Background: Hepatic artery stenosis (HAS) after pediatric liver transplantation (pLT) can progress to hepatic artery thrombosis, biliary complications, graft failure, and death. However, there is a lack of robust studies investigating outcomes of HAS after pLT. This study aimed to determine one-year graft and patient survival rates and identify risk factors associated with adverse outcomes in patients who develop HAS after pLT.
Methods: We analyzed data from patients who developed HAS after pLT from the HEPatic Artery stenosis and Thrombosis after liver transplantation In Children (HEPATIC) registry. This registry includes data from 24 centers across 20 countries and six continents, spanning a 20-year period during which 8,469 pLTs were performed. Clinical characteristics were examined at three timeframes: pre-transplant, immediate post-transplant, and after HAS diagnosis. Risk factors for graft loss and mortality after HAS were identified using multivariate Cox regression analyses, with model assumptions verified using Schoenfeld residuals.
Results: HAS was reported in 119 patients (estimated 1.4%; 51% female; median age 4.2 years). The overall one-year graft and patient survival rates after HAS diagnosis were 93% (95% CI: 89–98) and 97% (95% CI: 93–100), respectively. Multivariate Cox regression analysis identified dialysis requirement at HAS diagnosis as the sole independent risk factor for both one-year graft loss (p < 0.01) and mortality (p = 0.01).
Conclusions: HAS after pLT is associated with favorable one-year outcomes, with risk factors for unfavorable outcomes generally lacking. In patients requiring dialysis at the time of HAS diagnosis, other factors are more likely to contribute to multi-organ failure and poor outcomes. Future studies are needed to identify best clinical practice and treatment strategies for pediatric patients with HAS.