Treatment of Early Hepatic Artery Thrombosis After Liver Transplantation

• Published in: Transplantation proceedings Vol. 43; no. 8; pp. 3039 - 3042
• Main Authors: Grodzicki, M, Anysz-Grodzicka, A, Remiszewski, P, Cieślak, B, Kotulski, M, Kalinowski, P, Paluszkiewicz, R, Rowiński, O, Krawczyk, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.10.2011; Elsevier
• Subjects: Acute Disease; Angioplasty; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endovascular Procedures; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatic Artery - surgery; Humans; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - surgery; Radiography; Reoperation; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thrombosis - diagnostic imaging; Thrombosis - etiology; Thrombosis - surgery; Time Factors; Tissue, organ and graft immunology; Hepatic artery; Digestive system; Liver; Cardiovascular disease; Homotransplantation; Arterial disease; Vascular disease; Medicine; Treatment; Surgery; Graft; Early; Artery thrombosis; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.08.028

Abstract Introduction Early hepatic artery thrombosis remains one of the major causes of graft failure and mortality in liver transplant recipients. It is the most frequent severe vascular complication after orthotopic liver transplantation (OLT) accounting for >50% of all arterial complications. Most patients need to be considered for urgent liver retransplantation. Materials and Methods Among 911 OLTs in 862 from 1989 to 2011, we observed 23 cases (2.6%) of acute early hepatic artery thrombosis. Seventeen patients were qualified immediately for liver retransplantation, and 6 underwent endovascular therapies, including intra-arterial heparin infusion or percutaneous transluminal angioplasty with stent placement. Results Among patients who were assigned to early liver retransplantation, 11/17 survived with 3 succumbling due to postoperative complications, including 1 portal vein thrombosis, and 3 succumbling on the waiting list. All patients who underwent endovascular therapy survived with an excellent result obtained in 1 who underwent treatment <24 hours after arterial thrombosis. In 2 patients we achieved a satisfactory result not requiring retransplantation, but 3 patients assigned to endovascular treatment >24 hours after arterial thrombosis needed to be reassigned to liver retransplantation because of poor results of endovascular treatment. Conclusions Endovascular treatment efforts should be made to rescue liver grafts through urgent revascularization depending on the patient's condition and the interventional expertise at the transplant center, reserving the option of retransplantation for graft failure or severe dysfunction.