Late hepatic artery thrombosis after orthotopic liver transplantation

Abstract

Late hepatic artery thrombosis (HAT) is a rare complication after orthotopic liver transplantation (OLT), conventionally described as occurring more than 30 days after surgery. Only a few reports document its course. In a consecutive series of 634 OLTs (704 grafts), 11 patients (1.7%) had late HAT, diagnosed a median of 6 months (range, 1.8 to 79 months) after OLT. Clinical variables were compared with those of 415 patients without HAT who had a complete database and follow-up, including cytomegalovirus (CMV) surveillance. At presentation, 11 patients had fever, 4 patients had jaundice. Hepatic abscesses were present in 6 patients (3 patients with biliary leak), 4 patients had biliary tree necrosis (2 patients with biliary leak), and 1 patient had no biliary complications. Five patients (45%) underwent accessory hepatic artery anastomosis versus 73 patients (17%) without HAT (P < .05). Five patients (45%) with late HAT had CMV infection versus 14% without HAT (P < .05). Two episodes of late HAT (11 and 79 months) occurred in patients who underwent re-OLT for early HAT (3.9%). Re-OLT was performed in 8 patients a median of 11 days (range, 3 to 37 days) after diagnosis (preceded by intravenous antibiotics and percutaneous drainage). The other 3 patients underwent partial hepatectomy (1 patient), external percutaneous drainage as unfit for surgery (1 patient), and antibiotic therapy only (1 patient). Death occurred in 4 patients who underwent re-OLT (50%) because of septicemia at 11, 23, and 60 days after re-OLT and 17 days after a third OLT. There was one late death (30 months) after partial hepatectomy (hepatitis C recurrence) and one death 6 months after long-term biliary drainage because of sepsis. The 5 survivors have good health with normal liver function test results at a median 52 months (range, 6 to 57 months). In conclusion, late HAT presents with fever caused by hepatic abscesses or biliary leak associated with biliary ischemia and necrosis. CMV infection and accessory hepatic artery anastomosis are risk factors for late HAT in our cohort. Early intervention followed by re-OLT can salvage patients. (Liver Transpl 2003;9: 605-611.) H epatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT) is a potentially lifethreatening complication that occurs in 1.6% to 10.5% of adult liver transplant recipients and 10% to 25% of pediatric cadaver recipients. 1-3 HAT carries a mortality rate of 27% to 58%. 1,4,5 When re-OLT is not performed, the mortality rate increases to 73%. 5 HAT occurring early after OLT is associated with acute fulminant hepatic failure, biliary tract necrosis and leaks, or relapsing bacteremia and results in a high rate of graft loss and patient mortality. Late HAT generally is associated with a milder clinical course than acute HAT. [6][7][8] The time that divides early and late HAT has not been agreed on. Because technical aspects and surgical complications are associated with HAT development in the first 30 days after OLT, it is common practice to use 1 month from OLT to d...

Ischemic Arterial Complications After Liver Transplantation in the Adult

“…The available analyses 1,2,[4][5][6]12,13 are largely drawn from experiences of the early days of liver transplantation, and most fail to demonstrate clear risk factors.…”

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

“…Furthermore, it was reported that arterial anastomosis with operation microscope or loupe mangnification did not show any difference in incidence HAT [9,17,28,41] . Late HAT shows a lower incidence, ranging from 1% to 25% [38,42] . Torras et al [34] .…”

“…The presentation may be insidious. Liver graft ischemia and liver failure are other classical insidious clinical outcomes revealing late HAT [17,27,28,36,38,42,43] .…”

Interventional radiology in the management of complications after liver transplantation

“…Probably children have more facilities to revascularize the liver through all the adhesions of the graft to the diaphragm, and other adjacent organs [10]. In adults, even in the late phase after transplantation, hepatic artery occlusion may induce severe biliary complications such as biliary necrosis, biliary leak or liver abscesses [11,12]. The range of clinical symptoms goes from acute liver failure and death to biliary anastomotic stenosis.…”