Early detection of hepatic artery thrombosis after liver transplantation by Doppler ultrasonography: prognostic implications.

Abstract

We assessed the usefulness of routine Doppler ultrasonography for early detection of hepatic artery thrombosis after orthotopic liver transplantation and repercussions in patient prognosis. Seventeen confirmed cases of early hepatic artery thrombosis initially diagnosed by Doppler ultrasonography (10 of them before clinical indication) were reviewed. All patients underwent Doppler ultrasonographic studies in the first 3 days after orthotopic liver transplantation. Twelve cases of hepatic artery thrombosis (70.6%) were detected by this early Doppler ultrasonography. All 10 unsuspected cases of hepatic artery thrombosis and 5 of the 7 cases diagnosed after clinical indication were treated by revascularization. Grafts were salvaged in 80% of asymptomatic patients and in 42.8% of symptomatic patients. Furthermore, biliary complications were less serious in the first group. In conclusion, Doppler ultrasonography performed routinely in the first 3 days after orthotopic liver transplantation may permit early detection of hepatic artery thrombosis, even before clinical indications. This allows hepatic artery repermeabilization before liver function damage, improving graft rescue and patient prognosis.

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

“…In only two centers routine DUS was not performed (3,46 (12,27,28,33,42,44,48,51,52,54,62,65,71,84 (12,16,17,21,25,27,28,33,35,(41)(42)(43)(45)(46)(47)(48)(53)(54)(55)57,59,67,(70)(71)(72)(73)80,82,(84)(85)(86)(87) (12,27,28,33,42,…”

“…7 Only manuscripts mentioning the outcome are included. I 2,12,16,17,21,27,28,30,35,41,42,45,46,48,[51][52][53][54][55][56][57][58][59]61,62,64,65,[67][68][69][70][71][72][73]77,80,82,[84][85][86][87]16,17,21,25,27,28,33,35,[41][42][43]…”

“…For this review, we found only two publications dealing with the issue of whole versus reduced size grafting (55,64 (28,42,73,76,90,(104)(105)(106)(107)(108) (59). Urgent revascularization has been described by others as a useful treatment option for early HAT (4,16,45,46,84,85,(115)(116)(117) (Figure 2). …”

Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation

“…HAT was defined as the complete disruption of arterial blood flow to the allograft, which was identified by duplex ultrasonography, [16][17][18][19] hepatic artery angiography, 20 or surgical exploration. HAS was shown as abnormally decreased arterial blood flow, which was detected by duplex ultrasonography [16][17][18][19] and/or angiography. 20 PVT was diagnosed by the evidence of decrease or total disruption of venous blood flow in the portal system in a duplex ultrasonography study.…”

“…7,14,15 HAT occurring early after LT is more likely to be associated with an aggressive course and higher rate of allograft loss in comparison to late onset HAT (beyond 2 months after LT). 11,14 Some evidence suggests that a prompt and accurate diagnosis by duplex ultrasonography [16][17][18][19] with confirmation by hepatic artery angiography 20 or exploratory laparotomy, followed by urgent allograft rescue modalities (e.g., interventional radiology, surgical and medical therapy) can provide temporary or permanent support, avoiding higher morbidity and mortality from retransplantation. 21,22 The reported mortality rate for LT recipients developing HAT ranges from 30% to 75%.…”