Development of intrahepatic arterial shunts in a transplanted liver: A potential pitfall for Doppler sonography

Wolf, R.F.E.; Porte, Robert J.; Vliet, TM van der; Kok, Theo M. de

doi:10.1002/jcu.1057

Cited by 4 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Each extra anastomosis was associated with an approximately 2‐fold increased risk of E‐HAT. The other findings from the logistic regression concerning previous HAT and a small donor weight appear to be logical and in agreement with the literature . We advise routine daily monitoring of the arterial flow by Doppler US in the early postoperative period in the presence of 1 or both of these risk factors.…”

Section: Discussionsupporting

confidence: 87%

“…At our unit, the management of E‐HAT depends on hepatic ischemic changes detected on scans and the degree of deranged liver transaminases. Early cases with an unaffected hepatic parenchyma and normal transaminases were considered for urgent relaparotomy and revascularization, and there were excellent outcomes for both adults and children (4 cases in our series with a success rate of 75%). De Gaetano et al, Langnas et al, and Pinna et al have reported that prompt revascularization (either surgical or radiological) decreases the need for retransplantation in E‐HAT cases.…”

Section: Discussionmentioning

confidence: 77%

“…Graft function after LT is dependent on sufficient arterial perfusion. In contrast, the native liver has the ability to withstand even a major obstruction to its arterial hepatic blood flow through collaterals arising from the intrahepatic LHA or RHA, superior mesenteric artery, SA, inferior phrenic artery, left gastric artery, and arteries of the omentum and duodenum . Consequently, HAT after LT is devastating and requires urgent revascularization.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Etiology and management of hepatic artery thrombosis after adult liver transplantation

et al. 2014

View full text Add to dashboard Cite

Hepatic artery thrombosis (HAT) represents a major cause of graft loss and mortality after liver transplantation. It occurs in up to 9% of adult recipients. The early diagnosis of HAT decreases septic complications, multiorgan failure, and graft loss, and there are better outcomes after treatment. In this study, we reviewed 102 episodes of HAT, which were classified as early hepatic artery thrombosis (E-HAT) when they were diagnosed within the first 21 days after transplantation. The overall incidence of HAT was 7%: 31 episodes (30.4%) were identified as E-HAT, and 71 episodes (69.6%) were identified as late hepatic artery thrombosis (L-HAT). Graft dysfunction was the commonest presentation (30 cases or 29%). Most E-HAT cases were managed with retransplantation (74%), whereas early revascularization was carried out for only 13% with a 75% success rate. The incidence of retransplantation for L-HAT was only 41%, whereas 32% were too ill for relisting and eventually died. Successful conservative management was noted for 13 of the 102 patients (13%) with collateralization and good hepatic perfusion, with biliary complications encountered in 7 cases (54%) subsequently. A multivariate analysis showed that previous episodes of HAT, the number of arterial anastomoses, and a low donor weight were independent risk factors for E-HAT, whereas a history of upper abdominal operations (non-HAT), a previous history of HAT, a low donor weight, and a recipient age < 50 years were independent risk factors for L-HAT. The graft survival rates for HAT patients were 52%, 36.6%, and 27.4% at 1, 3, and 5 years, whereas the corresponding rates were 81.4%, 81.2%, and 76.4% for non-HAT patients. In conclusion, prompt revascularization for E-HAT patients decreases the incidence of serious, irreversible septic complications and graft loss and improves overall outcomes. A significant number of L-HAT patients do not require further intervention despite the high incidence of ischemic cholangiopathy. Liver transplantation (LT) is the ideal therapy for endstage liver disease. Vascular complications after LT are not uncommon despite the marked improvements and innovations in anastomotic vascular techniques; they frequently result in hepatic insufficiency and graft failure and thus the need for retransplantation.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Etiology and management of hepatic artery thrombosis after adult liver transplantation

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In addition, hepatic perfusion may be abnormal 10 days after transplantation given changes in vascularization and development of portosystemic shunting. 31,32 It is also unclear in this liver transplant study whether residual cyclosporine, which could potentially compete with midazolam for CYP3A enzymes in vitro, may have been present in liver biopsy samples.…”

Section: A Sampling Of Studies Assessing the Validity Of Midazolam Asmentioning

confidence: 89%

An evaluation of the suitability of intravenous midazolam as an in vivo marker for hepatic cytochrome P4503A activity

Rogers

2003

Clin Pharma and Therapeutics

View full text Add to dashboard Cite

Phenotyping is used to characterize hepatic drugmetabolizing enzyme activity as influenced by pharmacogenetics and environmental exposure. In many instances, phenotyping for hepatic drug-metabolizing enzyme activity involves the intravenous administration of a suitable biomarker (often a drug) and the determination of its total systemic clearance (CL). This procedure assumes that CL is correlated with the intrinsic hepatic clearance of the drug from plasma (CL int ), a measure of intrinsic hepatic enzyme activity. Ideally, the biomarker used for such evaluations should be completely metabolized by the liver, have a low hepatic extraction ratio (E H ) (ie, E H Յ 0.3), be minimally bound to plasma proteins, and be administered intravenously. 1 Intravenous midazolam is suggested to be an in vivo biomarker of hepatic cytochrome P4503A (CYP3A) activity. Notably, the United States Food and Drug Administration advocates its use for this purpose for in vivo drug metabolism and drug interaction studies. 2,3 Both oral and intravenous midazolam are used in these studies; however, this commentary is limited to discussion of intravenous midazolam. The use of intravenous midazolam as a biomarker of hepatic CYP3A activity assumes that midazolam CL is correlated with the CL int of midazolam, which in turn reflects hepatic CYP3A activity. Although we and other investigators use intra-venous midazolam as an in vivo biomarker of hepatic CYP3A activity for phenotyping and drug interaction evaluations, we have some concerns about whether midazolam CL truly reflects the CL int of midazolam in all instances. This commentary discusses these concerns. WELL-STIRRED MODEL OF HEPATIC CLEARANCETo examine the suitability of midazolam as an in vivo biomarker of hepatic CYP3A activity, we applied the well-stirred model of hepatic clearance. 4 It is appreciated that the well-stirred model oversimplifies midazolam clearance in that gastrointestinal CYP3A also contributes to the elimination of midazolam, thus making a splanchnic model for the elimination of midazolam more appropriate. Splanchnic models, however, are complex and of limited predictive value given that the gastrointestinal tract and liver are perfused in both a parallel and a sequential fashion. 5 As a result, splanchnic clearance is not simply the sum of gastrointestinal and hepatic clearance. 5 The well-stirred model assumes that the liver is a single well-stirred compartment and that unbound drug in hepatic venous blood is in equilibrium with unbound drug in the liver. With this model, the hepatic clearance of a drug (CL H ) can be described by equation 1:where Q H is liver blood flow and f u is the unbound fraction of drug in blood. Application of this model allows prediction of CL H relative to changes in Q H , f u , and CL int . This model equation can be simplified for low (E H Յ 0.3) and high (E H Ն 0.7) hepatic extraction ratio drugs to show which factors predominantly influence CL H in these limiting cases. The hepatic extraction ratio can be described by equation 2 4 :

show abstract

Risk factors of hepatic artery thrombosis in pediatric deceased donor liver transplantation

Song

Dong

et al. 2019

Pediatr Surg Int

View full text Add to dashboard Cite

Development of intrahepatic arterial shunts in a transplanted liver: A potential pitfall for Doppler sonography

Cited by 4 publications

References 11 publications

Etiology and management of hepatic artery thrombosis after adult liver transplantation

Etiology and management of hepatic artery thrombosis after adult liver transplantation

An evaluation of the suitability of intravenous midazolam as an in vivo marker for hepatic cytochrome P4503A activity

Risk factors of hepatic artery thrombosis in pediatric deceased donor liver transplantation

Contact Info

Product

Resources

About