Impact of colour Doppler sonography on detection of thrombosis of the hepatic artery and the portal vein after liver transplantation

Hellinger, A.; Stracke, A.; Erhard, J.; Eigler, F. W.; Roll, Claudia

doi:10.1007/bf00187624

Cited by 27 publications

(28 citation statements)

References 8 publications

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“…In addition, the 5-year patient survival was also similar for both groups, emphasizing the importance of early diagnosis of HAT and repeat OLT for the clinical outcome. 25,26 Comparing the overall survival with that of other larger series, it is evidently impaired by a remarkable number of patients (about 30%) who underwent transplantation for extended liver malignancies with a 5-year survival of less than 35%. However, this had no effect on the outcome of this specific study.…”

Section: Discussionmentioning

confidence: 98%

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Soliman

Bodingbauer

Langer

et al. 2003

Liver Transplantation

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The goal of this study was to analyze the influence of multiple anastomosis on outcome in orthotopic liver transplantation (OLT) and its implications for split-liver and living related liver transplantation programs. In a retrospective study, 683 first OLTs in adults were analyzed. Complex hepatic artery reconstruction was defined as revascularization of the graft requiring additional anastomosis between donor hepatic arteries. OLT was performed in a standard manner. All patients had daily ultrasound examination. In this series we found 72 grafts (10.5%) with anatomic arterial variations that required complex hepatic artery reconstruction. There was no difference in primary organ function and demographic data compared with patients with simple arterial reconstruction. However, hepatic artery thrombosis (HAT) occurred in 9.7% of patients (7 of 72) with complex reconstruction in contrast to 2.0% in the control group (12 of 638; P < .001). Statistical analysis identified multiple anastomoses (P < .002) and primary nonfunction (P < .02) as significant risk factors for HAT. Three patients underwent successful thrombectomy for HAT, all others had to undergo retransplantation. Although in the group with complex arterial reconstruction increased graft loss caused by HAT was found early postoperatively, the overall 5-year patient and graft survival was not different for both groups. Although complex reconstruction is a risk factor for HAT, early diagnosis of HAT by daily ultrasound and early repeat OLT can provide similar 5-year survival as for patients with simple reconstruction. We conclude that complex hepatic artery reconstruction challenges conventional OLT as well as split-liver and living related liver transplantation, but does not necessarily affect its longterm outcome. O rthotopic liver transplantation (OLT) is one of the outstanding innovations in the treatment of end-stage liver diseases in recent decades. The enormous success of this new surgical procedure resulted in an increasing organ shortage, which is the main challenge for OLT nowadays. Great efforts have been made to enlarge the donor pool, and especially split-liver transplantation and living related liver transplantation were to contribute to the solution of this problem. However, because these new surgical techniques are determined by their technical feasibility and limits, concepts that have been considered controversial since the early period of OLT have become of particular interest. [1][2][3][4] In this context, the vascular reconstruction of the hepatic artery and factors related to hepatic artery thrombosis (HAT), one of the most life-threatening complication in liver transplantation, are still being discussed. Many reports on the incidence of anatomic variations of the hepatic artery have been published and risk factors for HAT have been identified, 5-8 but an actual systematic analysis assessing exclusively the role of graft revascularization on outcome is rare. Therefore, the goal of this study is to analyze the results of complex hepatic ...

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Section: Discussionmentioning

confidence: 98%

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Soliman

Bodingbauer

Langer

et al. 2003

Liver Transplantation

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“…Frequent Doppler ultrasonography in the post-OLT period may prevent delay in the diagnosis of PVT and therefore the need for retransplantation and is recommended every 1 to 3 days during the first 2 weeks after OLT. 20,21 Although in some cases, rethrombosis of the portal vein is well tolerated without acute changes in hepatocellular function, there is a risk for progressive hepatic atrophy and bleeding from varices caused by portal hypertension. Some investigators 8 recommend a selective distal splenorenal shunt, whereas others 22 recommend sclerotherapy as the treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation in patients with portal vein thrombosis

Manzanet¹,

Sanjuan²,

Orbis³

et al. 2001

Liver Transpl

167

126

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The aim of this study is to analyze the incidence, risk factors, management, and follow-up of patients with portal vein thrombosis (PVT) undergoing primary orthotopic liver transplantation (OLT). Four hundred fifteen OLTs were performed in 391 patients. In 62 patients, partial (group 1; n ‫؍‬ 48) or complete (group 2; n ‫؍‬ 14) PVT was found at the time of surgery. Portal flow was reestablished by venous thrombectomy. In this study, we compare 62 primary OLTs performed in patients with PVT at the time of OLT with a group of 329 primary OLTs performed in patients without PVT (group 3) and analyze the incidence of PVT, use of diagnostic methods, surgical management, and outcome. We found no significant differences among the 3 groups for length of surgery, cold and warm ischemic times, and postoperative stay in the intensive care unit. With the piggyback technique, groups 1 and 2 had greater blood losses and required more blood transfusions than group 3. The early reoperation rate was greater in group 2. The incidence of rethrombosis was 4.8% (group 1, 2%; group 2, 14.3%). Reexploration and thrombectomy (2 patients) and retransplantation (1 patient) had a 100% mortality rate. In particular, the mortality rate of patients with complete PVT with extension into the splanchnic veins is high (33%). Three-month and 4-year patient survival rates were statistically similar in the 3 groups. The presence of PVT at the time of OLT is not a contraindication for OLT. However, if PVT extends into the splanchnic veins, the outcome is guarded. (Liver Transpl 2001;7:125-131.)

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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%

“…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]…”

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

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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Impact of colour Doppler sonography on detection of thrombosis of the hepatic artery and the portal vein after liver transplantation

Cited by 27 publications

References 8 publications

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Liver transplantation in patients with portal vein thrombosis

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

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