Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations
Hepatic artery thrombosis (HAT) after liver transplantation is associated with a marked increase in morbidity, leading to graft and patient loss. We evaluated the outcomes of adult living donor liver transplantation patients with HAT under an aggressive surgical intervention. A total of 1355 recipie...
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Veröffentlicht in: | Liver transplantation 2023-09, Vol.29 (9), p.961-969 |
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creator | Hong, Su Young Yi, Nam-Joon Hong, Kwangpyo Han, Eui Soo Suh, Sanggyun Lee, Jeong-Moo Hong, Suk Kyun Choi, YoungRok Jin, Ung Sik Chang, Hak Lee, Kwang-Woong Suh, Kyung-Suk Minn, Kyung Won |
description | Hepatic artery thrombosis (HAT) after liver transplantation is associated with a marked increase in morbidity, leading to graft and patient loss. We evaluated the outcomes of adult living donor liver transplantation patients with HAT under an aggressive surgical intervention. A total of 1355 recipients underwent adult living donor liver transplantation at the Seoul National University Hospital. Surgical redo reconstruction for HAT was performed in all cases except in those with graft hepatic artery injury and late detection of HAT. Postoperative HAT developed in 33 cases (2.4%) at a median time of 3.5 days. Thirty patients (90.9%) underwent redo-arterial reconstruction. The survival rates in patients with HAT were similar to the rates in those without HAT (72.7% vs. 83.8%, p = 0.115). Although graft survival rates were lower in patients with HAT (84.8%) than in those without HAT (98.0%) ( p < 0.001), the graft survival rate was comparable (92.0% vs. 98.0%, p = 0.124) in the 25 patients with successful revascularization. Biliary complication rates were higher in patients with HAT (54.5%) than in those without HAT (32.0%) ( p = 0.008). In conclusion, the successful redo reconstruction under careful selection criteria saved the graft without retransplantation in 96.0% of the cases. Surgical revascularization should be preferentially considered for the management of HAT in adult living donor liver transplantation. |
doi_str_mv | 10.1097/LVT.0000000000000185 |
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We evaluated the outcomes of adult living donor liver transplantation patients with HAT under an aggressive surgical intervention. A total of 1355 recipients underwent adult living donor liver transplantation at the Seoul National University Hospital. Surgical redo reconstruction for HAT was performed in all cases except in those with graft hepatic artery injury and late detection of HAT. Postoperative HAT developed in 33 cases (2.4%) at a median time of 3.5 days. Thirty patients (90.9%) underwent redo-arterial reconstruction. The survival rates in patients with HAT were similar to the rates in those without HAT (72.7% vs. 83.8%, p = 0.115). Although graft survival rates were lower in patients with HAT (84.8%) than in those without HAT (98.0%) ( p < 0.001), the graft survival rate was comparable (92.0% vs. 98.0%, p = 0.124) in the 25 patients with successful revascularization. Biliary complication rates were higher in patients with HAT (54.5%) than in those without HAT (32.0%) ( p = 0.008). In conclusion, the successful redo reconstruction under careful selection criteria saved the graft without retransplantation in 96.0% of the cases. Surgical revascularization should be preferentially considered for the management of HAT in adult living donor liver transplantation.</description><identifier>ISSN: 1527-6465</identifier><identifier>EISSN: 1527-6473</identifier><identifier>DOI: 10.1097/LVT.0000000000000185</identifier><identifier>PMID: 37254603</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Hepatic Artery - surgery ; Humans ; Liver Transplantation - adverse effects ; Living Donors ; Reoperation - adverse effects ; Retrospective Studies ; Thrombosis - etiology ; Thrombosis - surgery</subject><ispartof>Liver transplantation, 2023-09, Vol.29 (9), p.961-969</ispartof><rights>Copyright © 2023 American Association for the Study of Liver Diseases.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c307t-23b493dab85331e23fe8a5663e973dd1b0f65619271aa173d671248c4c84d2f03</citedby><cites>FETCH-LOGICAL-c307t-23b493dab85331e23fe8a5663e973dd1b0f65619271aa173d671248c4c84d2f03</cites><orcidid>0000-0001-6412-1926 ; 0000-0002-9934-0456 ; 0000-0002-0020-6215 ; 0000-0002-3220-8506 ; 0000-0001-9582-1255 ; 0000-0003-2408-7086 ; 0000-0002-9535-7349 ; 0000-0001-7806-8759 ; 0000-0002-5467-425 ; 0000-0001-7985-2975 ; 0000-0002-5467-425X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37254603$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hong, Su Young</creatorcontrib><creatorcontrib>Yi, Nam-Joon</creatorcontrib><creatorcontrib>Hong, Kwangpyo</creatorcontrib><creatorcontrib>Han, Eui Soo</creatorcontrib><creatorcontrib>Suh, Sanggyun</creatorcontrib><creatorcontrib>Lee, Jeong-Moo</creatorcontrib><creatorcontrib>Hong, Suk Kyun</creatorcontrib><creatorcontrib>Choi, YoungRok</creatorcontrib><creatorcontrib>Jin, Ung Sik</creatorcontrib><creatorcontrib>Chang, Hak</creatorcontrib><creatorcontrib>Lee, Kwang-Woong</creatorcontrib><creatorcontrib>Suh, Kyung-Suk</creatorcontrib><creatorcontrib>Minn, Kyung Won</creatorcontrib><title>Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations</title><title>Liver transplantation</title><addtitle>Liver Transpl</addtitle><description>Hepatic artery thrombosis (HAT) after liver transplantation is associated with a marked increase in morbidity, leading to graft and patient loss. We evaluated the outcomes of adult living donor liver transplantation patients with HAT under an aggressive surgical intervention. A total of 1355 recipients underwent adult living donor liver transplantation at the Seoul National University Hospital. Surgical redo reconstruction for HAT was performed in all cases except in those with graft hepatic artery injury and late detection of HAT. Postoperative HAT developed in 33 cases (2.4%) at a median time of 3.5 days. Thirty patients (90.9%) underwent redo-arterial reconstruction. The survival rates in patients with HAT were similar to the rates in those without HAT (72.7% vs. 83.8%, p = 0.115). Although graft survival rates were lower in patients with HAT (84.8%) than in those without HAT (98.0%) ( p < 0.001), the graft survival rate was comparable (92.0% vs. 98.0%, p = 0.124) in the 25 patients with successful revascularization. Biliary complication rates were higher in patients with HAT (54.5%) than in those without HAT (32.0%) ( p = 0.008). In conclusion, the successful redo reconstruction under careful selection criteria saved the graft without retransplantation in 96.0% of the cases. Surgical revascularization should be preferentially considered for the management of HAT in adult living donor liver transplantation.</description><subject>Adult</subject><subject>Hepatic Artery - surgery</subject><subject>Humans</subject><subject>Liver Transplantation - adverse effects</subject><subject>Living Donors</subject><subject>Reoperation - adverse effects</subject><subject>Retrospective Studies</subject><subject>Thrombosis - etiology</subject><subject>Thrombosis - surgery</subject><issn>1527-6465</issn><issn>1527-6473</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkF1LwzAUhoMobk7_gUguvenMd9pLGX7BQJDpbUnT1EXaZiapsgv_u9HNoeYmOeF5zzk8AJxiNMWokBfzp8UU_T4453tgjDmRmWCS7u_ego_AUQgvCcG8QIdgRCXhTCA6Bh8PpnZwaVYqWg2Vj8avoTfa9SH6QUfretg4D-PSu65ywQb4buPSDTFR0as-rFrVR_UN2h5iyjlU9dBG2No32z_D2vUpnwqTuvwNhGNw0Kg2mJPtPQGP11eL2W02v7-5m13OM02RjBmhFStoraqcU4oNoY3JFReCmkLSusYVagQXuCASK4XTl5CYsFwznbOaNIhOwPmm78q718GEWHY2aNOmTYwbQklygilLWouEsg2qvQvBm6Zcedspvy4xKr_El0l8-V98ip1tJwxVZ-pd6Mc0_QRUfoCE</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Hong, Su Young</creator><creator>Yi, Nam-Joon</creator><creator>Hong, Kwangpyo</creator><creator>Han, Eui Soo</creator><creator>Suh, Sanggyun</creator><creator>Lee, Jeong-Moo</creator><creator>Hong, Suk Kyun</creator><creator>Choi, YoungRok</creator><creator>Jin, Ung Sik</creator><creator>Chang, Hak</creator><creator>Lee, Kwang-Woong</creator><creator>Suh, Kyung-Suk</creator><creator>Minn, Kyung Won</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6412-1926</orcidid><orcidid>https://orcid.org/0000-0002-9934-0456</orcidid><orcidid>https://orcid.org/0000-0002-0020-6215</orcidid><orcidid>https://orcid.org/0000-0002-3220-8506</orcidid><orcidid>https://orcid.org/0000-0001-9582-1255</orcidid><orcidid>https://orcid.org/0000-0003-2408-7086</orcidid><orcidid>https://orcid.org/0000-0002-9535-7349</orcidid><orcidid>https://orcid.org/0000-0001-7806-8759</orcidid><orcidid>https://orcid.org/0000-0002-5467-425</orcidid><orcidid>https://orcid.org/0000-0001-7985-2975</orcidid><orcidid>https://orcid.org/0000-0002-5467-425X</orcidid></search><sort><creationdate>20230901</creationdate><title>Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations</title><author>Hong, Su Young ; Yi, Nam-Joon ; Hong, Kwangpyo ; Han, Eui Soo ; Suh, Sanggyun ; Lee, Jeong-Moo ; Hong, Suk Kyun ; Choi, YoungRok ; Jin, Ung Sik ; Chang, Hak ; Lee, Kwang-Woong ; Suh, Kyung-Suk ; Minn, Kyung Won</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-23b493dab85331e23fe8a5663e973dd1b0f65619271aa173d671248c4c84d2f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Hepatic Artery - surgery</topic><topic>Humans</topic><topic>Liver Transplantation - adverse effects</topic><topic>Living Donors</topic><topic>Reoperation - adverse effects</topic><topic>Retrospective Studies</topic><topic>Thrombosis - etiology</topic><topic>Thrombosis - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hong, Su Young</creatorcontrib><creatorcontrib>Yi, Nam-Joon</creatorcontrib><creatorcontrib>Hong, Kwangpyo</creatorcontrib><creatorcontrib>Han, Eui Soo</creatorcontrib><creatorcontrib>Suh, Sanggyun</creatorcontrib><creatorcontrib>Lee, Jeong-Moo</creatorcontrib><creatorcontrib>Hong, Suk Kyun</creatorcontrib><creatorcontrib>Choi, YoungRok</creatorcontrib><creatorcontrib>Jin, Ung Sik</creatorcontrib><creatorcontrib>Chang, Hak</creatorcontrib><creatorcontrib>Lee, Kwang-Woong</creatorcontrib><creatorcontrib>Suh, Kyung-Suk</creatorcontrib><creatorcontrib>Minn, Kyung Won</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Liver transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hong, Su Young</au><au>Yi, Nam-Joon</au><au>Hong, Kwangpyo</au><au>Han, Eui Soo</au><au>Suh, Sanggyun</au><au>Lee, Jeong-Moo</au><au>Hong, Suk Kyun</au><au>Choi, YoungRok</au><au>Jin, Ung Sik</au><au>Chang, Hak</au><au>Lee, Kwang-Woong</au><au>Suh, Kyung-Suk</au><au>Minn, Kyung Won</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations</atitle><jtitle>Liver transplantation</jtitle><addtitle>Liver Transpl</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>29</volume><issue>9</issue><spage>961</spage><epage>969</epage><pages>961-969</pages><issn>1527-6465</issn><eissn>1527-6473</eissn><abstract>Hepatic artery thrombosis (HAT) after liver transplantation is associated with a marked increase in morbidity, leading to graft and patient loss. We evaluated the outcomes of adult living donor liver transplantation patients with HAT under an aggressive surgical intervention. A total of 1355 recipients underwent adult living donor liver transplantation at the Seoul National University Hospital. Surgical redo reconstruction for HAT was performed in all cases except in those with graft hepatic artery injury and late detection of HAT. Postoperative HAT developed in 33 cases (2.4%) at a median time of 3.5 days. Thirty patients (90.9%) underwent redo-arterial reconstruction. The survival rates in patients with HAT were similar to the rates in those without HAT (72.7% vs. 83.8%, p = 0.115). Although graft survival rates were lower in patients with HAT (84.8%) than in those without HAT (98.0%) ( p < 0.001), the graft survival rate was comparable (92.0% vs. 98.0%, p = 0.124) in the 25 patients with successful revascularization. Biliary complication rates were higher in patients with HAT (54.5%) than in those without HAT (32.0%) ( p = 0.008). In conclusion, the successful redo reconstruction under careful selection criteria saved the graft without retransplantation in 96.0% of the cases. Surgical revascularization should be preferentially considered for the management of HAT in adult living donor liver transplantation.</abstract><cop>United States</cop><pmid>37254603</pmid><doi>10.1097/LVT.0000000000000185</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6412-1926</orcidid><orcidid>https://orcid.org/0000-0002-9934-0456</orcidid><orcidid>https://orcid.org/0000-0002-0020-6215</orcidid><orcidid>https://orcid.org/0000-0002-3220-8506</orcidid><orcidid>https://orcid.org/0000-0001-9582-1255</orcidid><orcidid>https://orcid.org/0000-0003-2408-7086</orcidid><orcidid>https://orcid.org/0000-0002-9535-7349</orcidid><orcidid>https://orcid.org/0000-0001-7806-8759</orcidid><orcidid>https://orcid.org/0000-0002-5467-425</orcidid><orcidid>https://orcid.org/0000-0001-7985-2975</orcidid><orcidid>https://orcid.org/0000-0002-5467-425X</orcidid></addata></record> |
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subjects | Adult Hepatic Artery - surgery Humans Liver Transplantation - adverse effects Living Donors Reoperation - adverse effects Retrospective Studies Thrombosis - etiology Thrombosis - surgery |
title | Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations |
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