Urgent Revascularization of Liver Allografts After Early Hepatic Artery Thrombosis1

Pinna, Antonio D.; Smith, Craig V.; Furukawa, Hiro; Starzl, Thomas E.; Fung, John J.

doi:10.1097/00007890-199612150-00010

Cited by 145 publications

(106 citation statements)

References 25 publications

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“…Regular scanning of the hepatic artery (HA) with the colour duplex scan can detect HA stenosis before complete HA occlusion, and HA stenosis can be successfully treated with angioplasty [ 141. Careful monitoring for HAT and early intervention can be effective in patients with HAT after OLT [8,15,16,17,181.…”

Section: Arterial Conduits For Hepatic Artery Revascularisation In Admentioning

confidence: 99%

“…HA stenosis [6] or HA aneurysm [20]. Several techniques of HA conduits have been reported, including arterial or venous grafts and suprarenal, infra-renal aortic conduits or interposition grafts [17,19,201. There have been few reports of the long-term patency of arterial conduits and the outcome of OLT in grafts revascularised using HA conduits [19,21,22].…”

Section: Arterial Conduits For Hepatic Artery Revascularisation In Admentioning

confidence: 99%

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Arterial conduits for hepatic artery revascularisation in adult liver transplantation

Muralidharan¹,

Imber²,

Leelaudomlipi³

et al. 2004

Transplant International

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Arterial complications after orthotopic liver transplantation (OLT), including hepatic artery thrombosis (HAT), are important causes of early graft failure. The use of an arterial conduit is an accepted alternative to the utilisation of native recipient hepatic artery for specific indications. This study aims to determine the efficacy of arterial conduits and the outcome in OLT. We retrospectively reviewed 1,575 cadaveric adult OLTs and identified those in which an arterial conduit was used for hepatic revascularisation. Data on the primary disease, indication for using arterial conduit, type of vascular graft, operative technique and outcome were obtained. Thirtysix (2.3%) patients underwent OLT in which arterial conduits were used for hepatic artery (HA) revascularisation. Six of these were performed on the primary transplant, while the rest (n = 30) were performed in patients undergoing re-transplantation, including six who had developed hepatic artery aneurysms. The incidence of arterial conduits was 0.4% (6/ 1,426 cases) in all primary OLTs and 20.1% (30/149 cases) in all re-transplants. Twenty-nine procedures utilised iliac artery grafts from the same donor as the liver, six used iliac artery grafts from a different donor, and a single patient underwent a polytetrafluoroethylene (PTFE) graft. Two techniques were used: infra-renal aorto-hepatic artery conduit and interposition between the donor and recipient native HAS, or branches of the HAS. The 30-day mortality rate for operations using an arterial conduit was 30.6%. Three conduits thrombosed at 9,25 and 155 months, respectively, but one liver graft survived without re-transplantation. The arterial conduits had 1-and 5-year patency rates of 88.5% and 80.8%. The 1-and 5-year patient survival rates were 66.7% and 44%. We can thus conclude that an arterial conduit is a viable alternative option for hepatic revascularisation in both primary and re-transplantation. Despite a lower patency rate than that of native HA in the primary OLT group, the outcomes of arterial conduit patency and patient survival rates are both acceptable at 1 and 5 years, especially in the much larger re-OLT group.

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Section: Arterial Conduits For Hepatic Artery Revascularisation In Admentioning

confidence: 99%

Section: Arterial Conduits For Hepatic Artery Revascularisation In Admentioning

confidence: 99%

Arterial conduits for hepatic artery revascularisation in adult liver transplantation

Muralidharan¹,

Imber²,

Leelaudomlipi³

et al. 2004

Transplant International

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“…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 reported mortality rate for LT recipients developing HAT ranges from 30% to 75%. 11,23 Several potential risk factors have been described, but in many recipients, the cause of HAT and other vascular complications remains multifactorial and unknown.…”

mentioning

confidence: 99%

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

Pungpapong

2002

Liver Transplantation

141

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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...

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“…Ischemia caused by HAT results in severe biliary and parenchyma damage and is associated with high rates of graft loss and mortality. Urgent thrombectomy and revascularization or re-transplantation is currently considered the treatment of choice in case of early diagnosis of HAT [10] . If Doppler US and/or computed tomograghy (CT) suspicious of HAT are present, an arteriogram is usually performed to confirm the imaging finding and, in very early diagnosis of HAT, to try to restore the hepatic flow with selective thrombolytic therapy and eventual treatment of concomitant HAS with balloon angioplasty and/or stent placement.…”

Section: Hepatic Artery Thrombosis (Hat)mentioning

confidence: 99%

Interventional radiology procedures in adult patients who underwent liver transplantation

Miraglia

Maruzzelli

Caruso

et al. 2009

WJG

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Interventional radiology has acquired a key role in every liver transplantation (LT) program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplantation. The aim of this paper is to review indications, technical consideration, results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

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Urgent Revascularization of Liver Allografts After Early Hepatic Artery Thrombosis1

Cited by 145 publications

References 25 publications

Arterial conduits for hepatic artery revascularisation in adult liver transplantation

Arterial conduits for hepatic artery revascularisation in adult liver transplantation

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

Interventional radiology procedures in adult patients who underwent liver transplantation

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