Hepatic Artery Thrombosis: Conservative Management or Retransplantation? Professor Nigel Heaton Professor Nigel Heaton Kings Health Partners Kings Health Partners Institute of Liver Studies Institute of Liver Studies Kings College Hospital Kings College Hospital London London
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Hepatic Artery Thrombosis: Conservative Management or Retransplantation? Professor Nigel Heaton Kings Health Partners Institute of Liver Studies Kings.
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Hepatic Artery Thrombosis: Conservative Management or Retransplantation?
Professor Nigel HeatonProfessor Nigel Heaton
Kings Health PartnersKings Health PartnersInstitute of Liver StudiesInstitute of Liver Studies
Kings College HospitalKings College Hospital
LondonLondon
Hepatic Artery Thrombosis: Conservative vs RetransplantionTopics to be covered
Arterial anatomy of the liver and biliary tree
Definition of early and late hepatic artery thrombosis
Incidence
Pathophysiology
Decision making and outcomes
:conservative management or retransplantation
Prevention? Personal data
Schematic of 3 & 9 o’clock arteries
Northover and Terblanche, BJS 1979
38%
60%
2%
Arterial contributions to the bile duct
axial
distal supply dominant
Early Hepatic Artery Thrombosis: Incidence
Definition not agreed – varying from 2 weeks to 3 months
Early HAT – within one month of transplant
Incidence: mean 3.9%, median 4.4%
Adults 2.9%, Children 8.3%
Era effect 1982-1996 6.9%
1993 – 2006 3.8%
Higher incidence in lower volume centers (< 30 LTx) 5.8% vs 3.2%)
Bekker et al, AJT 2009; 9: 757
Late Hepatic Artery Thrombosis
One month to more than 3 months
Bekker et al, AJT 2009; 9: 757
Hepatic Artery Thrombosis: Pattern of injury - Early
Depends on the speed and efficiency of collateralisation
Bile duct ischemia
Infection
Cholangiolitic abscesses
Parenchymal necrosis
Liver failure and death
Personal data
Hepatic Artery Thrombosis: Pattern of injury - late