Infected bilomas and hepatic artery thrombosis in infant recipients of liver transplants. Interventional radiology and medical therapy as an alternative to retransplantation

Fifteen children less than 12 kg in weight underwent transplantation of the liver for biliary atresia; eight survived. Five of the eight survivors had thrombosis of the hepatic artery without portal vein thrombosis. Three of the five patients with hepatic artery thrombosis developed infected bilomas, which were drained percutaneously under ultrasonographic (US) or computed tomographic (CT) guidance. Concurrent therapy with antibiotics and hyperoxygenation resulted in resolution of these intrahepatic collections. Although it had been thought that thrombosis of the hepatic artery most often results in necrosis of the graft and requires retransplantation, the five patients in this study survived without retransplantation. Diagnosis of hepatic artery thrombosis was achieved with the use of Doppler US in four cases, CT in four cases, and angiography in two cases. Duplex Doppler US is the preferred imaging modality.