Vascular Complications After Orthotopic Liver Transplantation: Hepatic Artery Thrombosis

Pareja, Eugenia; Cortes, Mauricio; Navarro, Ricard; Sanjuán, Francisco Miguel Ortíz; López, Rafael Martínez; Mir, José

doi:10.1016/j.transproceed.2010.07.063

Cited by 123 publications

(103 citation statements)

References 14 publications

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“…Although HAT is more common in the pediatric population, 16 it has been reported to complicate 3% to 5% of adult orthotopic LT procedures. [16][17][18] This is consistent with the data from the UK Transplant Registry, which has reported a 2.9% incidence of early HAT (occurring within 90 days of transplantation), and with the data from the center in Birmingham, which has reported a 3.1% incidence of late HAT (occurring after 90 days) during the period of study. The high incidence of HAT in AIP patients was previously unreported and is considerably higher than the rate expected for the general LT population.…”

Section: Discussionsupporting

confidence: 89%

Hepatic Artery Thrombosis

2010

High-Yield Imaging: Interventional

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Acute intermittent porphyria (AIP) is an autosomal-dominant condition resulting from a partial deficiency of the ubiquitously expressed enzyme porphobilinogen deaminase. Although its clinical expression is highly variable, a minority of patients suffer recurrent life-threatening neurovisceral attacks despite optimal medical therapy. Because the liver is the major source of excess precursor production, liver transplantation (LT) represents a potentially effective treatment for severely affected patients. Using data from the UK Transplant Registry, we analyzed all transplants performed for AIP in the United Kingdom and Ireland. Between 2002 and 2010, 10 patients underwent LT for AIP. In all cases, the indication for transplantation was recurrent, biochemically proven, medically nonresponsive acute attacks of porphyria resulting in significantly impaired quality of life. Five patients had developed significant neurological morbidities such as paraplegia before transplantation. The median follow-up time was 23.4 months, and there were 2 deaths from multiorgan failure at 98 days and 26 months. Eight recipients were alive for 3.2 to 109 months after transplantation. Complete biochemical and symptomatic resolution was observed in all patients after transplantation. However, there was a high rate of hepatic artery thrombosis (HAT; 4/10), with 1 patient requiring regrafting. The effects of previous neuronal damage such as joint contractures were not improved by transplantation. Thus, impaired quality of life in the surviving patients was usually a result of preoperative complications. Refractory AIP is an excellent indication for LT, and long-term outcomes for carefully selected patients are good. There is, however, an increased incidence of HAT in these patients, and we recommend routine antiplatelet therapy after transplantation.

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Section: Discussionsupporting

confidence: 89%

Hepatic Artery Thrombosis

2010

High-Yield Imaging: Interventional

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“…The true incidence of early HAT following OTL is unknown, but it varies widely from 0% to 12% in adults [5,9,24,25,27,30,38,41] . Bekker et al [28] (2009) reported in a systematic review comprising 21822 OLT cases an incidence of 843 cases (adults and children) of early HAT with an overall incidence of 4.4%.…”

Section: Incidencementioning

confidence: 99%

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

Piardi¹

2016

WJH

167

159

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Although vascular complications (VCs) following orthotopic liver transplantation (OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as they compromise the blood flow of the transplant (either inflow or outflow). Diagnosis and therapeutic management of VCs constitute a major challenge in terms of increasing the success rate of liver transplantation. While surgical treatment used to be considered the first choice for management, advances in endovascular intervention have increased to make this a viable therapeutic option. Considering VC as a rare but a major and dreadful issue in OLT history, and in view of the continuing and rapid progress in recent years, an update on these uncommon conditions seemed necessary. In this sense, this review comprehensively discusses the important features (epidemiological, clinical, paraclinical, prognostic and therapeutic) of VCs following OLT. Core tip: Although vascular complications (VCs) following orthotopic liver transplantation (OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as

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“…Центры, в которых трансплантацию печени проводят регу-лярно и в течение долгих лет, демонстрируют существенное снижение числа ТПА по мере накопления опыта. В клиниках, выполняющих менее 30 операций в год, частота ТПА значитель-но выше, чем в клиниках с большей трансплан-тационной активностью [1,2,12,26].…”

Section: Review Articles and Lecturesunclassified

“…Для ТПА характерно наличие множественных неанасто-мотических стриктур желчных протоков, абсце-дирующего рецидивирующего холангита и, как следствие, билиарного сепсиса. Как уже было отмечено, наиболее драматичный сценарий раз-вивается при ранних ТПА, в то время как при поздних тромбозах клинико-инструментальная картина может быть менее яркой, а порой и вовсе отсутствовать [2,6,19,26,33].…”

Section: Review Articles and Lecturesunclassified

“…Ретрансплантация показана у 53% пациентов с ТПА и у 30% больных, пере-несших тромбэктомию и реконструктивное вме-шательство на печеночной артерии. Некоторыми авторами ретрансплантация рассматривается как наиболее эффективный метод лечения, показан-ный большинству пациентов с ТПА [19,26,41,42]. По данным R. Bussutill и G. Klintman (2014), в США тромбоз артериального анастомоза, раз-вившийся в ранние сроки после ОТП, является абсолютным показанием к внесению пациента в экстренный Лист ожидания ретранспланта-ции печени [19].…”

Section: лечение тромбоза печеночной артерииunclassified

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