Skip to Main Content


Interrupts the graft blood supply:

  • Presentation in the early/immediate postoperative period differs from instances of delayed thrombosis”

  • Most of the irrigation of the biliary tree is derived from the hepatic artery.

  • Usually occurs within the first 2 months

  • More frequent in the pediatric population

    • Incidence in adult transplants: 3% to 10%

    • Incidence in pediatric transplants: 10% to 25%

  • Major cause of graft loss in the early postoperative period


Abdominal CT scan in early arterial phase. A 48-year-old female patient with hepatic artery thrombosis.

Risk Factors (Table 93-1)

    • Most cases of hepatic artery thrombosis do not have a clear cause

    • Low hepatic artery flow: less than 350 mL/minute

    • Age: Less than 1 year

    • Weight: Below 10 kg

    • ABO-incompatible grafts

    • Medial arcuate ligament syndrome

TABLE 93-1Potential Predisposing Factors for Hepatic Artery Thrombosis


    • Early diagnosis may prevent graft loss and potential recipient mortality.

    • Abrupt and marked elevation of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) enzymes are indicators of early HAT.

    • Serum total bilirubin, alkaline phosphatase, and gamma glutamyltransferase (GGT) levels are sensitive indicators of late HAT.

  • Radiology studies:

    • Doppler ultrasonography is used in the immediate postoperative period to screen for HAT or hepatic artery stenosis.

    • Contrast-enhanced ultrasonography is more accurate,

    • Computed tomography (CT) angiography is used to confirm the diagnosis

    • Multiphase, multislice CT angiography with multidetector reconstruction (sensitivity close to arteriography) (Fig. 93-2)

    • Magnetic resonance angiography (MRA) with contrast

    • Arteriography: Gold standard


Abdominal multiphase, multislice CT angiography with multidetector reconstruction. A 48-year-old female patient showing common hepatic artery and gastroduodenal artery with absence of the proper hepatic artery.


    • Daily routine Duplex Doppler Ultrasound evaluation in the first postoperative day that can be repeated as considered necessary.

    • HAT in the immediate postoperative period is a surgical emergency and requires immediate re-exploration to attempt thrombectomy.

    • Early diagnoses allow revascularization of the HAT through thrombectomy.

    • When thrombosis has been present for over 24-48 hours, revascularization is not usually ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.