Dajani, Alessandro Parente, David L. Bigam, Tingbo Liang, Xueli Bai, Jie Xiang, Lucie Gonsorčíková, Jiří Froněk, Šimon Bohuš, Stéphanie Franchi-Abella, Emmanuel Gonzales, Florent Guérin, Norman Junge, Ulrich Baumann, Nicolas Richter, Steffen Hartleif, Ekkehard Sturm, Muthukumarassamy Rajakannu, Kumar Palaniappan, Mohamed Rela, Arti Pawaria, Haritha Rajakrishnan, Sudhindran Surendran, Mukesh Kumar, Shaleen Agarwal, Subhash Gupta, Sonal Asthana, Mallikarjun Sakpal, Ashritha Avalareddy, Marco Spada, Lidia Monti, Tommaso Alterio, Yusuke Yanagi, Hajime Uchida, Ryuji Komine, Helen Evans, Peter Carr-Boyd, David Duncan, Marek Stefanowicz, Julita Latka-Grot, Adam Koleśnik, Dieter C. Broering, Dimitri A. Raptis, Kris Ann H. Marquez, Vidyadhar Mali, Marion Aw, Marisa Beretta, Francisca Van der Schyff, Jesús Quintero, Maria Mercadal-Hally, Jose Andrés Molino-Gahete, Ane M. Andres, Francisco Hernandez-Oliveros, Esteban Frauca Remacha, Thomas Casswall, Carl Jorns, Martin Delle, Girish L. Gupte, Khalid Sharif, Simon P. McGuirk, Riccardo Superina, Juan Carlos Caicedo, Catalina Jaramillo, Leandra Bitterfeld, Zachary Kastenberg, Amit Shah, Bryanna Domenick, Michael R. Acord, George Mazariegos, Kyle Soltys, Joseph DiNorcia, Puja Patel, Sander Florman, Bettina M. Buchholz, Uta Herden, Lutz Fischer, Rudi A.J.O. Dierckx, Hermien Hartog, Hubert P.J. Van der Doef
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Background: Guidelines for managing hepatic artery thrombosis (HAT) and stenosis (HAS) after pediatric liver transplantation (pLT) are lacking, with heterogeneous local practices. This study aims to evaluate management practices for HAT and HAS after pLT. Methods: An online and paper-based survey was sent to 36 international pLT centers. The survey included 36 questions covering center experience, screening protocols, diagnostic criteria, preventive management, post-procedural care, and follow-up. Treatment strategies were explored through hypothetical case scenarios categorized by early (≤14 d after pLT) and late onset complications (>14 d after pLT). Results: Responses from 36 centers showed that 60% applied interrupted sutures and 76% used a surgical loupe during transplantation. Additionally, 89% followed a specific anticoagulation protocol after uncomplicated pLT. All centers initiated Doppler ultrasound (DUS) within 24 hours after pLT, with 60% conducting it daily during the first week. Immediate re-transplantation was preferred for early HAT with pediatric acute liver failure (PALF) (61% vs. 11% for non-PALF, p<0.001), and surgical revascularization was more frequently chosen for non-PALF cases (51% vs. 24% for PALF, p<0.001). Endovascular therapy was selected in 35% of cases for both late HAT and HAS, with conservative management chosen in 51% for late HAT and 61% for late HAS (all p<0.001, compared to early cases). Conclusion: Internationally, there is agreement on the importance of early DUS screening in current management practices. Immediate re-transplantation was preferred for early HAT with PALF, while surgical revascularization was favored for non-PALF cases. Conservative management and endovascular therapy emerged as potential strategies for late-onset cases. This worldwide survey on real-world practice provides a basis for developing and implementing guidelines.

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