{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T12:55:59Z","timestamp":1782132959680,"version":"3.54.5"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hepatic arterial occlusion after living donor liver transplantation (LDLT) can be catastrophic, yet outcomes when revascularization fails are incompletely defined. We conducted a retrospective multicenter cohort study across 10 International Living Donor Liver Transplantation Group institutions (2008\u20132022), including LDLT recipients in whom durable hepatic arterial inflow could not be achieved\u2014either intraoperatively or after postoperative occlusion despite surgical or endovascular attempts. Twenty\u2010five patients met criteria. Median time to occlusion was 8 days (IQR 2\u201346). Etiologies were hepatic artery thrombosis (72%), occlusion after transarterial embolization (12%), intimal dissection (12%), and severe anastomotic stricture (4%). Diagnosis was imaging\u2010based in 84%. Revascularization was attempted in 16 patients, restoring temporary flow in 6. Portal vein arterialization was used in 3 intraoperative failures. Biliary complications occurred in 56%, and infectious complications in 76%. Collateral\u2010driven restoration of arterial flow occurred in 3 patients, and all three remain alive without graft failure. Using the date of failed revascularization as time zero, graft survival at 1\/3\/5 years was 48%\/31%\/23% (median 306 days, IQR 21\u2010604), and overall survival 60%\/50%\/50% (median 574 days, IQR 65\u20101926); seven patients underwent retransplantation (median 430 days). Failure to revascularize within 30 days was associated with worse overall survival, while graft survival was similar. Unsuccessful revascularization after LDLT predicts poor graft outcomes with substantial biliary and infectious morbidity; collateral reperfusion, though uncommon, may enable long\u2010term graft survival.<\/jats:p>","DOI":"10.1111\/ctr.70565","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T15:20:34Z","timestamp":1778858434000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes After Unsuccessful Revascularization Following Hepatic Artery Occlusion in Living Donor Liver Transplantation: Results From an International Multicenter Study"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3078-725X","authenticated-orcid":false,"given":"Takanobu","family":"Hara","sequence":"first","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences  Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2486-3139","authenticated-orcid":false,"given":"Ryugen","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Artificial Organ and Transplant Surgery Division, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9494-3717","authenticated-orcid":false,"given":"Robert C.","family":"Minnee","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Pancreato\u2010Biliary (HPB)\/Transplant Surgery, Erasmus MC Transplant Institute University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4019-8288","authenticated-orcid":false,"given":"Takeo","family":"Toshima","sequence":"additional","affiliation":[{"name":"Department of Surgery and Science, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2344-7783","authenticated-orcid":false,"given":"Tonguc Utku","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Organ Transplantation Atakent Hospital Acibadem Mehmet Ali Aydinlar University  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4284-0633","authenticated-orcid":false,"given":"Daniel Reis","family":"Waisberg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Liver and Gastrointestinal Transplant Division University of S\u00e3o Paulo School of Medicine  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5971-6173","authenticated-orcid":false,"given":"Shinya","family":"Okumura","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Hepato\u2010Biliary\u2010Pancreatic Surgery and Transplantation, Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8391-5593","authenticated-orcid":false,"given":"Keita","family":"Shimata","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Transplantation Kumamoto University Graduate School of Medical Sciences  Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7969-1243","authenticated-orcid":false,"given":"Sathish Kumar","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of HPB and Liver Transplantation Surgery, Institute of Liver Disease and Transplantation Gleneagles Health City  Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6821-1478","authenticated-orcid":false,"given":"Daniel","family":"Zamora\u2010Vald\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Sciences and Liver Transplantation KASCH, KAMC, MNGHA  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7876-0152","authenticated-orcid":false,"given":"Susumu","family":"Eguchi","sequence":"additional","affiliation":[{"name":"Department of Surgery Nagasaki University Graduate School of Biomedical Sciences  Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5539-9280","authenticated-orcid":false,"given":"Yuji","family":"Soejima","sequence":"additional","affiliation":[{"name":"Division of Gastroenterological, Hepato\u2010Biliary\u2010Pancreatic, Transplantation and Pediatric Surgery Department of Surgery Shinshu University School of Medicine  Nagano Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1651-0430","authenticated-orcid":false,"given":"Mureo","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center, National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5792-5045","authenticated-orcid":false,"given":"Toru","family":"Ikegami","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6412-1926","authenticated-orcid":false,"given":"Kwang 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