Introduction : Hepatic artery thrombosis (HAT) can result in biliary tree necrosis and graft loss necessitating re-transplantation. This study was performed to review the outcomes of HAT after living donor liver transplantation (LDLT), and to clarify the feasibility of different strategies.

Methods : From May 1996 to August 2017, LDLT using the right lobe was performed in 827 adult patients in our center. Diagnosis of HAT was performed using Doppler sonography and computed tomography (CT) angiography. HAT was initially treated with surgical or endovascular according to the graft condition.

Results : Among the 827 cases of LDLT using the right lobe, HAT occurred in 16 (1.9%) cases within 1 month after transplantation. Seven of these HAT cases occurred within the first week (early HAT), while the remaining nine cases occurred between the first week and 1 month (late HAT). The incidence of graft failure was high in early HAT (42.9%), and the frequency of biliary complications was high in late HAT (77.8%). The success rate of HA recanalization was 62.5%: 100% (5/5) after reoperation and 45.5% (5/11) after endovascular procedure. Of the five patients in whom treatment failed in late HAT, four underwent neovascularization during observation. Mortality occurred in three patients, including one in the surgical group and two in the endovascular group.

Conclusions : Early diagnosis and aggressive treatment of HAT are necessary to avoid graft failure, and the choice of treatment depends on various factors. Although further studies are required, early HAT requires preparation for graft failure, while late HAT requires treatment for biliary complications.