TECHNIQUES DESIGNED TO MINIMIZE THE INCIDENCE OF HEPATIC-ARTERY THROMBOSIS IN PEDIATRIC LIVER-TRANSPLANTATION

Hepatic artery thrombosis is a life-threatening complication after pediatric liver transplantation. We reviewed our experience in 62 children who received 72 liver transplant (69 whole grafts and 3 reduced-size grafts) between January 1984 and December 1991. They ranged in age from 6 months to 16 years (mean 5.8 years). Fifteen children (22 %) were under 2 years and 10 patients (14 %) were between 2 and 5 years. Forty-eight grafts in older children (age : 1 - 16 years, x = 7 years had an anastomosis between the donor hepatic/celiac artery and the recipient hepatic of splenic artery (A-A). Three thromboses occurred in this group for an incidence of 6,2 %. Two others types of arterial reconstruction were used in 24 children who were significantly younger (6-120 months, x = 47 months, p < 0.01). Eight grafts had an anastomosis between the donor celiac artery and the recipient aorta (A-Ao). No thromboses occurred in this group. Sixteen grafts were revascularized using a donor aortic conduit anastomosed to the recipient aorta (AC) with a 12,5 % (2 to 16) incidence of thrombosis. the incidence of arterial thrombosis for the entire group was 6.9 %. In conclusion, by using the recipient aorta for arterial reconstruction, a low incidence of hepatic artery thrombosis can be achieved even in the group of younger patients who are the highest risk for this complication.