RISK FACTORS ASSOCIATED WITH HEPATIC ARTERY THROMBOSIS: ANALYSIS OF 1050 LIVER TRANSPLANTS

PINTO, Luis Eduardo Veras; COELHO, Gustavo Rego; COUTINHO, Madalena Maria Silva; TORRES, Orlando Jorge Martins; LEAL, Plinio Cunha; VIEIRA, Ciro Bezerra; GARCIA, José Huygens Parente

doi:10.1590/0102-672020200004e1556

Brasil

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Original Article • ABCD, arq. bras. cir. dig. 33 (04) • 2020 • https://doi.org/10.1590/0102-672020200004e1556 linkcopy

RISK FACTORS ASSOCIATED WITH HEPATIC ARTERY THROMBOSIS: ANALYSIS OF 1050 LIVER TRANSPLANTS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones.

Aim: To evaluate the risk factors for the development of hepatic artery thrombosis.

Methods: The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient.

Results: Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture.

Conclusions: Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.

HEADINGS: Risk factors; Thrombosis; Hepatic artery; Transplant

Variable	n	%
Donor gender
Male	718	68.3
Female	333	31.7
Donor age range
< 10	16	1.5
10-19	169	16.1
20-29	259	24.6
30-39	183	17.4
40-49	180	17.1
50-59	148	14.1
60-69	75	7.1
≥ 70	19	1.8
Ignorado	3	0.3
Donor blood type
A	368	35.0
AB	29	2.8
B	96	9.1
O	556	52.8
Ignored	3	0.3
Cause of death (n=1050)
TBI	602	57.3
Stroke	352	33.5
FAP	17	1.6
CNS Tumor	11	1.0
Organophosphorus	10	1.0
Cerebral edema	5	0.5
Subarachnoid hemorrhage	5	0.5
Hypoxic encephalopathy	4	0.4
In blank	3	0.3
Hydrocephaly	3	0.3
Aneurysm	2	0.2
Hypoxia	4	0.4
Intoxication	2	0.2
Other causes with one case	30	2.9

Variable	n	%
Recipient age range
< 10	5	0.5
10-19	58	5.5
20-29	80	7.6
30-39	92	8.7
40-49	201	19.1
50-59	361	34.3
60-69	234	22.2
≥ 70	21	2.0
Recipient blood type
A	377	35.8
AB	37	3.5
B	117	11.1
O	521	49.5
Etiology
HCV	317	30.1
Alcoholic cirrhosis	223	21.2
Cryptogenic	116	11.0
HBV	115	10.9
AIH	65	6.2
Fulminant hepatitis	37	3.5
Graft disfunction retx	10	1.0
PSC	17	1.6
Wilson’s disease	16	1.5
HAT	30	2.8
Buddchiari	15	1.4
Secondary biliary cirroshis	11	1.0
HCC	11	1.0
PBC	10	1.0
Other etiologies with one case	34	3.2

Variable	Positive if greater than or equal to	Sensitivity	1 - Specificity
Calculated MELD	12.50	0.828	0.866
	13.50	0.759	0.829
	14.50	0.655	0.780
	15.50	0.552	0.723
	16.50	0.483	0.679
	17.50	0.483	0.631
Adjusted MELD	16.50	0.714	0.807
	17.50	0.714	0.765
	18.50	0.643	0.690
	19.50	0.536	0.651
	20.50	0.214	0.419
Warm Ischemia Time	32.50	0.724	0.585
	33.50	0.690	0.550
	34.50	0.690	0.527
	35.50	0.690	0.407
	36.50	0.655	0.391
	37.50	0.621	0.364
	38.50	0.621	0.333

Variable	Recipient thrombosis	n	Mean	SD	p
Donor age	No	1018	35.8	16.2	0.773
Donor age	Yes	31	36.6	14.7	0.773
Recipient age	No	1021	48.8	14.6	0.369
Recipient age	Yes	31	46.4	14.8	0.369
Calculated MELD	No	982	19.7	7.0	0.043
Calculated MELD	Yes	30	17.1	6.4	0.043
Adjusted MELD	No	972	21.5	8.2	0.297
Adjusted MELD	Yes	29	19.9	5.4	0.297
WIT	No	991	342.6	113.2	0.428
WIT	Yes	31	359.0	127.6	0.428
CIT	No	991	36.7	11.4	0.005
CIT	Yes	31	44.0	13.4	0.005

	Variable in the equation	p	OR	IC95% OR
	Variable in the equation	p	OR	Lower	Upper
Step 1a	Recipient gender (male)	0.183	0.57	0.25	1.30
	Recipient age (=42 years)	0.001	4.96	2.26	10.93
	Recipient age (=55 years)	0.004	6.29	1.78	22.20
	Recipient blood type (A, AB or B)	0.863	0.93	0.41	2.11
	Calculated MELD (= 14.5)	0.034	2.35	1.07	5.18
	Adjusted MELD(= 19)	0.374	0.67	.273	1.629
	Cold ischemia time(=5 h)	0.290	0.63	.266	1.485
	Warm ischemia time (=35)	0.008	3.85	1.43	10.38
	Constant	0.363	0.27

Recipient thrombosis	Anastomosis			Total	RP	p
Recipient thrombosis	Continuous suture	%	Interrupted suture	%
Yes	7	6.7	24	2.5	31	2.63	0.018
No	98	93.3	923	97.5	1021	2.63	0.018
Total	105	100.0	947	100.0	1052

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[TFN1] TBI= trauma brain injury; FAP=firearm projectile;CNS=central nervous system