PREVENTION OF BILIARY-CIRRHOSIS FOLLOWING HEPATIC ARTERIAL THROMBOSIS AFTER LIVER-TRANSPLANTATION IN CHILDREN BY USING URSODEOXYCHOLIC ACID

Hepatic artery thrombosis (HAT) after liver transplantation is a severe complication that often requires retransplantation. The authors have adopted a different approach, aimed at treating the perioperative HAT complications aggressively and early, with ursodeoxycholic acid (UDCA), to try to preserve the original graft. Eighty-six liver transplants were performed in 73 children (age range, 4.5 months to 17.5 years; median, 2.6 years). HAT occurred eight times, in seven patients (9.3%). Patients with HAT were significantly younger and smaller (mean age, 0.8 +/- 0.4 v 4.8 +/- 5.3 years; P < .02; mean weight, 7.4 +/- 0.8 v 18.7 +/- 16.2 kg; P < .05). The incidence of HAT varied significantly according to the method of arterial reconstruction used: 4 of 16 (25%) when a donor iliac artery interposition graft to the aorta was used, 4 of 61 (6.6%) when the native hepatic artery was used, and 0 of 9 when the donor celiac axis was anastomosed directly to the aorta (P < .05). The incidence of HAT was not significantly different when reduced size grafts were used. Early retransplantation was performed in three of the eight patients; two survived. All other patients were treated for 4 to 6 weeks with broad-spectrum antibiotics and amphotericin. Five patients were treated with UDCA, three immediately after the acute event and two after 4 and 6 months (respectively) post-HAT. The patients who had UDCA immediately post-HAT had histologically normal liver biopsy specimens. Results of liver function tests have been normal. One of these patients required transhepatic stenting of a common bile duct stricture for several months. For the two patients whose UDCA treatment began 4 or 6 months after HAT, sequential biopsy specimens showed progressive evolution of biliary cirrhosis, which led to the need for retransplantation in both patients, 4 and 3.5 years (respectively) after the original transplants. The authors believe that early initiation of UDCA treatment after liver transplantation and HAT may prevent the hepatotoxic effect of cholestasis and bile salt retention and the accompanying biliary cirrhosis. Copyright (C) 1995 by W.B. Saunders Company