Clinical Presentation of Hepatic Artery Thrombosis After Liver Transplantation in the Cyclosporine Era

Abstract

Hepatic artery thrombosis is a dreadful complication of orthotopic liver transplantation. It should be suspected in cases of fulminant liver failure, delayed bile leak, or intermittent sepsis of unknown cause after liver transplantation. Accurate diagnosis is assisted by ultrasound and computerized tomography scans, but usually requires arteriography. Prompt retransplantation is required in most of the cases.

Changes in tissue oxygenation of the porcine liver measured by near-infrared spectroscopy

“…Liver transplantation, for example, can be successfully performed in rodents without restoring the HA inflow, 19 whereas HA occlusion in human liver transplantation causes a significant postoperative morbidity and mortality. 20 This study has provided further insight into the interrelationship between the HA and PV blood flow. The portal blood flow did not increase significantly with HA occlusion, in agreement with other studies.…”

Partial dearterialization of the liver allograft

“…Complete HAT can simulate acute cellular rejection (ACR) early after OLTx [10]. Partial dearterialization of the hepatic allograft could also mimic ACR and lead to an ill-advised increase in immunosuppression and consequent opportunistic infection, as occurred in most of our patients.…”

“…On the 187 other hand. the hepatic allograft is connected to the recipient with vascular and biliary anastomoses, and HAT after OLTx results in rapid formation of a graft gangrene or delayed bile leak [10].…”

“…ACR itself has been known to be a contributing factor to the development of complete HAT [10). Although merely speCUlative.…”

“…The arterial blood supply of the liver is extremely variable, and the interruption of the hepatic artery is a feared complication in hepatobiliary or pancreatic surgical procedures, as well as in liver transplantation [2,7,10,11]. Although the clinical consequences of complete dearterialization of an allograft in orthotopic liver transplantation (OLTx) are well documented [10], little is known about the behavior of a partially dearterialized liver graft.…”