Hepatic artery thrombosis following orthotopic liver transplantation: A 10-year experience from a single centre in the United Kingdom
Hepatic artery thrombosis following orthotopic liver transplantation: A 10-year experience from a single centre in the United Kingdom
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DOI：
10.1002/lt.20566
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发表时间：
2006-01-01
影响因子：
4.6
通讯作者：
Bramhall, SR
中科院分区：
文献类型：
--
作者：
Silva, MA;Jambulingam, PS;Bramhall, SR
肝动脉血栓形成（HAT）发生在所有肝移植的3-9%，急性移植物丢失是可能的后遗症。我们介绍了我们在10年期间管理HAT的经验。分析了1994年4月至2004年4月期间收集的数据。共有1，257例肝移植，669例男性，中位年龄51（16-73）岁。有61例（4.9%）HAT。21例（1.8%）发生早期HAT。36例移植物功能障碍，11例需要再次移植，14例死亡。供体CMV血清学阳性、冷缺血时间、手术持续时间、输注超过6个单位的血液和15个单位的血浆、用于动脉重建的主动脉导管、Roux-en-Y胆道重建、再植和再次剖腹术与HAT相关。在多变量分析中，胆道吻合类型是与HAT相关的唯一显著因素。肝移植物裂开或减少不是HAT的危险因素。需要多动脉吻合的肝动脉数量不是HAT的风险。HAT导致肝移植后总生存率降低。HAT的发生率为4.9%，其中1.8%为早期HAT，HAT影响生存。手术技术不是HAT的病因。总之，虽然Roux-en-Y胆道重建是HAT、冷缺血和手术时间的独立风险因素，但在动脉重建中使用血液和血浆以及使用主动脉导管与HAT相关。再次移植和再次手术也是确定的风险因素。
Hepatic artery thrombosis (HAT) occurs in 3-9% of all liver transplants and acute graft loss is a possible sequelae. We present our experience in the management of HAT over a 10-year period. Prospectively collected data from April 1994 to April 2004 were analyzed. There were 1,257 liver transplants, 669 males, median age 51 (16-73) years. There were 61 (4.9%) cases of HAT. Early HAT occurred in 21 (1.8%). Thirty six had graft dysfunction, 11 required a regraft, and 14 died. Positive CMV serology in the donor, cold ischemia time, duration of operation, transfusions of more than 6 units of blood, and 15 units of plasma, an aortic conduit for arterial reconstruction, Roux-en-Y biliary reconstructions, regrafts and relaparotomy were associated with HAT. At multivariate analysis, type of biliary anastomosis was the only significant factor associated with HAT. Split or reduced liver graft were not risk factors for HAT. Number of hepatic arteries requiring multiple arterial anastomosis was not a risk for HAT. HAT resulted in a reduction in overall survival post liver transplantation. The incidence of HAT was 4.9%; with 1.8% early HAT and HAT impacted on survival. Surgical technique was not an aetiological factor for HAT. In conclusion, while a Roux-en-Y biliary reconstruction was an independent risk factor for HAT, cold ischemia and operative times, the use of blood and plasma and the use of aortic conduits in arterial reconstruction were associated with HAT. Regrafts and reoperation were also identified risk factors.