Abstract No. 513 Endovascular interventions safely and effectively maintain long-term patency in patients with arterial complications of liver transplantation

Abstract

To investigate the long-term safety and efficacy of endovascular interventions at treating transplant hepatic artery stenosis and thrombosis An IRB-approved, retrospective single-center cohort study was conducted on patients who underwent liver transplantation surgery from 1986 to 2020. Of the 1984 liver transplant patient records reviewed, 29 contained diagnoses of transplant hepatic artery stenosis (HAS) or thrombosis (HAT) necessitating a total of 50 endovascular interventions between 2005 and 2020. Median follow-up time from the initial intervention was 644 days (range, 5–4782 days) with follow-up time exceeding 2500 days in 11 cases. Complications were considered clinically significant if the Common Terminology Criteria for Adverse Events grade was 2 or greater. Two-sided, Wilcoxon signed-rank tests were performed to compare pre- and post-procedural duplex imaging measurements of resistive index and peak systolic velocity; P values less than 0.05 were considered statistically significant. Kaplan-Meier analyses were used to evaluate the primary patency and primary-assisted patency rates of the interventions. 94% (47/50) of interventions were performed for HAS, and 6% (3/50) were performed for HAT. Primary technical success was achieved in 92% (46/50) of cases. Clinically significant peri-procedural complications occurred in 6% (3/50) of cases. Pre- and post-procedural duplex imaging demonstrated improvements in both resistive index (mean difference, 0.10; P < 0.05) and peak systolic velocity (mean difference, -128 cm/s; P < 0.01). The primary patency rate of initial interventions was 90%, 63%, and 55% at 1, 6, and 12 months, respectively. The primary-assisted patency rate was maintained at 97% through 10 years of follow-up. Endovascular interventions used to treat transplant HAS and HAT demonstrate safety and efficacy on long-term follow-up. Although one-year primary patency is modest, additional interventions can be performed to maintain primary-assisted patency for a durable long-term result.