Study On The Factors Of Hepatic Artery Thrombosis In The Early Stage Of Liver Transplantation In Children

Objective: To analyze the risk factors of hepatic artery thrombosis after liver transplantation in children,and explore the measures to further reduce the hepatic artery thrombosis after liver transplantation in children.Methods: Research methods: Retrospective case-control analysis was used.From July 2011 to November 2019,the clinical data of 98 cases of liver transplantation in Chongqing Medical University Affiliated Children's Hospital were collected,46 cases were female,aged(3.9±4.7)years old,ranging from 3 months to 15 years;Group Introduction: 7 cases of early postoperative hepatic artery thrombosis were included in the early hepatic artery thrombosis group,except 4 cases which did not meet the inclusion criteria,and the remaining 87 cases were included in the non-early hepatic artery thrombosis group.Observation indexes :(1)Information and operation of children with liver transplantation.(2)Follow-up.(3)Early hepatic artery thrombosis and its treatment.(4)Analysis of risk factors for early postoperative hepatic artery thrombosis.Follow up was performed by outpatient,telephone and WeChat group to know whether there was hepatic artery in one month after operation.All patients were followed up until December 2019.The measurement data of normal distribution is represented by mean ± SD,the counting data is represented by absolutenumber,the rank sum test is used for rank data,the single factor Logistic test is used for single factor analysis,and the ROC curve is used for prediction model analysis.Results:(1)Patients and liver transplantation operation: clinical data of 98 children with liver transplantation: 52 male and 46 female;age(3years and 11 month ± 56 months),age range 3 months to 15 years;There are 47 live liver transplantation,48 DCD liver transplantation,and 3autogenous liver transplantation.The weight of Children is 15.05±12.33 kg.;Minimum diameter of donor-recipient anastomosis arterioles(smaller diameter between donor and recipient anastomotic arteries)is 0.277±0.067 cm.Among the primary diseases were 72 cases of biliary atresia,8 cases of decompensation of primary cirrhosis,3 cases of IV stage hepatoblastoma,3cases of hepatolenticular degeneration,2 cases of glycogen accumulation,2cases of cholangiectasia type V,2 cases of carbamyl phosphatase I deficiency,2 cases of portal vein cavernous degeneration,1 case of short rib polyfinger malformation syndrome,1 case of Alagille syndrome,1 case of AIH-PSC overlap syndrome,and 1 case of cirrhosis decompensation caused by biliary obstruction.Two of them were diagnosed as urea nitrogen circulation disorder,but all the children did not have obvious abnormal preoperative creatinine,serious heart failure,respiratory failure or other serious circulatory respiratory diseases.During the operation,heparin water was used to wash the anastomoses of the hepatic arteries,and alprostadil was used routinely after the opening of the hepatic arteries.No controlled hypotension was carried out.The blood pressure was maintained by the blood circulation drugs such as dopamine,noradrenaline and adrenaline which pumped by the routine micro pump.Antibiotics were used routinely during and after the operation to prevent infection.(2)Follow-up :98children with liver transplantation were followed up for 1 month to 98 months,with a median follow-up of 18 months.Early hepatic artery thrombosis occurred in 7 cases after operation,1 case was boy,6 cases were girls,the age range was 3 months to 15 years old,the median age was July,and the early hepatic artery thrombosis occurred again after the second operation in 1 case.Two children died of pulmonary infection,one died of septic shock,one died of liver failure.Conclusion: The accumulation of experience in liver transplantation of medical team may reduce the occurrence of early HAT.Intraoperative urine volume,intraoperative fluid replacement,operative time and minimum anastomotic diameter of donor hepatic artery are independent risk factors for early hepatic artery thrombosis.When the urine to weight ratio in liver transplantation is more than 174.5ml/kg that can predict the occurrence of early hepatic artery thrombosis.The effective choice of hepatic artery branch anastomosis and good arterial anastomosis technique can reduce the incidence of hepatic artery thrombosis.