Single-Center Experience of Therapeutic Management of Hepatic Artery Stenosis after Orthotopic Liver Transplantation

Abstract

Background/Aims: Hepatic artery stenosis (HAS) is a potentially life-threatening complication of liver transplantation because the associated mortality and morbidity rates are high. Surgical reconstruction was recommended as first choice of treatment and interventional radiologic techniques have been introduced recently. However, the mid- or long-term outcomes of HAS were unclear. The purpose of this study was to evaluate the efficacy of interventional therapy and clinical outcomes of HAS following liver transplantation. Methods: A retrospective analysis was performed for 20 cases of HAS documented by angiography from October 2003 to August 2007 at the authors’ institution. All patients underwent transluminal interventional therapy including percutaneous transluminal angioplasty and endovascular stent placement. The technical results, hepatic artery patency and clinical outcome were reviewed. Results: All patients were treated with interventional management. Technical and immediate success was 100%. Of 8 patients with early HAS (within 1 month of transplantation), 1 underwent retransplantation due to deterioration of liver function. One died of acute liver failure waiting for retransplantation. Of 12 patients with late HAS (after 1 month of liver transplantation), 1 died of severe sepsis 38 days after transplantation. Five patients underwent late retransplantation due to ischemic-type biliary strictures or recurrent attacks of cholangitis. One of these patients died 11 days after retransplantation. The median follow-up of all 20 patients was 14.4 months after liver transplantation. The Kaplan-Meier curve of patency showed that cumulated primary patency of hepatic artery interventional treatment at 3, 6 and 12 months was 94, 87 and 79%, respectively. Two patients died of causes unrelated to HAS. Three patients developed recurrent HAS and were successfully treated with second interventional therapy. Eight patients (40%) developed ischemic-type biliary strictures and 7 underwent endoscopic treatment or percutaneous transhepatic cholangiodrainage. Graft function in 5 patients improved. The Kaplan-Meier curve of survival showed that the 1- and 2-year cumulated survival rates of early and late HAS were 87.5 and 43.8% and 81.5 and 61.1%, respectively. There was no significant difference in 1- and 2-year survival rates between early and late HAS (log-rank test, p = 0.928). Conclusion: Interventional therapy is an effective treatment for both early and late HAS with excellent short- and mid-term outcomes, while without irreversible graft dysfunction resulted from HAS. However, the patients have a high incidence of ischemic-type biliary lesions.

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

“…Similar to HAT, HAS may be divided in two groups: HAS occurring within 30 d after OLT (early HAS), and HAS occurring more than 30 d after OLT (late HAS). Chen et al [61] (2009) reported an overall HAS incidence of 2.8%, with an early HAS incidence of 40% vs a late HAS incidence of 60% (mean time elapsed between transplantation to diagnosis: 91 d; range: 1-430 d). Abbasoglu et al [57] (1997) reported that stenosis occurred in 59% of cases at the level of the anastomosis with a median time of diagnosis at 75 d postOLT, in 41% of cases at the level of the graft HA with a median time of diagnosis at 160 d postOLT, and in 2.6% at the level of the recipient HA [57] .…”

Intention‐to‐treat analysis of percutaneous endovascular treatment of hepatic artery stenosis after orthotopic liver transplantation

“…In the last decade, endovascular treatment by percutaneous transluminal angioplasty ± stenting (PTA) has been developed as the primary treatment of hepatic arterial complications including HAS except in those with very early thrombosis or stenosis (≤7 days from LT) which are treated by surgical revascularization . PTA ensures good arterial patency and improves graft and patient survivals in patients with HAS . However, there are no generally accepted management guidelines for HAS by an endovascular approach especially in patients with established biliary ischemia .…”

Use of Coronary Techniques in Celiac and Hepatic Artery Stenting in Post-Hepatic Transplant Patients

“…6 Saad et al reported primary patency rates at 1 year of 44% after angioplasty alone, 3 while Chen et al demonstrated patency rates of 79% at 1 year. 8 A technical issue in endovascular repair, identified in multiple reports, 9 that may affect procedure success rate and outcome is significant kinking or tortuosity of the hepatic artery. This is most often related to either redundancy from a longer vessel or from significant mismatch in size between donor and recipient arteries.…”