The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia

Christopher R. Shackleton, John A. Goss, Kim Swenson, Steven D Colquhoun, Philip Seu, Milan M. Kinkhabwala, Stephen M. Rudich, Jay S. Markowitz, Suzanne V. McDiarmid, Ronald W. Busuttil

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival. METHODS: A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR. RESULTS: Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71%, 61%, and 57% versus 85%, 85%, and 85%, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19%), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81% in group 1 and 100% in group 2 (P = 0.02). CONCLUSIONS: In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.

Original languageEnglish (US)
Pages (from-to)431-435
Number of pages5
JournalAmerican Journal of Surgery
Volume173
Issue number5
DOIs
StatePublished - May 1 1997
Externally publishedYes

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Biliary Atresia
Hepatic Artery
Liver Transplantation
Thrombosis
Liver
Survival
Incidence
Bilirubin
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia. / Shackleton, Christopher R.; Goss, John A.; Swenson, Kim; Colquhoun, Steven D; Seu, Philip; Kinkhabwala, Milan M.; Rudich, Stephen M.; Markowitz, Jay S.; McDiarmid, Suzanne V.; Busuttil, Ronald W.

In: American Journal of Surgery, Vol. 173, No. 5, 01.05.1997, p. 431-435.

Research output: Contribution to journalArticle

Shackleton, CR, Goss, JA, Swenson, K, Colquhoun, SD, Seu, P, Kinkhabwala, MM, Rudich, SM, Markowitz, JS, McDiarmid, SV & Busuttil, RW 1997, 'The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia', American Journal of Surgery, vol. 173, no. 5, pp. 431-435. https://doi.org/10.1016/S0002-9610(97)00066-4
Shackleton, Christopher R. ; Goss, John A. ; Swenson, Kim ; Colquhoun, Steven D ; Seu, Philip ; Kinkhabwala, Milan M. ; Rudich, Stephen M. ; Markowitz, Jay S. ; McDiarmid, Suzanne V. ; Busuttil, Ronald W. / The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia. In: American Journal of Surgery. 1997 ; Vol. 173, No. 5. pp. 431-435.
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title = "The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia",
abstract = "BACKGROUND: Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival. METHODS: A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR. RESULTS: Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71{\%}, 61{\%}, and 57{\%} versus 85{\%}, 85{\%}, and 85{\%}, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19{\%}), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81{\%} in group 1 and 100{\%} in group 2 (P = 0.02). CONCLUSIONS: In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.",
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T1 - The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia

AU - Shackleton, Christopher R.

AU - Goss, John A.

AU - Swenson, Kim

AU - Colquhoun, Steven D

AU - Seu, Philip

AU - Kinkhabwala, Milan M.

AU - Rudich, Stephen M.

AU - Markowitz, Jay S.

AU - McDiarmid, Suzanne V.

AU - Busuttil, Ronald W.

PY - 1997/5/1

Y1 - 1997/5/1

N2 - BACKGROUND: Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival. METHODS: A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR. RESULTS: Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71%, 61%, and 57% versus 85%, 85%, and 85%, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19%), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81% in group 1 and 100% in group 2 (P = 0.02). CONCLUSIONS: In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.

AB - BACKGROUND: Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival. METHODS: A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR. RESULTS: Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71%, 61%, and 57% versus 85%, 85%, and 85%, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19%), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81% in group 1 and 100% in group 2 (P = 0.02). CONCLUSIONS: In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.

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