Hepatic artery thrombosis (HAT) is a devastating complication that occurs in 3-9% of all liver transplantations and acute graft failure is a possible sequel. It may present with acute graft failure, sepsis or liver abscess, or a bile duct complication such as biliary leak or stricture. Methods: All 11 episodes of HAT were identified among 242 orthotropic liver transplantations (whole, LDCT, Split) that were performed on 238 patients, between April 1993 and July 2006, in a single liver transplant center in Iran. HAT was suspected clinically and confirmed by DUS, MRA, Angiography, or reexploration. One patient was excluded from the study due to poor follow up. Treatment options included exploration with HA thrombectomy plus thrombolysis, retransplantation, or conservative treatment of hepatic and biliary complications. One patient was excluded Due to poor follow up. Among 11 patients with mean age of 26.6 years (10 months -56 years), 2 had split right lobe liver transplantation and 9 received whole organ. None of LDLD was identified to have HAT. The causes of liver cirrhosis were auto immune hepatitis (n=3), Cryptogenic (n=3), Wilson (n=l), PBC (n=1), biliary atresia (n=l), and HBs (n=1). HAT was diagnosed 7.8 (2-16) days after operation. Most patients developed RUQ pain at presentation. Two patients developed acidosis, fever, or SIRS and underwent retransplantation. Four underwent exploration of HA and 1 treated conservatively. Three cases expired due to HAT complications.
Conclusion: We found RUQ pain as the presenting sign of early HAT in majority of cases. RUQ pain is reported to occur in late HAT. Whenever HAT is confirmed, LT patients should be revascularized or even retransplanted. Intra arterial thrombolysis and throbmolytic therapy for HAT should be done cautiously due to the potential risk of hemorrhage.