Re-transplantation for Hepatic Artery Thrombosis: A National Perspective

Background: Hepatic artery thrombosis (HAT) is a major complication after liver transplantation that commonly requires re-transplantation. Methods: We queried the UNOS dataset for all patients transplanted between 1995 and 2015 for HAT. Results: We identified 623 patients who underwent re-transplantation for HAT with a mean age of 51.25 + 10.4 years. The mean BMI was 26.72 kg/m², and mean MELD score was 19.62 + 9.09. There was a higher proportion of male patients, with higher prevalence of pre-transplant portal vein thrombosis (7.4 vs. 5.4%, p = 0.04), lower incidence of hepatitis C virus infection (29.5 vs. 35.8%, p = 0.002), and shorter waiting time (61 vs. 111 days, p = 0.001) in the HAT group compared to those re-transplanted for other indications. The perioperative 90-day mortality was lower in patients re-transplanted for HAT (16 vs. 20%, p = 0.02). Patients undergoing re-transplantation for HAT had 13% decreased graft survival and 13% increased long-term survival. After case–control matched analysis, graft survival and patient survival were significantly better in the HAT group. Late re-transplantation (>30 days) for HAT was linked to decreased graft and patient survival when compared to those undergoing early re-transplantation (within 30 days). Conclusions: Improved outcomes were seen in patients undergoing re-transplantation for HAT compared to patients who underwent re-transplantation for other indications. Those re-transplanted late after HAT (>30 days) were associated with worse outcomes when compared to early re-transplantation.