To investigate the strategies of preventing hepatic artery thrombosis (HAT) after pediatric split liver transplantation (SLT).

Clinical data of 88 consecutive pediatric recipients undergoing SLT in the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to January 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 56 recipients were male and 32 female, aged from 2 to208 months, with a median age of 9 months. The types of donor livers included right triple lobes in 11 cases, right liver in 5 cases, left liver in 9 cases and left lateral lobes in 63 cases, respectively. The donors' arteries were anastomosed end-to-end to the recipients' arteries discontinuously with 8-0 suture under a 3.5×magnification surgical microscope, and the arterial branches were anastomosed as much as possible. The blood flow after anastomosis, before and after abdominal closure was monitored by color Doppler ultrasound and blood-flow meter. Postoperatively, heparin sodium bridges warfarin was performed for anticoagulation.

2 children developed HAT after SLT at postoperative 1 d with an incidence of 2%(2/88). These 2 children underwent SLT using the right triple lobes and left lateral lobe, respectively, and interventional thrombolysis and hepatic artery stent implantation were immediately performed. In one recipient, the hepatic artery was recanalized after stent implantation. During 48-month regular follow-up, no vascular or biliary complication was reported. The other recipient died of multiple organ failure at postoperative 2 d.

Appropriate matching of the donor-recipient arteries, intermittent anastomosis of all arterial branches under surgical microscope, standard anticoagulation regimen and perioperative blood flow monitoring can effectively prevent the incidence of HAT in pediatric SLT recipients.