Incidence and Risk Factors of Hepatic Artery Thrombosis and Stenosis After Pediatric Liver Transplantation: Results From the HEPATIC Registry

BACKGROUND: The incidence and risk factors of hepatic artery complications (HACs), including thrombosis (HAT) and stenosis (HAS), after pediatric liver transplantation (pLT) are not well characterized. This study aimed to assess the incidence and risk factors of HACs after pLT and quantify the screening effort required to identify a single HAC. METHODS: We performed a retrospective multicenter analysis using the HEPATIC registry, including pLTs from 32 centers over a 20-y period. HAC incidence was assessed across subgroups defined by pLT indication, recipient age, donor type, transplant era, and annual center volume. Timing of HAC occurrence and the number needed to screen were analyzed. RESULTS: Among 11 443 pLTs, HACs occurred in 4.8% (HAT 3.6%; HAS 1.2%). Most HACs developed within the first-month posttransplant (82.4%), with HAT peaking in the first 2 wk, whereas HAS was more evenly distributed. The overall incidence increased in 2012-2021 (5.3%), with rising HAS and stable HAT rates. Modifiable factors included living donor transplantation (3.4%) and high-volume centers (3.8%), both associated with lower HAC rates, whereas whole grafts in infants <1 y with biliary atresia (15.3%) were associated with higher incidence (all P < 0.001). Patient-related risk factors included retransplantation following previous HACs (11.3%) and noncirrhotic metabolic diseases (7.6%, both P < 0.001). The number needed to screen ranged from 173 to 1907 and was lower in high-risk groups. CONCLUSIONS: HACs occurred in 4.8% of pLTs, with recent increases driven by HAS. Infants <1 with biliary atresia receiving whole grafts and patients undergoing retransplantation after prior HACs were at the highest risk.

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Journal
Transplantation
Published
2026-10-28
DOI
https://doi.org/10.1097/tp.0000000000005920
Primary Topic
Organ Transplantation Techniques and Outcomes
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article
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article

Incidence and Risk Factors of Hepatic Artery Thrombosis and Stenosis After Pediatric Liver Transplantation: Results From the HEPATIC Registry

Reinoud P.H. Bokkers, Sander S Florman, Martín de Santibañes, Victoria Ardiles et al.
Transplantation
Organ Transplantation Techniques and Outcomes
article

Incidence and Risk Factors of Hepatic Artery Thrombosis and Stenosis After Pediatric Liver Transplantation: Results From the HEPATIC Registry

Reinoud P.H. Bokkers, Sander S Florman, Martín de Santibañes, Victoria Ardiles, Jiří Froněk, Julia Minetto, Lidia Monti, Emmanuel M. Gonzales, Ulrich Baumann, Shaleen K. Agarwal, Martin Delle, Riccardo Antonio Superina, Ane Miren Andrés, George Vincent Mazariegos, Muthukumarassamy Rajakannu, Francisca van der Schyff, Dieter Clemens Broering, Luiza Salgado Nader, Catalina Jaramillo, Carl Jorns, María Mercadal‐Hally, Ryuji Komine, Juan Carlos Caicedo, Denise Aldrian, Khaled Z. Dajani, Marcelo Dip, Stéphanie Franchi‐Abella, Alexis Ricoeur, Girish L. Gupte, Winita Hardikar, Hubert P. J. van der Doef, Yusuke Yanagi, Lynette Goh, Marco Farina, Sergio Sierre, Florent Guérin, Norman Junge, Georg Friedrich Vogel, Šimon Bohuš, Renana Yemini, Domenico Pinelli, Lorenzo D’Antiga, René Scheenstra, Marion Aw, Hermien Hartog, Amit A. Shah, Vachan Subhash Hukkeri, Thomas Casswall, Kyle A Soltys, Vidyadhar Padmakar Mali, David L. Bigam, Leandra Bitterfeld, Arti Pawaria, Tommaso Alterio, Michael R. Acord, Cristina Targa Ferreira, Alessandro Parente, Paolo Marra, Lucie Gonsorčíková, Barbara Elisabeth Wildhaber, Eduardo Antunes da Fonseca, Nicolas Richter, Sue Bates, Joseph DiNorcia, Esteban Frauca Remacha, Marco Spada, Carolina Magalhães Costa, Haritha Rajakrishnan, Bryanna N. Domenick, Kumar Palaniappan, Hajime Uchida, Sonal Asthana, Dimitri A. Raptis, Rudi A. J. O. Dierckx, Jonathan Seisenbacher, Simon Prosser McGuirk, Marisa Renata Beretta, Khalid Sharif, Mohamed Rela, Jimmy Walker Uño, Ashritha Avalareddy, Arielle Melen, Jesús Quintero, Tingbo Liang, Sudhindran Surendran, Francisco Hernandez-Oliveros, Jose Andrés Molino, Kris Ann H. Marquez, Ana M Calinescu, Jie Xiang, João Seda Neto, Mukesh Kumar, Weihao Li, Xueli Bai, Subhash Gupta
article en

Abstract

BACKGROUND: The incidence and risk factors of hepatic artery complications (HACs), including thrombosis (HAT) and stenosis (HAS), after pediatric liver transplantation (pLT) are not well characterized. This study aimed to assess the incidence and risk factors of HACs after pLT and quantify the screening effort required to identify a single HAC. METHODS: We performed a retrospective multicenter analysis using the HEPATIC registry, including pLTs from 32 centers over a 20-y period. HAC incidence was assessed across subgroups defined by pLT indication, recipient age, donor type, transplant era, and annual center volume. Timing of HAC occurrence and the number needed to screen were analyzed. RESULTS: Among 11 443 pLTs, HACs occurred in 4.8% (HAT 3.6%; HAS 1.2%). Most HACs developed within the first-month posttransplant (82.4%), with HAT peaking in the first 2 wk, whereas HAS was more evenly distributed. The overall incidence increased in 2012-2021 (5.3%), with rising HAS and stable HAT rates. Modifiable factors included living donor transplantation (3.4%) and high-volume centers (3.8%), both associated with lower HAC rates, whereas whole grafts in infants <1 y with biliary atresia (15.3%) were associated with higher incidence (all P < 0.001). Patient-related risk factors included retransplantation following previous HACs (11.3%) and noncirrhotic metabolic diseases (7.6%, both P < 0.001). The number needed to screen ranged from 173 to 1907 and was lower in high-risk groups. CONCLUSIONS: HACs occurred in 4.8% of pLTs, with recent increases driven by HAS. Infants <1 with biliary atresia receiving whole grafts and patients undergoing retransplantation after prior HACs were at the highest risk.

Transplantation
Intermountain Healthcare (US), 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), Mount Sinai Hospital (US), 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), University of Groningen (NL), University of Pittsburgh (US), Universität Innsbruck (AT), Charles University (CZ), University of Utah (US), Université Paris-Saclay (FR), Sir H.N. Reliance Foundation Hospital and Research Centre (IN), Garrahan Hospital (AR), Hospital Universitario La Paz (ES), King Faisal Specialist Hospital & Research Centre (SA), Hospital Italiano de Buenos Aires (AR), Max Super Speciality Hospital (IN), Karolinska Institutet (SE), Medizinische Hochschule Hannover (DE), Assistance Publique – Hôpitaux de Paris (FR), University Hospital of Geneva (CH), Ospedale Papa Giovanni XXIII (IT), Wits University Donald Gordon Medical Centre (ZA), Bambino Gesù Children's Hospital (IT), 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), National University Hospital (SG), University of Utah Health Care (US), Hospital Sírio-Libanês (BR), National University Health System (SG), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Birmingham Women’s and Children’s NHS Foundation Trust (GB), Bicêtre Hospital (FR), First Affiliated Hospital Zhejiang University (CN), ERN TRANSPLANT-CHILD (ES), Geneva College (US), University of Milano-Bicocca (IT), Zhejiang University (CN), University of Pennsylvania (US), Amrita Vishwa Vidyapeetham (IN), Bharath University (IN)
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Organ Transplantation Techniques and Outcomes
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