Hepatic artery complications after pediatric liver transplantation: incidence, management, and outcomes
| PhD ceremony: | Mr W. (Weihao) Li |
| When: | October 13, 2025 |
| Start: | 16:15 |
| Supervisor: | R.A.J.O. (Rudi) Dierckx |
| Co-supervisors: | dr. R.P.H. Bokkers, dr. H.P.J. van der Doef |
| Where: | Academy building RUG / Student Information & Administration |
| Faculty: | Medical Sciences / UMCG |
Hepatic artery complications after pediatric liver transplantation: incidence, management, and outcomes
Hepatic artery complications (HAC), including hepatic artery thrombosis (HAT) and stenosis (HAS), remain significant challenges after pediatric liver transplantation (pLT). Despite their clinical importance, current knowledge of HAT and HAS remains limited due to single-center studies with small cohorts. To address this gap, the HEPatic Artery stenosis and Thrombosis after liver transplantation In Children (HEPATIC) Registry was established, forming the foundation of this thesis of Weihao Li.
This thesis aims to investigate the incidence, management, and outcomes of HAC. Chapter 2 presented the protocol of the HEPATIC Registry, which collected data from 36 centers on pLTs performed between 2002 and 2022. Chapter 3 reported an overall HAC incidence of 4.9% (HAT 3.6%; HAS 1.3%). Chapter 4 showed that current evidence remains insufficient to identify the most effective treatment strategy for preventing graft failure. Chapter 5 emphasized the importance of early Doppler ultrasound screening within 24 hours after pLT. Management of early HAT (≤14 days post-pLT), particularly in cases of pediatric acute liver failure, often required surgical revascularization or immediate re-transplantation, whereas late HAT and HAS were more frequently managed conservatively or with endovascular therapy (EVT). Chapter 6 demonstrated favorable outcomes for late HAS: graft survival was 100% with EVT and 83% with conservative management among 13 patients. Chapter 7 analyzed 341 patients (3.8%) with HAT, showing that graft loss reached 58% and mortality 20% within one year of diagnosis. Finally, Chapter 8 evaluated 124 patients (1.4%) with HAS and found one-year graft and patient survival rates of 93% and 97%, respectively.
Conclusions: HAT is the principal driver of graft loss after pLT, underscoring the need for early duplex ultrasound screening and rapid intervention. Management should be timing- and phenotype-specific—favoring surgery/re-transplantation for early HAT and considering EVT for late HAS—while the field urgently needs standardized definitions, surveillance protocols, and prospective comparative studies through international collaboration.