Early Hepatic Artery Thrombosis After Living Donor Liver Transplant: A 13-Year Single-Center Experience in Jordan

Obed, Mikal; Othman, Mohammad; Siyam, Mahmoud; Hammoudi, Saeb; Jarrad, Anwar; Bashir, Abdalla; Obed, Aiman

doi:10.6002/ect.2020.0565

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…Concerning higher rates of re-thrombosis in revision technique and risk of exploring the HA, AHCI seems a better approach, indeed not free of problems, similar to the previous observation [ 8 , 13 , 22 , 23 ]. RT and death have been reported in nearly all investigations on E-HAT, indicating that the causality is complicated and multifactorial and cannot be correlated with just a surgical technique [ 25 , 27 ]. Although the statistical analysis did not find a significant difference, RT and death favor revision more.…”

Section: Discussionmentioning

confidence: 99%

Early hepatic artery thrombosis treatments and outcomes: aorto-hepatic arterial conduit interposition or revision of anastomosis?

Sohrabi Nazari,

Eslamian,

Sheikhbahaei

et al. 2024

BMC Surg

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Background Hepatic artery thrombosis (HAT) is one of the critical conditions after an orthotopic liver transplant (OLT) and leads to severe problems if not corrected promptly. However, multiple treatments have been proposed for HAT, in which surgical revascularization with either auto-hepatic conduit interposition (AHCI) or revision of the anastomosis is more familiar indeed indicated for some patients and in specific situations. In this study, we want to evaluate the success and outcomes of treating early HAT (E-HAT), which defines HAT within 30 days after OLT with either of the surgical revascularization techniques. Method In this retrospective study, we collected information from the medical records of patients who underwent either of the surgical revascularization procedures for E-HAT after OLT. Patients who needed early retransplantation (RT) or died without surgical intervention for E-HAT were excluded. Demographic data, OLT surgery information, and data regarding E-HAT were gathered. The study outcomes were secondary management for E-HAT in case of improper inflow, biliary complications (BC), RT, and death. Results A total of 37 adult patients with E-HAT after OLT included in this study. These E-HATs were diagnosed within a mean of 4.6 ± 3.6 days after OLT. Two patients had their HA revised for the initial management of E-HAT; however, it changed to AHCI intraoperatively and finally needed RT. Two and nine patients from the AHCI and revision groups had re-thrombosis (12.5% vs. 47.3%, respectively, p = 0.03). RT was used to manage rethrombosis in all patients of AHCI and two patients of the revision group (22.2%). In comparison to the AHCI, revision group had statistically insignificant higher rates of BC (47.4% vs. 31.2%); however, RT for nonvascular etiologies (12.5% vs. 5.3%) and death (12.5% vs. 10.5%) were nonsignificantly higher in AHCI group. All patients with more than one HA exploration who were in the revision group had BC; however, 28.5% of patients with just one HA exploration experienced BC (p < 0.001). Conclusion Arterial conduit interposition seems a better approach for the initial management of E-HAT in comparison to revision of the HA anastomosis due to the lower risk of re-thrombosis and the number of HA explorations; indeed, BC, RT, and death remain because they are somewhat related to the ischemic event of E-HAT than to a surgical treatment itself.

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Section: Discussionmentioning

confidence: 99%

Early hepatic artery thrombosis treatments and outcomes: aorto-hepatic arterial conduit interposition or revision of anastomosis?

Sohrabi Nazari,

Eslamian,

Sheikhbahaei

et al. 2024

BMC Surg

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“…Ранние сосудистые осложнения, особенно артериальные, могут привести к потере трансплантата, особенно если они были вовремя не диагностированы и пролечены. Тромбоз артерии трансплантата печени (ТАТП) [1][2][3][4] и стеноз артерии трансплантата печени (САТП) [4][5] могут потребовать реваскуляризации или, в некоторых случаях, повторной трансплантации [4][5][6][7][8]. В то же время синдром обкрадывания селезеночной артерией (СА) (steal-синдром) представляет собой еще одну причину ишемии трансплантата у реципиентов печени и может иметь такой же негативный эффект.…”

Section: Introductionunclassified

Single-center experience of intraoperative ligation of the splenic artery for prevention of splenic artery steal syndrome in patients after living donor liver transplant

Semash,

Dzhanbekov,

Gaybullaev

2024

Transplantologiâ (Mosk.)

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Background. Living donor liver transplant is an effective method of treatment in patients with different types of endstage liver diseases. Unfortunately, patients undergoing such a complex treatment sometimes develop various vascular complications. Splenic artery steal syndrome has emerged as a cause of graft ischemia in living donor liver transplant recipients and may lead to high liver enzyme levels, cholestasis, hepatic artery thrombosis, and even a graft loss in some severe cases.Objective. Evaluation of the first results in the experience of our center with a routine intraoperative ligation of the splenic artery during the procedure of right lobe living donor liver transplantation in adult recipients for the prevention of the steal syndrome development in the postoperative period.Material and methods. Living donor liver transplant recipients with known hepatic arterial flow impairment were retrospectively studied. Patients were allocated into groups with regard whether the splenic artery had been ligated or not during the transplant procedure. Arterial complications were reviewed in both groups.Results. None of 30 patients with ligated splenic artery developed splenic artery steal syndrome after living donor liver transplant. splenic artery steal syndrome occurred in 60% patients with non-ligated splenic artery. Surgical technique of performing arterial anastomosis was not related to the splenic artery steal syndrome development (p<0.01 There was no local ischemic necrosis noted in the spleen in patients with the ligated splenic artery.Conclusion. Based on the analysis of our own experience and literature data, the splenic artery ligation appears to be an effective and safe method for preventing a splenic artery steal syndrome in patients following right lobe liver transplantation, with a minimal risk of ischemic complications for the spleen. However, further studies with larger sample sizes are needed to obtain more reliable results. Ultrasound examination and endovascular intervention are the primary tools for an early detection of abnormalities and rapid restoration of arterial blood flow in the hepatic artery of the graft.

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Algorithmic Approach to Deranged Liver Functions After Transplantation

Mishra,

Taneja

2024

Journal of Clinical and Experimental Hepatology

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Early Hepatic Artery Thrombosis After Living Donor Liver Transplant: A 13-Year Single-Center Experience in Jordan

Cited by 3 publications

References 27 publications

Early hepatic artery thrombosis treatments and outcomes: aorto-hepatic arterial conduit interposition or revision of anastomosis?

Early hepatic artery thrombosis treatments and outcomes: aorto-hepatic arterial conduit interposition or revision of anastomosis?

Single-center experience of intraoperative ligation of the splenic artery for prevention of splenic artery steal syndrome in patients after living donor liver transplant

Algorithmic Approach to Deranged Liver Functions After Transplantation

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