Risk factors and management of hepatic artery stenosis post liver transplantation

Bommena, Shoma; Fallon, Michael B.; Rangan, Pooja; Hirsch, Kevin; Mehta, Shivang

doi:10.1016/j.dld.2022.02.012

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…Intervention depends on the degree of stenosis; patients with ∼50% occlusion may not require intervention. Angioplasty with stent placement can carry high risk for patients, 37 and revision of anastomosis can resolve or improve stenosis with controversial results. 13 38 In a study by Abbasoglu et al, out of 857 LTs, 41 patients had HAS, with 17 (41.4%, 17/41) being treated with primary reanastomosis.…”

Section: Hepatic Artery Stenosismentioning

confidence: 99%

Surgical and Interventional Radiology Management of Vascular and Biliary Complications in Liver Transplantation: Narrative Review

Barragan,

Vera,

Hoyos

et al. 2023

Digestive Disease Interventions

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Liver transplant patients require a multidisciplinary and personalized approach to optimize outcomes. Posttransplant complications can be devastating for the patient and can jeopardize graft survival. Therefore, a careful evaluation and stepwise decision-making process is necessary to determine the best strategy, whether it is surgical, interventional, or a combination of both. While access to liver transplant interventions in Latin America can be more limited compared with other parts of the world, many countries in the region have made significant progress in developing their liver transplant programs and improving the management of posttransplant complications. For example, in Brazil, specialized transplant centers and multidisciplinary teams have been established to reduce morbidity and improve graft survival rates. The article also explores the latest advancements in interventional radiology techniques, such as angioplasty, stent placement, and embolization, and how they can be used to successfully treat these complications. Overall, this article highlights the importance of a comprehensive approach to managing complications in liver transplant patients and emphasizes how individualized treatment plans can lead to improved outcomes, even in settings with limited resources.

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Section: Hepatic Artery Stenosismentioning

confidence: 99%

Surgical and Interventional Radiology Management of Vascular and Biliary Complications in Liver Transplantation: Narrative Review

Barragan,

Vera,

Hoyos

et al. 2023

Digestive Disease Interventions

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“…Ранние сосудистые осложнения, особенно артериальные, могут привести к потере трансплантата, особенно если они были вовремя не диагностированы и пролечены. Тромбоз артерии трансплантата печени (ТАТП) [1][2][3][4] и стеноз артерии трансплантата печени (САТП) [4][5] могут потребовать реваскуляризации или, в некоторых случаях, повторной трансплантации [4][5][6][7][8]. В то же время синдром обкрадывания селезеночной артерией (СА) (steal-синдром) представляет собой еще одну причину ишемии трансплантата у реципиентов печени и может иметь такой же негативный эффект.…”

Section: Introductionunclassified

Single-center experience of intraoperative ligation of the splenic artery for prevention of splenic artery steal syndrome in patients after living donor liver transplant

Semash,

Dzhanbekov,

Gaybullaev

2024

Transplantologiâ (Mosk.)

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Background. Living donor liver transplant is an effective method of treatment in patients with different types of endstage liver diseases. Unfortunately, patients undergoing such a complex treatment sometimes develop various vascular complications. Splenic artery steal syndrome has emerged as a cause of graft ischemia in living donor liver transplant recipients and may lead to high liver enzyme levels, cholestasis, hepatic artery thrombosis, and even a graft loss in some severe cases.Objective. Evaluation of the first results in the experience of our center with a routine intraoperative ligation of the splenic artery during the procedure of right lobe living donor liver transplantation in adult recipients for the prevention of the steal syndrome development in the postoperative period.Material and methods. Living donor liver transplant recipients with known hepatic arterial flow impairment were retrospectively studied. Patients were allocated into groups with regard whether the splenic artery had been ligated or not during the transplant procedure. Arterial complications were reviewed in both groups.Results. None of 30 patients with ligated splenic artery developed splenic artery steal syndrome after living donor liver transplant. splenic artery steal syndrome occurred in 60% patients with non-ligated splenic artery. Surgical technique of performing arterial anastomosis was not related to the splenic artery steal syndrome development (p<0.01 There was no local ischemic necrosis noted in the spleen in patients with the ligated splenic artery.Conclusion. Based on the analysis of our own experience and literature data, the splenic artery ligation appears to be an effective and safe method for preventing a splenic artery steal syndrome in patients following right lobe liver transplantation, with a minimal risk of ischemic complications for the spleen. However, further studies with larger sample sizes are needed to obtain more reliable results. Ultrasound examination and endovascular intervention are the primary tools for an early detection of abnormalities and rapid restoration of arterial blood flow in the hepatic artery of the graft.

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“…These variables have been found to be independently associated with poor outcomes (higher risk of acute cellular rejection, hepatic artery thrombosis, and mortality). [2,3] Therefore, we highly recommend that the authors use propensity score matching to partly eliminate the discrepancies between 2 groups of patients possessing distinct baseline characteristics. In a retrospective study design, propensity score matching analysis has been widely implemented to adjust confounders.…”

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confidence: 99%

“…First, many critical baseline characteristics of the 2 groups differed significantly, including the model for end-stage liver disease score, body mass index, prior transarterial chemoembolization, cold ischemia time, intraoperative transfusion, etc. These variables have been found to be independently associated with poor outcomes (higher risk of acute cellular rejection, hepatic artery thrombosis, and mortality) 2,3. Therefore, we highly recommend that the authors use propensity score matching to partly eliminate the discrepancies between 2 groups of patients possessing distinct baseline characteristics.…”

mentioning

confidence: 99%

Protective effect of low-dose aspirin against acute cellular allograft rejection after primary liver transplantation

Zhou

Jiang

Sun

et al. 2023

Liver Transplantation

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To the editor,We read with great interest the study by Oberkofler et al [1] entitled "Low-dose aspirin confers protection against acute cellular allograft rejection after primary liver transplantation." The authors analyzed data from an international, multicenter cohort study of primary adult liver transplantation. They found that low-dose aspirin may reduce the risk of acute cellular rejection and hepatic artery thrombosis. Although inspiring, we would like to raise the following comments.First, many critical baseline characteristics of the 2 groups differed significantly, including the model for end-stage liver disease score, body mass index, prior transarterial chemoembolization, cold ischemia time, intraoperative transfusion, etc. These variables have been found to be independently associated with poor outcomes (higher risk of acute cellular rejection, hepatic artery thrombosis, and mortality). [2,3] Therefore, we highly recommend that the authors use propensity score matching to partly eliminate the discrepancies between 2 groups of patients possessing distinct baseline characteristics. In a retrospective study design, propensity score matching analysis has been widely implemented to adjust confounders. Although the authors have taken an effort to perform multivariate analysis for bias reduction, propensity score matching would have probably been a better modality to adjust for potential confounders mentioned above, thus enabling balanced and unbiased comparison.Second, the authors did not specify whether the patients were simultaneously under other drugs during follow-up, including statins, which are often used in combination with aspirin. Recipients in the aspirin group had a higher cardiovascular risk, particularly for dyslipidemia and cardiovascular disease, thus being likely to be taking statins simultaneously. Becchetti et al demonstrated that statin use by liver transplantation recipients may confer a survival advantage and protection against biliary-vascular complications. [4] It is reasonable to infer that the between-group differences might be partly attributed to stain exposure. Moreover, thromboprophylaxis protocol mainly focuses on aspirin, unfractionated heparin, low-molecular-weight heparin, and Vitamin K antagonists or a combination of these regimens. The authors should clarify whether recipients, especially those in the no-aspirin group, were using other anticoagulants. Potential confounders mentioned above should be adjusted for in the Cox regression multivariable analysis to eliminate selection bias.In summary, due to the limitations mentioned above, the conclusion that low-dose aspirin use after primary liver transplantation confers protection against acute cellular rejection and hepatic artery thrombosis still needs more robust evidence to confirm.

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Risk factors and management of hepatic artery stenosis post liver transplantation

Cited by 5 publications

References 32 publications

Surgical and Interventional Radiology Management of Vascular and Biliary Complications in Liver Transplantation: Narrative Review

Surgical and Interventional Radiology Management of Vascular and Biliary Complications in Liver Transplantation: Narrative Review

Single-center experience of intraoperative ligation of the splenic artery for prevention of splenic artery steal syndrome in patients after living donor liver transplant

Protective effect of low-dose aspirin against acute cellular allograft rejection after primary liver transplantation

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