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

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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

ASJC Scopus subject areas

  • Surgery

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    Shackleton, C. R., Goss, J. A., Swenson, K., Colquhoun, S. D., Seu, P., Kinkhabwala, M. M., Rudich, S. M., Markowitz, J. S., McDiarmid, S. V., & Busuttil, R. W. (1997). The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia. American Journal of Surgery, 173(5), 431-435. https://doi.org/10.1016/S0002-9610(97)00066-4