Early Hepatic Artery Thrombosis After Liver Transplantation: Diagnosis and Treatment S. Nikeghbalian, K. Kazemi, H.R. Davari, H. Salahi, A. Bahador, H. Jalaeian, M.B. Khosravi, S. Ghaffari, M. Lahsaee, M. Alizadeh, A.R. Rasekhi, S.M.R. Nejatollahi, and S.A. Malek-Hosseini ABSTRACT Background. Hepatic artery thrombosis (HAT) occurs in 3% to 9% of all liver transplantations with acute graft failure as a possible sequel. Methods. Eleven episodes of HAT were identified among 256 orthotropic liver trans- plantations (whole, LDCT, split) performed on 253 patients between April 1993 and July 2006. HAT was suspected clinically and confirmed by Doppler ultrasonography, magnetic resonance angiography, angiography, or reexploration. One patient was excluded due to poor follow-up. Treatment options included exploration with HA thrombectomy plus thrombolysis, retransplantation, or conservative treatment of hepatic and biliary compli- cations. Results. Among 11 patients of mean age 29.98  17.14 years (range, 10 months to 56 years). 2 had split right lobe liver transplantations and 9 received whole organs. None of LDLTs were identified to have HAT. The causes of liver cirrhosis among HAT patients were autoimmune hepatitis (n = 3), cryptogenic (n = 3), Wilson (n = 1), PBC (n = 1), biliary atresia (n = 1), and HBs (n = 1). HAT was diagnosed at 5.9  4.43 (range, 2 to 16) days after operation. Most patients developed right upper quadrant (RUQ) pain at presentation. Two patients developed acidosis, fever, or SIRS and underwent retransplan- tation. Four underwent exploration of HA and 1 was treated conservatively. Three cases expired due to HAT complications. Conclusion. We found RUQ pain to be the presenting sign of early HAT in majority of cases. RUQ pain has been reported to occur in late HAT. Whenever HAT is confirmed, liver transplanted patients should be revascularized or even retransplanted. Intra-arterial thrombolysis and thrombolytic therapy for HAT should be done cautiously due to the potential risk of hemorrhage. H EPATIC ARTERY thrombosis (HAT) occurs in 3% to 9% of all liver transplantations. It may present with acute graft failure, sepsis, liver failure, or biliary leak, early after transplant (within 4 weeks). 1 The presence of arterial complications signifies a poorer prognosis owing to severe graft dysfunction, which requires early diagnosis and treatment to prevent patient death. 2 The aim of this study was to report the incidence of HAT arising from 256 orthotopic liver transplants (OLT) performed over a period of 14 years. PATIENTS AND METHODS The 256 OLT were performed in 253 patients, of mean age 31.06  14 years (range, 9 months to 65 years) and predominantly men (64.4%). The most common indication was hepatic cirrhosis, with a predominance of cryptogenic causes (n = 460, 23.7%). Donor selection criteria were based on blood group compatibility, size, as well as clinical and hemodynamic parameters. Mean cold ischemia time was 570.375  187.83 minutes (range, 258 to 705). University of Wisconsin solution was used in all cases. In all cases, hepatectomy was performed followed by the piggy- From the Shiraz Transplant Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Address reprint requests to Saman Nikeghbalian, Associate Professor of Clinical Surgery and Transplantation, Shiraz Organ Transplantation Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail: transpln@sums.ac.ir © 2007 by Elsevier Inc. All rights reserved. 0041-1345/07/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2007.02.017 Transplantation Proceedings, 39, 1195–1196 (2007) 1195