03:00 PM Abstract No. 248 Treatment of liver transplant hepatic artery stenosis: drug-eluting vs. bare-metal stents

Abstract

Hepatic artery stenosis (HAS) following liver transplantation is generally treated with endovascular techniques. Our institution has adapted the use of drug-eluting stents (DES) in transplant HAS, particularly in small caliber arteries. The aim of this study is to compare patency rates for DES to traditional bare-metal stents (BMS). A single-institution retrospective review of HAS in liver transplant patients treated with stent placement was performed. Demographics, pre-procedural indication, procedural details, technical success, complications, surveillance imaging, and subsequent interventions were recorded. Primary patency and graft survival was calculated using the Kaplan-Meier method. Primary patency was defined as time from stent placement to: resistive index (RI) on Doppler U/S <0.5, hepatic artery thrombosis, additional endovascular intervention or surgical revision/re-transplant. 48 cases were identified (mean age 56, 29M/19F). Median time from transplant to stent placement was 123 days. There were 11 DES and 37 BMS with mean (SD) arterial diameters of 3.9 mm (0.42) and 5.1 mm (1.01), respectively. Technical success was 48/48 (100%). Mean (SD) pre-procedural RI was 0.36 (0.12), and post-procedural RI was 0.55 (0.15). There were 2 procedure-related complications (dissections), and 1 delayed complication (pseudoaneurysm). Median follow-up was 1032 days (range 182-3413). Median primary patency for DES, BMS, and the whole group was 2113, 931 and 979 days, respectively. Primary patency at 1, 2 and 3 years was: DES 62%, 62%, 62%; BMS 65%, 53%, 45% (p = 0.77); whole group 64%, 55%, 49%. Graft survival at 1, 3, and 5 years was: DES 100%, 100%, 100%; BMS 97%, 87%, 83%; whole group 98%, 89%, 86%. Median primary patency for DES vs. comparable diameter (3.5-4.5 mm, n = 10 each) BMS was 2113 and 739 days, respectively. Stenting for HA stenosis following liver transplantation is a safe and effective intervention. Observed long-term patency in the DES cases appeared longer despite placement in smaller caliber arteries. Consideration to DES could be given in liver transplant HAS, particularly in vessels less than 4.5 mm in diameter.