Piscaglia F et al. (2007) Analysis of risk factors for early hepatic artery thrombosis after liver transplantation: possible contribution of reperfusion in the early morning. Dig Liver Dis 39: 52–59

Hepatic artery thrombosis is a severe, early complication of orthotopic liver transplantation (OLT), with a reported mean incidence of 4–15% in adults; however, it remains unclear which patients are at the greatest risk of this complication. Since the incidence of other arterial thrombotic events is highest in the early morning when there is a relatively hypercoagulable state, Piscaglia et al. hypothesized that patients who undergo reperfusion after OLT during the early morning would have an increased risk of early hepatic artery thrombosis.

Piscaglia et al. retrospectively analyzed medical records from 255 consecutive patients who underwent a first liver transplant for chronic liver disease. Early hepatic artery thrombosis (<30 days from transplantation) occurred in 12 patients (4.7%). The incidence of hepatic artery thrombosis in the high-coagulability group (reperfusion between 0600 h and 1000 h) was about three times that of patients in the low-coagulability group (reperfusion at all other times): 7 of 78 patients (9.0%) and 5 of 177 patients (2.8%), respectively.

Three factors were found to be independent predictors of early hepatic artery thrombosis: increased donor age (odds ratio [OR] for age >60 years 6.84), bench reconstruction of the artery (OR 5.06) and graft reperfusion during the time of high coagulability (OR 2.93). The authors suggest that candidates for OLT with one or more of these risk factors for early hepatic artery thrombosis should receive strict early postoperative surveillance.