Effect of Protocol Doppler Ultrasonography and Urgent Revascularization on Early Hepatic Artery Thrombosis After Pediatric Liver Transplantation

Nishida, Seigo; Kato, Tomoaki; Levi, David; Mittal, Naveen; Berney, Thierry; Vianna, Rodrigo; Selvaggi, Gennaro; Buitorago, Efren; Al-Niami, Ahmed; Nakamura, Noboru; Vaidya, Anil; Nery, Jose; Tzakis, Andreas G.

doi:10.1001/archsurg.137.11.1279

Cited by 91 publications

(78 citation statements)

References 20 publications

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“…15 The impact of this changing landscape on the rate of anastomotic biliary complications and identification of contemporary risk factors was the purpose of the present study. Although historical studies indicate that cytomegalovirus infection, 19 hepatic artery thrombosis or stenosis, 10,20 and ABO incompatibility 21 all increase the biliary complication rate, these factors are relatively minimized in contemporary series as viral prophylaxis has improved and events such as ABO incompatibility and hepatic artery thrombosis are infrequent events. 15 Additionally, many of these studies evaluated intrahepatic biliary strictures rather than anastomotic complications.…”

Section: Discussionmentioning

confidence: 99%

“…9 Clearly, bile leaks are thought to promote development of biliary strictures, 1,6 and hepatic arterial complications promote both bile leaks and strictures. 1,10,11 Debate has centered on the type of biliary reconstruction, 1,12,13 use of stents, 12,14 and recipient factors of illness severity, such as preoperative serum bilirubin and international normalized ratio. 6 However, the relative influence of these factors and their interactions with other variables on the risk of biliary complications is not completely known in contemporary liver transplant experience.…”

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confidence: 99%

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Biliary complications following liver transplantation in the model for end-stage liver disease era: Effect of donor, recipient, and technical factors

et al. 2007

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Biliary complications remain a significant problem following liver transplantation in the Model for End-Stage Liver Disease (MELD) era. We hypothesized that donor, recipient, and technical variables may differentially affect anastomotic biliary complications in MELD era liver transplants. We reviewed 256 deceased donor liver transplants after the institution of MELD at our center and evaluated these variables' association with anastomotic biliary complications. The bile leak rate was 18%, and the stricture rate was 23%. Univariate analysis revealed that recipient age, MELD, donor age, and warm ischemia were risk factors for leak, whereas a Roux limb or stent was protective. A bile leak was a risk factor for anastomotic stricture, whereas use of histidine tryptophan ketoglutarate (HTK) versus University of Wisconsin (UW) solution was protective. Additionally, use of a transcystic tube/stent was also protective. Multivariate analysis showed that warm ischemia was the only independent risk factor for a leak, whereas development of a leak was the only independent risk factor for a stricture. HTK versus UW use and transcystic tube/stent use were the only independent protective factors against stricture. Use of an internal stent trended in the multivariate analysis toward being protective against leaks and strictures, but this was not quite statistically significant. This represents one of the first MELD era studies of deceased donor liver transplants evaluating factors affecting the incidence of anastomotic bile leaks and strictures. Donor, recipient, and technical factors appear to differentially affect the incidence of anastomotic biliary complications, with warm ischemia, use of HTK, and use of a stent emerging as the most important variables. Liver Transpl 14: 73-80, 2008.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Biliary complications following liver transplantation in the model for end-stage liver disease era: Effect of donor, recipient, and technical factors

et al. 2007

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“…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,…”

Section: Doppler Ultrasound Screening Protocolsmentioning

confidence: 99%

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

Bekker¹,

Ploem

Jong³

2009

American Journal of Transplantation

504

507

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To clarify inconsistencies in the literature we performed a systematic review to identify the incidence, risk factors and outcome of early hepatic artery thrombosis (eHAT) after liver transplantation. We searched studies identified from databases (MEDLINE, EMBASE, Science Citation Index) and references of identified studies. Seventy-one studies out of 999 screened abstracts were eligible for this systematic review. The incidence of eHAT was 4.4% (843/21, 822); in children 8.3% and 2.9% in adults (p < 0.001). Doppler ultrasound screening (DUS) protocols varied from 'no routine' to 'three times a day.' The median time to detection was at day seven. The overall retransplantation rate was 53.1% and was higher in children (61.9%) than in adults (50%, p < 0.03). The overall mortality rate of patients with eHAT was 33.3% (range: 0-80%). Mortality in adults (34.3%) was higher than in children (25%, p < 0.03). The reported risk factors for eHAT were, cytomegalovirus mismatch (seropositive donor liver in seronegative recipient), retransplantation, arterial conduits, prolonged operation time, low recipient weight, variant arterial anatomy, and low volume transplantation centers. eHAT is associated with significant graft loss and mortality. Uniform definitions of eHAT and uniform treatment modalities are obligatory to confirm these results and to obtain a better understanding of this disastrous complication.

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“…Relationship between non-stoma bile duct stricture and treatment of HAS following OLT Through prompt PTA operation, HAS could be eliminated, normal blood flow in hepatic artery could be recovered, bile duct blood supply could be improved, therefore, the non-stoma bile duct stricture could be delayed or avoided following OLT [7] . When HAS was not eliminated in a timely manner, the probability of non-stoma bile duct stricture occurrence was increased.…”

Section: Non-stoma Bile Duct Stricture Following Oltmentioning

confidence: 99%

Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

Zhao

Song²,

Jiang³

et al. 2007

WJG

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AIM:To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture. METHODS:Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases. RESULTS:Diffuse intra-and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION: P r o g r e s s i v e , n o n -a n a s t o m o s i s , and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

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Effect of Protocol Doppler Ultrasonography and Urgent Revascularization on Early Hepatic Artery Thrombosis After Pediatric Liver Transplantation

Cited by 91 publications

References 20 publications

Biliary complications following liver transplantation in the model for end-stage liver disease era: Effect of donor, recipient, and technical factors

Biliary complications following liver transplantation in the model for end-stage liver disease era: Effect of donor, recipient, and technical factors

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

Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

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