Journal club: vascular complications of orthotopic liver transplantation

This recent article, published in the J Amer Coll Surg (see link below) analyzed the experience of over 4,000 liver transplants, and specifically at the outcomes of portal vein thrombosis (PVT) and hepatic artery thrombosis (HAT).  Rates of graft loss and patient mortality were studied.

Roughly 5% of patients had a HAT and 2% had a PVT.  Graft survival was reduced by either complication, while only PVT resulted in reduced patient survival.  The likelihood of salvaging a graft with thrombolysis or anastamotic revision of HAT was only 10%, so retransplantation is indicated. That said, retransplantation does not confer a long term (5-year) survival advantage (only 56%). 

Risk factors for HAT include pediatric recipient, hepatocellular carcinoma and aberrant arterial anatomy requiring complex reconstruction.  The HCC risk may be related to arterial trauma from previous TACE procedures.  For patients with operative risk factors, consideration should be given for pre-transplant thrombophilic workups so that appropriate post-operative measures can be taken, such as the use of an antiplatelet medication. 

For further reading on this article, please refer to the link here:

HAT and PVT; J Am Coll Surg

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