New England Surgical Society

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Early Diagnosis of Hepatic Artery Thrombosis (Hat) Post Liver Transplant Prevents Graft Loss
Patricia Sheiner, *Justin Salm, *Caroline Rochon, *Bejon Maneckshana, *Yong Kwon
Hartford Hospital, Hartford, CT

Hepatic artery thrombosis (HAT) post liver transplant has a major impact on graft and patient survival. Early revascularization has shown to result in graft salvage. We perform a duplex ultrasound (dUS) within six hours after transplant. US that show no flow in the artery result in an immediate reoperation and revascularization. US with poor flow are repeated within 6-12 hours. We reviewed charts on all patients transplanted between Jan 2012 and March noting time of initial US, incidence of return to OR for HAT and late outcome. We reviewed subsequent imaging studies to determine if an early dUS missed late HAT. There were 68 patients; all had dUS within 6 hours post liver transplant. Three patients developed HAT. One patient had no flow on initial US and underwent revascularization. A second patient poor flow, follow up within 12 hours, showed no flow and he too underwent immediate revascularization. Both have normal graft function and no biliary complications at 1517 and 1565 days respectively. The third patient had HAT in the setting of PNF and required retransplant for PNF despite revascularization. An additional patient had poor arterial flow, at reoperation we identified a splenic artery steal, the splenic artery was clipped with no subsequent HAT. 85% underwent subsequent imaging studies, with an average of 3.3 studies (range 0-10), at 302 days post transplant (range 0-1300) days. There was no patient with an initial normal 6 hour dUS that developed late HAT. HAT is a technical complication that occurs early after transplant. In the absence of other reasons of early graft dysfunction, such as PNF, early identification and immediate revascularization can result in 100 percent graft salvage.


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