Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

Guidelines for managing hepatic artery thrombosis (HAT) and stenosis (HAS) after pediatric liver transplantation (pLT) are lacking, with heterogeneous local practices. This study aims to evaluate management practices for HAT and HAS after pLT. An online and paper-based survey was sent to 36 international pLT centers. The survey included 36 questions covering center experience, screening protocols, diagnostic criteria, preventive management, post-procedural care, and follow-up. Treatment strategies were explored through hypothetical case scenarios categorized by early (≤14 d after pLT) and late onset complications (>14 d after pLT). Responses from 36 centers showed that 60% applied interrupted sutures and 76% used a surgical loupe during transplantation. In addition, 89% followed a specific anticoagulation protocol after uncomplicated pLT. All centers initiated Doppler ultrasound (DUS) within 24 hours after pLT, with 60% conducting it daily during the first week. Immediate re-transplantation was preferred for early HAT with pediatric acute liver failure (PALF) (61% vs. 11% for non-PALF, p <0.001), and surgical revascularization was more frequently chosen for non-PALF cases (51% vs. 24% for PALF, p <0.001). Endovascular therapy was selected in 35% of cases for both late HAT and HAS, with conservative management chosen in 51% for late HAT and 61% for late HAS (all p <0.001, compared to early cases). Internationally, there is agreement on the importance of early DUS screening in current management practices. Immediate re-transplantation was preferred for early HAT with PALF, while surgical revascularization was favored for non-PALF cases. Conservative management and endovascular therapy emerged as potential strategies for late-onset cases. This worldwide survey on real-world practice provides a basis for developing and implementing guidelines.

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Journal
Liver Transplantation
Published
2025-06-30
DOI
https://doi.org/10.1097/lvt.0000000000000671
Citations
1
Primary Topic
Organ Transplantation Techniques and Outcomes
Type
article
Field-Weighted Citation Impact
2.01
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Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

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Organ Transplantation Techniques and Outcomes
2.01
article

Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

Reinoud P.H. Bokkers, Sander S Florman, Martín de Santibañes, Victoria Ardiles, Jiří Froněk, Julia Minetto, Tingbo Liang, Lidia Monti, Emmanuel Gonzalès, Ulrich Baumann, Marco Spada, Shaleen Agarwal, David Duncan, Mallikarjun Sakpal, Martin Delle, Riccardo Antonio Superina, Ane Miren Andrés, George Vincent Mazariegos, Muthukumarassamy Rajakannu, Jesús Quintero, Francisca van der Schyff, Dieter C. Bröering, Luiza Salgado Nader, Catalina Jaramillo, Carl Jorns, María Mercadal‐Hally, Ryuji Komine, Sonal Asthana, S Sudhindran, Juan Carlos Caicedo, Denise Aldrian, Ana M. Calinescu, Khaled Dajani, Marcelo Dip, Stéphanie Franchi‐Abella, Alexis Ricoeur, Jie Xiang, Girish Gupte, Winita Hardikar, Uta Herden, Yusuke Yanagi, Hajime Uchida, Lynette Goh, Marco Farina, Adam Koleśnik, Xueli Bai, Sergio Sierre, Florent Guérin, Norman Junge, Georg F. Vogel, Šimon Bohuš, D. Pinelli, F Hernández, Marion Aw, Hermien Hartog, Helen Evans, Amit A. Shah, Zachary J. Kastenberg, Kyle Soltys, Kris Ann Hervera Marquez, Thomas Casswall, João Seda Neto, Vidyadhar Padmakar Mali, David L. Bigam, Ekkehard Sturm, Leandra Bitterfeld, Arti Pawaria, Tommaso Alterio, Steffen Hartleif, Michael R. Acord, Cristina Targa Ferreira, Subhash Gupta, Bettina M. Buchholz, Alessandro Parente, Paolo Marra, Lucie Gonsorčíková, Barbara E. Wildhaber, Eduardo A. Fonseca, Nicolas Richter, Sue Bates, Joseph DiNorcia, Esteban Frauca Remacha, Julita Latka-Grot, Lutz Fischer, Carolina Magalhães Costa, Haritha Rajakrishnan, Bryanna Domenick, Peter Carr‐Boyd, Kumar Palaniappan, Mukesh Kumar, Weihao Li, Dimitri A. Raptis, Hubert Petrus Johannes van der Doef, Mohamed Rela, Rudi Dierckx, Marek Stefanowicz, M. Bravi, Jonathan Seisenbacher, Simon Prosser McGuirk, Marisa Beretta, Khalid Sharif, Puja Patel, Jimmy Walker Uño, Ashritha Avalareddy, Jose Andrés Molino-Gahete
article en
1 citations

Abstract

Guidelines for managing hepatic artery thrombosis (HAT) and stenosis (HAS) after pediatric liver transplantation (pLT) are lacking, with heterogeneous local practices. This study aims to evaluate management practices for HAT and HAS after pLT. An online and paper-based survey was sent to 36 international pLT centers. The survey included 36 questions covering center experience, screening protocols, diagnostic criteria, preventive management, post-procedural care, and follow-up. Treatment strategies were explored through hypothetical case scenarios categorized by early (≤14 d after pLT) and late onset complications (>14 d after pLT). Responses from 36 centers showed that 60% applied interrupted sutures and 76% used a surgical loupe during transplantation. In addition, 89% followed a specific anticoagulation protocol after uncomplicated pLT. All centers initiated Doppler ultrasound (DUS) within 24 hours after pLT, with 60% conducting it daily during the first week. Immediate re-transplantation was preferred for early HAT with pediatric acute liver failure (PALF) (61% vs. 11% for non-PALF, p <0.001), and surgical revascularization was more frequently chosen for non-PALF cases (51% vs. 24% for PALF, p <0.001). Endovascular therapy was selected in 35% of cases for both late HAT and HAS, with conservative management chosen in 51% for late HAT and 61% for late HAS (all p <0.001, compared to early cases). Internationally, there is agreement on the importance of early DUS screening in current management practices. Immediate re-transplantation was preferred for early HAT with PALF, while surgical revascularization was favored for non-PALF cases. Conservative management and endovascular therapy emerged as potential strategies for late-onset cases. This worldwide survey on real-world practice provides a basis for developing and implementing guidelines.

Liver TransplantationVol. 31(12)
ASTER (CA), Northwestern University (US), University of Geneva (CH), Amrita Institute of Medical Sciences and Research Centre (IN), Lurie Children's Hospital (US), Royal Children's Hospital (AU), Primary Children's Hospital (US), University Medical Center Groningen (NL), Karolinska University Hospital (SE), Children's Hospital of Philadelphia (US), Innsbruck Medical University (AT), University of Alberta (CA), Universität Hamburg (DE), University of Groningen (NL), Universität Innsbruck (AT), Charles University (CZ), University of Utah (US), Université Paris-Saclay (FR), Garrahan Hospital (AR), Hospital Universitario La Paz (ES), King Faisal Specialist Hospital & Research Centre (SA), Auckland City Hospital (NZ), Hospital Italiano de Buenos Aires (AR), Max Super Speciality Hospital (IN), Karolinska Institutet (SE), Medizinische Hochschule Hannover (DE), Hospital de Clínicas de Porto Alegre (BR), Assistance Publique – Hôpitaux de Paris (FR), Mount Sinai Hospital (US), University Hospital of Geneva (CH), Ospedale Papa Giovanni XXIII (IT), University Medical Center Hamburg-Eppendorf (DE), Children's Memorial Health Institute (PL), Wits University Donald Gordon Medical Centre (ZA), Bambino Gesù Children's Hospital (IT), Lurie Children's Hospital (US), University Children's Hospital Tübingen (DE), Vall d'Hebron Hospital Universitari (ES), Institute of Clinical and Experimental Medicine (CZ), Children's Hospital of Pittsburgh (US), National Center For Child Health and Development (JP), University of Pittsburgh Medical Center (US), Thomayer University Hospital (CZ), Starship Children's Health (NZ), National University Hospital (SG), Affiliated Hangzhou First People's Hospital, Westlake University, School of Medicine (CN), Hospital Sírio-Libanês (BR), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Birmingham Women’s and Children’s NHS Foundation Trust (GB), Ministry of Public Health (MG), Bicêtre Hospital (FR), First Affiliated Hospital Zhejiang University (CN), University of Milano-Bicocca (IT), University of Pennsylvania (US), University of Tübingen (DE), Bharath University (IN)
Openalex Percentile: Top 14%
Organ Transplantation Techniques and Outcomes
2.01
DOIOpen Access PDFOpenAlex
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