Abstract: Objective:To investigate the influencing factors for early-stage hepatic artery thrombosis in pediatric liver transplantation.
Methods:The retrospective case-control study was conducted. The clinical data of 93 pediatric recipients who underwent liver transplantation in Children′s Hospital of Chongqing Medical University from July 2011 to November 2019 were collected. There were 50 males and 43 females, aged from 3 months to 15 years, with a median age of 7 months. The body mass of 93 children was 7.0 kg(6.5 kg, 11.0 kg). Observation indicators: (1) follow-up; (2) occurrence of early-stage hepatic artery thrombosis after operation and its treatment; (3) analysis of influencing factors for early-stage hepatic artery thrombosis after operation; (4) prediction efficiency of the ratio of volume of intraoperative urine output to body mass and the average volume of intraoperative urine output for occurrence of early-stage hepatic artery thrombosis. Follow-up using outpatient examination, telephone interview and WeChat group communication was conducted to detect occurrence of early-stage hepatic artery thrombosis within 1 month after operation. The follow-up was up to December 2019. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range) or M (P25, P75). Count data were described as absolute numbers. Univariate analysis was conducted using the Logistic test. Clinical data inconformity of Logistic test was analyzed using the Fisher exact probability. Multivariate analysis was conducted using the Logistic test. The receiver operating characteristic (ROC) curve was constructed, and the Youden index was calculated.
Results:(1) Follow-up: 93 recipients undergoing liver transplantation were followed up for 1 to 98 months, with a median follow-up time of 18 months. (2) Occurrence of early-stage hepatic artery thrombosis after operation and its treatment: Of 93 cases, 7 cases had early-stage hepatic artery thrombosis after operation including 1 male and 6 females, aged from 5 months to 15 years, with a median age of 7 months. Of 7 cases, one case had early-stage hepatic artery thrombosis for the secondary time after operation. The time to first postoperative occurrence of early-stage hepatic artery thrombosis and the operation time of liver transplantation of the 7 cases were 4 days(1 days, 9 days) and 9.0 hours(7.3 hours, 17.5 hours). All 7 cases underwent hepatic artery anastomosis in liver transplantation using 8-0 Prolene suture including 3 cases of running suture and 4 cases of interrupted suture. The diameter of hepatic artery anastomosis was from 0.25 to 0.40 cm. Of 7 cases, 4 cases underwent hepatic artery anastomosis and reconstruction in liver transplantation using the hepatic artery of donor, 2 cases underwent hepatic artery anastomosis and reconstruction in liver transplantation using the inherent hepatic artery of donor, 1 case underwent hepatic artery anastomosis and reconstruction in liver transplantation using the celiac trunk on the side wall of abdominal aorta of donor; 3 cases underwent hepatic artery anastomosis and reconstruction in liver transplantation using the proper hepatic artery of recipient, 2 cases underwent hepatic artery anastomosis and reconstruction in liver transplantation using the reconstructed artery of left and right hepatic artery of recipient, 1 case underwent hepatic artery anastomosis and reconstruction in liver transplantation using the right hepatic artery of recipient, 1 case underwent hepatic artery anastomosis and reconstruction in liver transplantation using the variated right hepatic artery of recipient. Of 7 cases, 5 cases underwent endovascular interventional thrombolysis including 1 case with a good prognosis after thrombolysis and the other 4 cases with no significant improvement in blood flow after thrombolysis confirmed by B ultrasound examination. Of 7 cases, 2 cases had good prognosis, 2 cases died of pulmonary infection, 1 case died of septic shock, 1 case died of liver failure, and 1 case died of severe capillary leakage syndrome. (3) Analysis of influencing factors for early-stage hepatic artery thrombosis after operation: results of univariate analysis showed that the source of donor liver was a related factor for early-stage hepatic artery thrombosis after operation (P<0.05), and intraoperative fluid input including the volume of intraoperative colloids input excluding blood transfusion and volume of intraoperative crystalloids input, intraoperative urine volume related indicators including volume of intraoperative urine output, ratio of volume of intraoperative urine output to body mass and the average volume of intraoperative urine output, and operation time were related factors for early-stage hepatic artery thrombosis after operation (odds ratio=0.999, 1.000, 0.996, 0.978, 0.859, 0.754, 95% confidence interval: 0.998-1.000, 0.999-1.000, 0.994-0.998, 0.966-0.990, 0.776-0.952, 0.585-0.972, P<0.05). Results of multivariate analysis showed that the volume of intraoperative colloids input excluding blood transfusion, volume of intraoperative crystalloids input, volume of intraoperative urine output, ratio of volume of intraoperative urine output to body mass, the average volume of intraoperative urine output, operation time were not independent influencing factors for early-stage hepatic artery thrombosis after operation (odds ratio=0.999, 1.000, 0.998, 0.969, 1.195, 0.840, 95% confidence interval: 0.997-1.001, 0.999-1.001, 0.995-1.000, 0.893-1.050, 0.573-2.493, 0.449-2.800, P>0.05). (4) Prediction efficiency of the ratio of volume of intraoperative urine output to body mass and the average volume of intraoperative urine output for occurrence of early-stage hepatic artery thrombosis: results of ROC curve showed when the ratio of volume of intraoperative urine output to body mass was 174.5 mL/kg, the specificity and sensitivity were 98.8% and 57.1% in predicting occurrence of early-stage hepatic artery thrombosis, and the Youden index was 0.559 (area under curve=0.799, 95% confidence interval: 0.626-0.972, P<0.05); when the average volume of intraoperative urine output was 3.715 mL/(kg·h), the specificity and sensitivity were 43.7% and 100.0% in predicting occurrence of early-stage hepatic artery thrombosis, and the Youden index was 0.430 (area under curve=0.762, 95% confidence interval: 0.593-0.932, P<0.05). Conclusion:The source of donor liver, the intraoperative fluid input, intraoperative urine volume related indicators and operation time are related factors but not independent influencing factors for early-stage hepatic artery thrombosis after operation.