Table 2.
Hepatic artery thrombosis highlights
| Summary of the clinical characteristics about HAT |
| HA supplies exclusively the bile duct, so HAT is associated with a high frequency of biliary complications |
| HAT represents more than 50% of all arterial complications following OL |
| The incidence of HAT following OLT is 3.5% with early and late HAT incidences of 2.9% and 2.2%, respectively |
| HAT carries an incidence of graft failure and mortality of more than 50% without prompt treatment |
| The median time to detection of early and late HAT was 6.9 d (range: 1-17.5 POD) and 6 mo (range: 1.8-79 mo), respectively |
| No differences in HAT incidences were observed between DDLT and LDLT |
| Clinical presentation spectrum: Mild elevation of serum transaminase and bilirubin levels (75%), biliary complications (15%), fever and sepsis (6%), graft dysfunction or failure (4%) |
| Risk factors of early HAT are mainly represented by technical problems, LDLT, cigarette smoking and hypercoagulability state, while late HAT is usually related to ischemic or immunologic injury: CMV positive donor, female donor and male recipient and hepatitis C seropositive recipient |
| Early diagnosis is achieved by assessing the serum transaminase level and performing Doppler ultrasound monitoring in the postoperative period and confirmed by contrast-enhanced abdominal CT scan and/or visceral angiography |
| Currently, the literature on the curative management of early HAT suggests the following procedures: First endovascular radiological intervention (IAT, PTA and stent placement), secondly open surgical revascularization, and finally retransplantation, which is associated with the best survival rate compared with revision or thrombolysis, but is a limited therapeutic option due to organ shortage |
HA: Hepatic artery; HAT: Hepatic artery thrombosis; OLT: Orthotopic liver transplantation; DDLT: Deceased donor liver transplantation; LDLT: Living donor liver transplantation; CMV: Cytomegalovirus; IAT: Intra-arterial thrombolysis; PTA: Percutaneous transluminal angioplasty; CT: Computed tomography.