The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia

Christopher R. Shackleton, John A. Goss, Kim Swenson, Steven D. Colquhoun, Philip Seu, Milan Kinkhabwala, Stephen M. Rudich, Jay S. Markowitz, Suzanne V. McDiarmid, Ronald W. Busuttil

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

BACKGROUND: Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival. METHODS: A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR. RESULTS: Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71%, 61%, and 57% versus 85%, 85%, and 85%, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19%), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81% in group 1 and 100% in group 2 (P = 0.02). CONCLUSIONS: In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.

Original languageEnglish (US)
Pages (from-to)431-435
Number of pages5
JournalAmerican Journal of Surgery
Volume173
Issue number5
DOIs
StatePublished - May 1997
Externally publishedYes

Fingerprint

Biliary Atresia
Hepatic Artery
Liver Transplantation
Thrombosis
Liver
Survival
Incidence
Bilirubin
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia. / Shackleton, Christopher R.; Goss, John A.; Swenson, Kim; Colquhoun, Steven D.; Seu, Philip; Kinkhabwala, Milan; Rudich, Stephen M.; Markowitz, Jay S.; McDiarmid, Suzanne V.; Busuttil, Ronald W.

In: American Journal of Surgery, Vol. 173, No. 5, 05.1997, p. 431-435.

Research output: Contribution to journalArticle

Shackleton, CR, Goss, JA, Swenson, K, Colquhoun, SD, Seu, P, Kinkhabwala, M, Rudich, SM, Markowitz, JS, McDiarmid, SV & Busuttil, RW 1997, 'The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia', American Journal of Surgery, vol. 173, no. 5, pp. 431-435. https://doi.org/10.1016/S0002-9610(97)00066-4
Shackleton, Christopher R. ; Goss, John A. ; Swenson, Kim ; Colquhoun, Steven D. ; Seu, Philip ; Kinkhabwala, Milan ; Rudich, Stephen M. ; Markowitz, Jay S. ; McDiarmid, Suzanne V. ; Busuttil, Ronald W. / The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia. In: American Journal of Surgery. 1997 ; Vol. 173, No. 5. pp. 431-435.
@article{84635381434643f498d213c10611e9a9,
title = "The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia",
abstract = "BACKGROUND: Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival. METHODS: A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR. RESULTS: Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71{\%}, 61{\%}, and 57{\%} versus 85{\%}, 85{\%}, and 85{\%}, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19{\%}), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81{\%} in group 1 and 100{\%} in group 2 (P = 0.02). CONCLUSIONS: In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.",
author = "Shackleton, {Christopher R.} and Goss, {John A.} and Kim Swenson and Colquhoun, {Steven D.} and Philip Seu and Milan Kinkhabwala and Rudich, {Stephen M.} and Markowitz, {Jay S.} and McDiarmid, {Suzanne V.} and Busuttil, {Ronald W.}",
year = "1997",
month = "5",
doi = "10.1016/S0002-9610(97)00066-4",
language = "English (US)",
volume = "173",
pages = "431--435",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - The impact of microsurgical hepatic arterial reconstruction on the outcome of liver transplantation for congenital biliary atresia

AU - Shackleton, Christopher R.

AU - Goss, John A.

AU - Swenson, Kim

AU - Colquhoun, Steven D.

AU - Seu, Philip

AU - Kinkhabwala, Milan

AU - Rudich, Stephen M.

AU - Markowitz, Jay S.

AU - McDiarmid, Suzanne V.

AU - Busuttil, Ronald W.

PY - 1997/5

Y1 - 1997/5

N2 - BACKGROUND: Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival. METHODS: A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR. RESULTS: Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71%, 61%, and 57% versus 85%, 85%, and 85%, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19%), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81% in group 1 and 100% in group 2 (P = 0.02). CONCLUSIONS: In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.

AB - BACKGROUND: Hepatic artery thrombosis (HAT) after liver transplantation for biliary atresia (BA) is a serious complication that most often leads to retransplantation (re-OLT). The purpose of the present study was: (1) to identify risk factors associated with HAT and (2) to analyze the impact of recently introduced microsurgical hepatic arterial reconstruction (MHR) on the incidence of HAT, subsequent need for re-OLT, and patient survival. METHODS: A retrospective review of 194 patients transplanted for BA was performed. One hundred and sixty-six patients (group 1) underwent conventional arterial reconstruction and 28 (group 2) had MHR. RESULTS: Actuarial survival for patients with HAT was significantly worse than for patients without HAT at 1, 2, and 5 years (71%, 61%, and 57% versus 85%, 85%, and 85%, P = 0.0007). Stepwise logistic regression analysis revealed that the risk of HAT correlated best with the type of arterial reconstruction (P = 0.007) followed by pretransplant bilirubin concentration (P = 0.04) and the number of acute rejection episodes (P = 0.03). In group 1, 32 patients developed HAT (19%), and of these, 18 underwent re-OLT for HAT. No patient in group 2 developed HAT (P = 0.006 versus group 1). One-year actuarial patient survival was 81% in group 1 and 100% in group 2 (P = 0.02). CONCLUSIONS: In OLT for BA, (1) the predominant risk factor for HAT is the technique of arterial reconstruction, and (2) MHR markedly reduces the incidence of HAT and the need for re-OLT while improving patient survival.

UR - http://www.scopus.com/inward/record.url?scp=17644445066&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=17644445066&partnerID=8YFLogxK

U2 - 10.1016/S0002-9610(97)00066-4

DO - 10.1016/S0002-9610(97)00066-4

M3 - Article

C2 - 9168083

AN - SCOPUS:17644445066

VL - 173

SP - 431

EP - 435

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 5

ER -