Prolonged Preservation in University of Wisconsin Solution Associated With Hepatic Artery Thrombosis After Orthotopic Liver Transplantation

Mor, Eytan; Schwartz, Myron; Sheiner, Patricia A.; Menesses, Pedro; Hytiroglou, Prodromos; Emre, Sukru; Kishikawa, Keiji; Chiodini, S.; Miller, Charles M.

doi:10.1097/00007890-199312000-00024

Cited by 68 publications

(30 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22 A similar association has also been shown with Eurocollins solution. 33 However, inhibition of platelet aggregation by UW solution (when the preservation is within 12 hours) may be responsible for the observed lower incidence of HAT compared with other preservation fluids.…”

Section: Technique Of Graft Preservationsupporting

confidence: 66%

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

et al. 2001

View full text Add to dashboard Cite

Section: Technique Of Graft Preservationsupporting

confidence: 66%

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

et al. 2001

View full text Add to dashboard Cite

“…Some published reports support this result, 20,21 whereas other state opposite findings. 5,6 A feasible explanation might be that the rate of found arterial variants and that of variants needing arterial reconstruction, as reported in various publications, seems to be very different. This is in further support of our intention to analyze complex arterial reconstructions per se, without the confounding information of anatomic variants, many of which do not need arterial reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…[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][6][7][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 artery reconstruction with respect to patient and graft survival in full-sized OLT in adults, as well as its effect on primary graft function, HAT, and bile duct stricture or necrosis.…”

mentioning

confidence: 99%

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Soliman

Bodingbauer

Langer

et al. 2003

Liver Transplantation

View full text Add to dashboard Cite

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 ...

show abstract

“…Many suspected potential risk factors have been implicated in the incidence of arterial complications, such as CMV serologic incompatibility between recipients and donors, 32 hypercoagulable state, [30][31] and cold ischemic duration between explantation and transplantation. [27][28][29] Modern technology and newer diagnostic modalities available for prompt and accurate diagnosis have decreased mortality after LT. However, there are still significant and severe morbidities when vascular complications develop in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 Technical factors such as intimal dissection, clamp injury, kinking or stenosis of the anas-tomosis, and size of the recipient hepatic artery have been associated with severe acute rejection in the pathogenesis of early onset HAT. 26 Furthermore, other factors, e.g., cold ischemic time, [27][28][29] hypercoagulable states (deficiency of protein C, protein S, and antithrombin III), 30,31 increased hematocrit, 24 and cytomegalovirus (CMV) serologic incompatibility (CMVseronegative recipients receiving a CMV-seropositive allograft), 32 have also been associated with an increased incidence of HAT in the early postoperative period. In contrast, late onset HAT has been associated with chronic allograft rejection 25 and ABO-incompatible grafts.…”

mentioning

confidence: 99%

Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation

Pungpapong

2002

Liver Transplantation

142

View full text Add to dashboard Cite

Hepatic artery thrombosis (HAT) and other vascular comIn patients with a history of cigarette smoking, incidence of vascular complications was higher than in those without history of cigarette smoking (17.8% v 8%, P ‫؍‬ .02). Having quit cigarette smoking 2 years before liver transplantation reduced the incidence of vascular complications by 58.6% (24.4% v 11.8%, P ‫؍‬ .04). The incidence of arterial complications was also higher in patients with a history of cigarette smoking compared with those without such history (13.5% v 4.8%, P ‫؍‬ .015). Cigarette smoking cessation for 2 years also reduced the risk of arterial complications by 77.6% (21.8% v 5.9%, P ‫.)500.؍‬ However, the incidence of venous complications was not associated with cigarette smoking. Furthermore, there was no significant association between development of vascular complications and all other characteristics studied. Cigarette smoking is associated with a higher risk for developing vascular complications, especially arterial complications after liver transplantation. Cigarette smoking cessation at least 2 years before liver transplantation can significantly reduce the risk for vascular complications. Cigarette smoking cessation should be an essential requirement for liver transplantation candidates to decrease the morbidity C hanges in coagulation after successful liver transplantation (LT) include a tendency toward a hypercoagulable state leading to an increased incidence of vascular complications. Such changes have been known and studied in animals and humans for more than 30 years. 1,2 In particular, hepatic artery thrombosis (HAT) and other vascular complications (hepatic artery stenosis [HAS], portal vein thrombosis [PVT] and deep vein thrombosis [DVT]) remain devastating complications after LT. 2,3 The reported incidence of HAT is estimated to be 25% in living related allografts, 4 10% to 25% in pediatric cadaver liver recipients, 5-8 2.6% to 20% in adult cadaver liver recipients, 9 and as high as 30% in children younger than 1 year old. 10 Early onset HAT usually develops within the first 2 months, 11,12 especially the first 5 days after LT. 13 Clinical presentations include acute, massive hepatic necrosis leading to fulminant hepatic failure, relapsing bacteremia with recurrent biliary sepsis from cholangitis, biliary tract ischemia leading to bile duct necrosis and leaks, and asymptomatic presentation with normal liver function tests. 7,14,15 HAT occurring early after LT is more likely to be associated with an aggressive course and higher rate of allograft loss in comparison to late onset HAT (beyond 2 months after LT). 11,14 Some evidence suggests that a prompt and accurate diagnosis by duplex ultrasonography [16][17][18][19] with confirmation by hepatic artery angiography 20 or exploratory laparotomy, followed by urgent allograft rescue modalities (e.g., interventional radiology, surgical and medical therapy) can provide temporary or permanent support, avoiding higher morbidity and mortality from retransplantation. 21,22 The repo...

show abstract

Prolonged Preservation in University of Wisconsin Solution Associated With Hepatic Artery Thrombosis After Orthotopic Liver Transplantation

Cited by 68 publications

References 0 publications

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

The role of complex hepatic artery reconstruction in orthotopic liver transplantation

Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation

Contact Info

Product

Resources

About