Hepatic-artery aneurysm in adult liver transplantation

Abstract

Hepatic artery aneurysm (HAA) is a rare vascular complication, but has a high mortality rate in liver transplant recipients. This study reports the precipitating factors, clinical manifestation, pre-operative diagnosis, related micro-organism, management, and outcome, in a series of HAAs that developed after adult orthotopic liver transplantation (OLT). Data on the primary disease as well as on the above were obtained from a prospective database, and all case records were reviewed. There were eight (0.5%) HAAs in 1,575 adult cadaveric OLTs between 1982 and March 2001. All were pseudo-aneurysms around the native hepaticartery (HA) anastomosis, and all occurred in whole-organ OLTs. There were three types of clinical presentations: sudden hypotension (n = 4), gastrointestinal (GI) bleeding (n = 2), and abnormal liverfunction tests (LFTs) (n = 2). The majority (n = 7) presented within the first 2 months (median: 27.5 days, range: 12-760 days) following OLT. A pre-operative diagnosis of HAA was not determined in five cases. The sensitivity of abdominal ultrasound scan (USS), computed tomography (CT) scan and angiography for detection of HAAs was 3 of 5, 1 of 2 and 3 of 4, respectively. Micro-organisnis could be identified in six patients (bacteria n = 4 and fungi n = 3). All patients underwent urgent operations (excision of HAA in six and ligation in two cases). Immediate reconstruction of the HA was carried out, two different methods being used: repair of native arteries (n = 2) and arterial conduit (interposition n = 3 and aortic conduit n = 2). Two patients died peri-operatively, two died within 2 months, and the remaining four patients are alive at between 8.6 and 12.8 years after repair. HAA following OLT is unpredictable in its presentation, and the sensitivity of clinical and radiological detection is low. A high index of suspicion is required, and urgent surgery with immediate revascularisation and use of appropriate antibiotic/anti-fungal agents is recommended.

Vascular complications following liver transplantation: A literature review of advances in 2015

“…In fact, most HAP occurred in the early postoperative period around one month post-OLT: 69% presented within 20 d and 81% within 35 d following LT. The median time of presentation of HAP was 13 d. This corresponds to the median time reported by many authors, varying from 13.4 to 29 d postLT [26,30,78,80,81] .…”

“…In case of HAR, mortality remains very high and curr ently there is no consensus on the indications for these procedures [26,73,78,80,88] . Boleslawski et al [26] (2013) pub lished the largest series of ruptured posttransplant HAP; they highlighted the efficacy of primary HA ligation on both early and late survival.…”

Rescue for rare complications of the hepatic artery in living donor liver transplantation using grafts of autologous inferior mesenteric artery

“…It has an incidence of less than 1 YO, and major clinical signs are gastrointestinal or abdominal bleeding [4]. The main cause of the pseudoaneurysm is a bacterial infection due to bile leaks, pancreatitis or other infections such as fungal infections.…”

Post-transplant hepatic complications: Imaging findings

“…It is a rare complication, which can become lethal if it is not embolized [6]. Pseudoaneurysms are usually asymptomatic, and if they are not detected they can burst and cause biliary tract hemorrhage and peritoneal or gastrointestinal hemorrhage.…”