Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation

Seigo Nishida, Tomoaki Kato, David Levi, Naveen K Mittal, Berney Thierry, Rodrigo Vianna, Gennaro Selvaggi, Efren Buitorago, Ahmed Al-Niami, Noboru Nakamura, Anil Vaidya, Jose Nery, Andreas Tzakis

Research output: Contribution to journalArticle

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Abstract

Hypothesis: Protocol Doppler ultrasonography of the liver (DUSL) is useful for detecting early hepatic artery thrombosis (HAT). Urgent exploration based on DUSL findings and immediate revascularization of the liver may avoid HAT-related sequelae, namely, biliary complications and retransplantation after pediatric liver transplantation. Design: Case-control study. Setting: University hospital. Patients: Group 1 included 96 liver transplantations performed in 75 pediatric patients from June 1, 1994, to August 31, 1999. Group 2 included 43 liver transplantations performed in 39 pediatric patients from September 1, 1999, to September 30, 2001. Intervention: In group 1, DUSL was performed on the first posttransplantation day or on request. Angiographic confirmation of suggested HAT was treated with thrombolysis, angioplasty, or thrombectomy. In group 2, protocol DUSL was performed every 12 hours in the first week and every 24 hours in the second week. The suspicion of HAT warranted urgent surgery without the patient undergoing angiography. Main Outcome Measures: Incidence of HAT, biliary complications, and retransplantation. Graft and patient survival. Hospital stay, and number of admissions and operations after undergoing HAT. Results: The incidence of HAT was 10.4% (10 of 96 transplantations) in group 1 and 7.0% (3 of 43 transplantations) in group 2. The incidence of biliary complications after HAT was 100% in group 1 and 0% in group 2 (P = .02). The incidence of retransplantation after HAT was 90.0% (9 of 10 patients) in group 1 and 0% in group 2 (P = .01). Of the 10 patients who experienced HAT in group 1, 5 patients underwent early retransplantation (mean length of time, 13.2 days). All 5 patients who did not undergo early retransplantation had biliary complications. Four of these 5 patients underwent retrasplantation at a later time (mean length of time, 687 days). In group 2, DUSL identified early HAT in 3 patients (7.0%). Emergent thrombectomy and arterial reconstruction were undertaken. All 3 (100%) have their original graft and are alive. None experienced biliary complications. One-year graft and patient survival is 72.0% and 84.0%, respectively, in group 1 and 80.0% and 85.0%, respectively, in group 2. Shorter hospital stay, fewer readmissions, and surgery after HAT were noted in group 2. Conclusions: Protocol DUSL detects early HAT and urgent revascularization based on DUSL can significantly reduce the incidence of biliary complication and graft loss requiring retransplantation in pediatric liver transplantation.

Original languageEnglish (US)
Pages (from-to)1279-1283
Number of pages5
JournalArchives of Surgery
Volume137
Issue number11
StatePublished - Nov 1 2002
Externally publishedYes

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Doppler Ultrasonography
Hepatic Artery
Liver Transplantation
Thrombosis
Pediatrics
Liver
Incidence
Thrombectomy
Graft Survival
Length of Stay
Transplantation
Transplants
Angioplasty
Case-Control Studies
Angiography

ASJC Scopus subject areas

  • Surgery

Cite this

Nishida, S., Kato, T., Levi, D., Mittal, N. K., Thierry, B., Vianna, R., ... Tzakis, A. (2002). Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation. Archives of Surgery, 137(11), 1279-1283.

Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation. / Nishida, Seigo; Kato, Tomoaki; Levi, David; Mittal, Naveen K; Thierry, Berney; Vianna, Rodrigo; Selvaggi, Gennaro; Buitorago, Efren; Al-Niami, Ahmed; Nakamura, Noboru; Vaidya, Anil; Nery, Jose; Tzakis, Andreas.

In: Archives of Surgery, Vol. 137, No. 11, 01.11.2002, p. 1279-1283.

Research output: Contribution to journalArticle

Nishida, S, Kato, T, Levi, D, Mittal, NK, Thierry, B, Vianna, R, Selvaggi, G, Buitorago, E, Al-Niami, A, Nakamura, N, Vaidya, A, Nery, J & Tzakis, A 2002, 'Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation', Archives of Surgery, vol. 137, no. 11, pp. 1279-1283.
Nishida, Seigo ; Kato, Tomoaki ; Levi, David ; Mittal, Naveen K ; Thierry, Berney ; Vianna, Rodrigo ; Selvaggi, Gennaro ; Buitorago, Efren ; Al-Niami, Ahmed ; Nakamura, Noboru ; Vaidya, Anil ; Nery, Jose ; Tzakis, Andreas. / Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation. In: Archives of Surgery. 2002 ; Vol. 137, No. 11. pp. 1279-1283.
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abstract = "Hypothesis: Protocol Doppler ultrasonography of the liver (DUSL) is useful for detecting early hepatic artery thrombosis (HAT). Urgent exploration based on DUSL findings and immediate revascularization of the liver may avoid HAT-related sequelae, namely, biliary complications and retransplantation after pediatric liver transplantation. Design: Case-control study. Setting: University hospital. Patients: Group 1 included 96 liver transplantations performed in 75 pediatric patients from June 1, 1994, to August 31, 1999. Group 2 included 43 liver transplantations performed in 39 pediatric patients from September 1, 1999, to September 30, 2001. Intervention: In group 1, DUSL was performed on the first posttransplantation day or on request. Angiographic confirmation of suggested HAT was treated with thrombolysis, angioplasty, or thrombectomy. In group 2, protocol DUSL was performed every 12 hours in the first week and every 24 hours in the second week. The suspicion of HAT warranted urgent surgery without the patient undergoing angiography. Main Outcome Measures: Incidence of HAT, biliary complications, and retransplantation. Graft and patient survival. Hospital stay, and number of admissions and operations after undergoing HAT. Results: The incidence of HAT was 10.4{\%} (10 of 96 transplantations) in group 1 and 7.0{\%} (3 of 43 transplantations) in group 2. The incidence of biliary complications after HAT was 100{\%} in group 1 and 0{\%} in group 2 (P = .02). The incidence of retransplantation after HAT was 90.0{\%} (9 of 10 patients) in group 1 and 0{\%} in group 2 (P = .01). Of the 10 patients who experienced HAT in group 1, 5 patients underwent early retransplantation (mean length of time, 13.2 days). All 5 patients who did not undergo early retransplantation had biliary complications. Four of these 5 patients underwent retrasplantation at a later time (mean length of time, 687 days). In group 2, DUSL identified early HAT in 3 patients (7.0{\%}). Emergent thrombectomy and arterial reconstruction were undertaken. All 3 (100{\%}) have their original graft and are alive. None experienced biliary complications. One-year graft and patient survival is 72.0{\%} and 84.0{\%}, respectively, in group 1 and 80.0{\%} and 85.0{\%}, respectively, in group 2. Shorter hospital stay, fewer readmissions, and surgery after HAT were noted in group 2. Conclusions: Protocol DUSL detects early HAT and urgent revascularization based on DUSL can significantly reduce the incidence of biliary complication and graft loss requiring retransplantation in pediatric liver transplantation.",
author = "Seigo Nishida and Tomoaki Kato and David Levi and Mittal, {Naveen K} and Berney Thierry and Rodrigo Vianna and Gennaro Selvaggi and Efren Buitorago and Ahmed Al-Niami and Noboru Nakamura and Anil Vaidya and Jose Nery and Andreas Tzakis",
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T1 - Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation

AU - Nishida, Seigo

AU - Kato, Tomoaki

AU - Levi, David

AU - Mittal, Naveen K

AU - Thierry, Berney

AU - Vianna, Rodrigo

AU - Selvaggi, Gennaro

AU - Buitorago, Efren

AU - Al-Niami, Ahmed

AU - Nakamura, Noboru

AU - Vaidya, Anil

AU - Nery, Jose

AU - Tzakis, Andreas

PY - 2002/11/1

Y1 - 2002/11/1

N2 - Hypothesis: Protocol Doppler ultrasonography of the liver (DUSL) is useful for detecting early hepatic artery thrombosis (HAT). Urgent exploration based on DUSL findings and immediate revascularization of the liver may avoid HAT-related sequelae, namely, biliary complications and retransplantation after pediatric liver transplantation. Design: Case-control study. Setting: University hospital. Patients: Group 1 included 96 liver transplantations performed in 75 pediatric patients from June 1, 1994, to August 31, 1999. Group 2 included 43 liver transplantations performed in 39 pediatric patients from September 1, 1999, to September 30, 2001. Intervention: In group 1, DUSL was performed on the first posttransplantation day or on request. Angiographic confirmation of suggested HAT was treated with thrombolysis, angioplasty, or thrombectomy. In group 2, protocol DUSL was performed every 12 hours in the first week and every 24 hours in the second week. The suspicion of HAT warranted urgent surgery without the patient undergoing angiography. Main Outcome Measures: Incidence of HAT, biliary complications, and retransplantation. Graft and patient survival. Hospital stay, and number of admissions and operations after undergoing HAT. Results: The incidence of HAT was 10.4% (10 of 96 transplantations) in group 1 and 7.0% (3 of 43 transplantations) in group 2. The incidence of biliary complications after HAT was 100% in group 1 and 0% in group 2 (P = .02). The incidence of retransplantation after HAT was 90.0% (9 of 10 patients) in group 1 and 0% in group 2 (P = .01). Of the 10 patients who experienced HAT in group 1, 5 patients underwent early retransplantation (mean length of time, 13.2 days). All 5 patients who did not undergo early retransplantation had biliary complications. Four of these 5 patients underwent retrasplantation at a later time (mean length of time, 687 days). In group 2, DUSL identified early HAT in 3 patients (7.0%). Emergent thrombectomy and arterial reconstruction were undertaken. All 3 (100%) have their original graft and are alive. None experienced biliary complications. One-year graft and patient survival is 72.0% and 84.0%, respectively, in group 1 and 80.0% and 85.0%, respectively, in group 2. Shorter hospital stay, fewer readmissions, and surgery after HAT were noted in group 2. Conclusions: Protocol DUSL detects early HAT and urgent revascularization based on DUSL can significantly reduce the incidence of biliary complication and graft loss requiring retransplantation in pediatric liver transplantation.

AB - Hypothesis: Protocol Doppler ultrasonography of the liver (DUSL) is useful for detecting early hepatic artery thrombosis (HAT). Urgent exploration based on DUSL findings and immediate revascularization of the liver may avoid HAT-related sequelae, namely, biliary complications and retransplantation after pediatric liver transplantation. Design: Case-control study. Setting: University hospital. Patients: Group 1 included 96 liver transplantations performed in 75 pediatric patients from June 1, 1994, to August 31, 1999. Group 2 included 43 liver transplantations performed in 39 pediatric patients from September 1, 1999, to September 30, 2001. Intervention: In group 1, DUSL was performed on the first posttransplantation day or on request. Angiographic confirmation of suggested HAT was treated with thrombolysis, angioplasty, or thrombectomy. In group 2, protocol DUSL was performed every 12 hours in the first week and every 24 hours in the second week. The suspicion of HAT warranted urgent surgery without the patient undergoing angiography. Main Outcome Measures: Incidence of HAT, biliary complications, and retransplantation. Graft and patient survival. Hospital stay, and number of admissions and operations after undergoing HAT. Results: The incidence of HAT was 10.4% (10 of 96 transplantations) in group 1 and 7.0% (3 of 43 transplantations) in group 2. The incidence of biliary complications after HAT was 100% in group 1 and 0% in group 2 (P = .02). The incidence of retransplantation after HAT was 90.0% (9 of 10 patients) in group 1 and 0% in group 2 (P = .01). Of the 10 patients who experienced HAT in group 1, 5 patients underwent early retransplantation (mean length of time, 13.2 days). All 5 patients who did not undergo early retransplantation had biliary complications. Four of these 5 patients underwent retrasplantation at a later time (mean length of time, 687 days). In group 2, DUSL identified early HAT in 3 patients (7.0%). Emergent thrombectomy and arterial reconstruction were undertaken. All 3 (100%) have their original graft and are alive. None experienced biliary complications. One-year graft and patient survival is 72.0% and 84.0%, respectively, in group 1 and 80.0% and 85.0%, respectively, in group 2. Shorter hospital stay, fewer readmissions, and surgery after HAT were noted in group 2. Conclusions: Protocol DUSL detects early HAT and urgent revascularization based on DUSL can significantly reduce the incidence of biliary complication and graft loss requiring retransplantation in pediatric liver transplantation.

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