Hepatic artery dissection after living-donor liver transplantation requires different management based on the locations and clinical outcomes: A retrospective cohort study.

Abstract

HAD is a rare complication of living donor liver transplantation (LDLT) and is associated with hepatic artery thrombosis (HAT). Given its low incidence, the clinical outcomes of HAD are not well established. This study aimed to identify the clinical outcomes of hepatic artery dissection (HAD) according to its location and extent. To achieve this, we retrospectively reviewed adult LDLT recipients at the Asan Medical Center from January 2010 to December 2022. The patients were categorized into three groups: Group 1 (confined to the proper hepatic artery, PHA), Group 2 (common hepatic artery, CHA, extending to PHA), and Group 3 (confined to the CHA). Among the 4,065 LDLT recipients, 114 (2.8%) had HAD. Of these, Group 1 accounted for 47.3% (54/114), whereas Groups 2 for 41.2% (47/114) and Group 3 for 11.4%(13/114), respectively. HAD resolved in 81.6% of the patients (93/114), with a mean resolution time of 104.3 days. Notably, HAT developed in 6.1% of the patients in Group 1 (7 cases). Furthermore, of the 5 cases (4.39%) of graft failure following HAD, 4 cases (7.41%) occurred in Group 1. In conclusion, although HAD presents with severe imaging findings, it generally has a favorable prognosis. However, when HAD involves only PHA, owing to the high risk of HAT, more frequent surveillance and aggressive management are recommended.