One-year outcomes of hepatic artery stenosis after pediatric liver transplantation: Results from the international, multicenter HEPATIC registry.
TL;DR
One-year graft and patient survival after hepatic artery stenosis (HAS) following pediatric liver transplantation (pLT) were high and antithrombotic therapy alone and EVT were the most common management strategies.
Abstract
Aim
This study aimed to describe one-year graft and patient survival after hepatic artery stenosis (HAS) following pediatric liver transplantation (pLT), and to explore outcomes by timing of HAS diagnosis and treatment strategy within the HAS cohort.
Methods
Patients who developed HAS after pLT were included as per definition from the HEPATIC registry. The registry contains data from 32 centers across 21 countries over a 20-year period, during which 10,564 primary pLTs were performed. Donor-, recipient-, and transplant-related characteristics were analyzed. The primary outcome was one-year graft and patient survival.
Results
HAS was diagnosed in 1.2% of patients (n = 130; 51% female; median age 4.4 years [IQR 1.4-11.6]), of whom 5% (n = 7) progressed to thrombosis (HAT). One-year graft and patient survival were 93% and 96%, respectively. Management consisted mainly of antithrombotic therapy alone (41.5%) or endovascular therapy (EVT; 41.5%), with no significant difference in one-year graft or patient survival between these approaches. Early HAS (≤21 days post-pLT) was associated with significantly higher one-year graft loss than late HAS (16%vs. 1%; p < 0.001). All deaths occurred in the early HAS group.
Conclusions
One-year graft and patient survival after HAS were high. Antithrombotic therapy alone and EVT were the most common management strategies. Early HAS was associated with lower one-year survival. Prospective studies with standardized diagnostic and treatment criteria are needed for validation.