Treatment of Hepatic Artery Stenosis in Liver Transplant Patients Using Drug-Eluting versus Bare-Metal Stents

Abstract

Hepatic artery stenosis after liver transplant is often treated with endovascular stent placement. Our institution has adopted use of drug-eluting stents, particularly in small-caliber arteries. We aimed to compare patency rates of drug-eluting stents vs. traditional bare-metal stents. This was a single-institution, retrospective study of liver transplant hepatic artery stenosis treated with stents. Primary patency was defined as time from stent placement to resistive index on Doppler ultrasonography (<0.5), hepatic artery thrombosis, or any intervention including surgery. Fifty-two patients were treated with stents (31 men; mean age, 57 years): 15, drug-eluting stents; 37, bare-metal stents. Mean arterial diameters were 4.1 mm and 5.1 mm, respectively. Technical success was 100% (52/52). At 6 months, 1, 2, and 3 years, primary patency for drug-eluting stents was 80%, 71%, 71%, and 71%; bare-metal stents: 76%, 65%, 53%, and 46% (p = 0.41). Primary patency for small-caliber arteries (3.5–4.5 mm) with drug-eluting stents was 93%, 75%, 75%, and 75%; bare-metal stents: 60%, 60%, 50%, and 38% (p = 0.19). Overall survival was 100%, 100%, 94%, and 91%. Graft survival was 100%, 98%, 96%, and 90%. Stenting for hepatic artery stenosis was safe and effective. While not statistically significant, patency improved with drug-eluting stents compared with bare-metal stents, especially in arteries < 4.5 mm in diameter. Drug-eluting stents can be considered for liver transplant hepatic artery stenosis, particularly in small-caliber arteries.

Hepatic Artery Stenosis Following Adult Liver Transplantation: Evaluation of Different Endovascular Treatment Approaches

“…When excluding thrombosis, our complication rate of 9.5% (2/21) following hepatic artery angioplasty and/or stenting was similar to previously reported rates of 5.3-12% [5,8,[10][11][12]. When comparing the rates of hepatic artery thrombosis following angioplasty and/or stenting for HAS, our rate of 19% (4/21) was slightly lower than previously reported rates of 27-28% [20][21]. Previous retrospective reviews reported an increase in RI between 0.1 to 0.2 following direct hepatic artery interventions, which is concordant with the + 0.11 change in RI within our HAI treatment group [8,9].…”

Hepatic artery stenosis following adult liver transplantation: evaluation of different endovascular treatment approaches

“…When excluding thrombosis, our complication rate of 9.5% (2/21) following hepatic artery angioplasty and/or stenting was similar to previously reported rates of 5.3–12% [ 5 , 8 , 10 – 12 ]. When comparing the rates of hepatic artery thrombosis following angioplasty and/or stenting for HAS, our rate of 19% (4/21) was slightly lower than previously reported rates of 27–28% [ 20 , 21 ]. Previous retrospective reviews reported an increase in RI between 0.1 to 0.2 following direct hepatic artery interventions, which is concordant with the + 0.11 change in RI within our HAI treatment group [ 8 , 9 ].…”

Emergency interventional endovascular treatment for early disorder of arterial blood flow in the liver graft

“…Имплантация стентов в зону сужения ПА после ТП является безопасным и эффективным вмешательством. Стенты с лекарственным покрытием (СЛП) после ТП показывают лучшие результаты по проходимости в сравнении с голометаллическими стентами (ГМС) [14,17]. D. Fleck et al сообщают о том, что проходимость СЛП в печеночной артерии составляет 62% через 1, 2 и 3 года.…”

“…А проходимость ГМС составляет 65%, 53% и 45% через те же сроки соответственно. Выживаемость трансплантата печени после имплантации СЛП составляет 100% через 1, 3 и 5 лет, а после стентирования ГМС через те же сроки составляет 97%, 87%, 83% соответственно [17].…”

“…Рентгенхирургические эндоваскулярные вмешательства (РЭВ) демонстрируют хорошие результаты при лечении артериальных осложнений после ТП, особенно при развитии сужений [1,7,8,11,13,16,17], их непосредственная успешность составляет от 46 до 68% [5]. Срочная РЭВ в случаях раннего ТПА в течение первой недели после ТП может достигать 81% успеха и может существенно уменьшать риск утраты трансплантата и потребность в ретрансплантации.…”