Early Hepatic Artery Thrombosis Research Articles

Intraoperative indocyanine green fluorescence imaging to predict early hepatic arterial complications after liver transplantation.

In liver transplantation (LT) setting, to propose an innovative intraoperative criterion to judge arterial flow abnormality that may lead to early hepatic arterial occlusion, i.e. thrombosis or stenosis, when left untreated and to carry out re-anastomosis. After liver graft implantation, and after ensuring that there is no abnormality on the Doppler ultrasound (qualitative and quantitative assessment), we intraoperatively injected indocyanine green dye (ICG, 0.01mg/Kg) and we quantified the fluorescence signal at the graft pedicle using ImageJ software. From the obtained images of 89 adult patients transplanted in our center between September 2017 and April 2019, we constructed fluorescence intensity curves of the hepatic arterial signal, and examined their relationship with the occurrence of early hepatic arterial occlusion (thrombosis or stenosis). Early hepatic arterial occlusion occurred in seven patients (7.8%), including three thrombosis and four stenosis. Among various parameters of the flow intensity curve analyzed, the ratio of peak to plateau (RPP) fluorescence intensity and the jagged wave pattern at the plateau phase were closely associated with this dreaded event. By combining RPP at 0.275 and a jagged wave, we best predicted the occurrence of early hepatic arterial occlusion and thrombosis, with sensitivity/specificity of 0.86/0.98 and 1.00/0.94, respectively. Through a simple composite parameter, indocyanine green fluorescence imaging system is an additional and promising intraoperative modality for identifying transplant recipients at high risk of developing early hepatic arterial occlusion. This tool could assist the surgeon in the decision to redo the anastomosis despite normal Doppler ultrasonography.

Treatment strategies for hepatic artery complications after pediatric liver transplantation: A systematic review.

This study aimed to evaluate the effectiveness of different treatments for hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) after pediatric liver transplantation. We systematically reviewed studies published since 2000 that investigated the management of HAT and/or HAS after pediatric liver transplantation. Studies with a minimum of 5 patients in one of the treatment methods were included. The primary outcomes were technical success rate and graft and patient survival. The secondary outcomes were hepatic artery patency, complications, and incidence of HAT and HAS. Of 3570 studies, we included 19 studies with 328 patients. The incidence was 6.2% for HAT and 4.1% for HAS. Patients with an early HAT treated with surgical revascularization had a median graft survival of 45.7% (interquartile range, 30.7%-60%) and a patient survival of 61.3% (interquartile range, 58.7%-66.9%) compared with the other treatments (conservative, endovascular revascularization, or retransplantation). As for HAS, endovascular and surgical revascularization groups had a patient survival of 85.7% and 100% (interquartile range, 85%-100%), respectively. Despite various treatment methods, HAT after pediatric liver transplantation remains a significant issue that has profound effects on the patient and graft survival. Current evidence is insufficient to determine the most effective treatment for preventing graft failure.

Hepatic artery thrombosis and use of anticoagulants and antiplatelet agents in pediatric liver transplantation.

Hepatic artery thrombosis (HAT) is a reported complication of 5%-10% of pediatric liver transplantations, rates 3-4 times that seen in adults. Early HAT (seen within 14 days after transplant) can lead to severe allograft damage and possible urgent re-transplantation. In this report, we present our analysis of HAT in pediatric liver transplant from a national clinical database and examine the association of HAT with anticoagulant or antiplatelet medication administered in the post-operative period. Data were obtained from the Pediatric Health Information System database maintained by the Children's Hospital Association. For each liver transplant recipient identified in a 10-year period, diagnosis, demographic, and medication data were collected and analyzed. Our findings showed an average rate of HAT of 6.3% across 31 centers. Anticoagulant and antiplatelet medication strategies varied distinctly among and even within centers, likely due to the fact there are no consensus guidelines. Notably, in centers with similar medication usage, HAT rates continue to vary. At the patient level, use of aspirin within the first 72 h of transplantation was associated with a decreased risk of HAT, consistent with other reports in the literature. We suggest that concerted efforts to standardize anticoagulation approaches in pediatric liver transplant may be of benefit in the prevention of HAT. A prospective multi-institutional study of regimen-possibly including aspirin-following transplantation could have significant value.

Results of liver retransplantations

Aim. To present the results of repeated liver transplantations performed in a federal center. Materials and methods. The results of 268 orthotopic full-liver postmortem transplantations in 248 patients since 1998 were analyzed. Retransplantation was performed in 20 patients (8.1%) – 10 men and 10 women, 18-64 years old (median age 44.4 years). The median MELD score was 21 (19-24). Observations before 2006 were analyzed retrospectively. Early hepatic artery thrombosis and late biliary complications due to insufficient arterial blood supply to the graft indicated the retransplantation in the majority of patients. Results. The duration of preservation stages was comparable to the primary transplantation. Significant differences were found in the duration of the anhepatic period, the volume of hemotransfusion, the duration of the surgery, the rate of complications and the hospital mortality rate. Currently, 9 of the 20 patients (45%) are alive, with a follow-up period of 7-140 months. Graft function was satisfactory in most recipients. Hospital mortality accounted for 35%. Conclusion. Liver retransplantation is accompanied by considerable technical difficulties, as well as by an increase in surgery duration, volume of blood transfusion, time of stay in the intensive care unit, and incidence of postoperative complications. Infectious complications were the main cause of death. With successful retransplantation, long-term results and survival rates were comparable to those of primary transplantation.

Effect of Pre-Transplant Covid-19 Exposure on Post-Liver Transplant Clinical Outcomes

BackgroundCOVID-19 has led to an unprecedented global health crisis. This situation caused an immediate reduction in solid organ transplantation activity. This study aimed to present the follow-up results of patients with chronic liver disease who underwent liver transplantation (LT) after a history of COVID-19 infection. MethodsSociodemographic characteristics and clinicopathological data of 474 patients who underwent LT at Inonu University Liver Transplant Institute between March 11, 2020 and March 17, 2022 were prospectively recorded and analyzed retrospectively. Among these, the data of 35 patients with chronic liver disease who were found to be exposed to COVID-19 infection in the pre-LT period were analyzed for this study. ResultsThe median body mass index, Child score, and Model for end-stage liver disease/ Pediatric end-stage liver disease scores of the 35 patients were calculated as 25.1 kg/m2 (IQR: 7.4), 9 points (IQR: 4), and 16 points (IQR: 10), respectively. Graft rejection occurred in 4 patients at a median of 25 days post-transplant. Five patients underwent retransplantation at a median of 25 days post-transplant. The most common cause of retransplantation is early hepatic artery thrombosis. There were 5 deaths during postoperative follow-up. Mortality developed in 5 (14.3%) patients exposed to COVID-19 infection in the pretransplant period, whereas mortality occurred in 56 (12.8%) patients not exposed to COVID-19 infection. There was no statistically significant difference in mortality between the groups (P = .79). ConclusionsThe results of this study showed that exposure to COVID-19 before LT does not affect post-transplant patients and graft survival.

Low resistive index on doppler ultrasound predicts worse graft survival in liver transplantation

Background: Although liver transplantation (LT) outcomes have improved significantly over the last decades, early post-transplant vascular complications, such as hepatic arterial thrombosis (HAT), are still associated with an elevated risk of graft failure. Doppler Ultrasound (DUS) is a non-invasive, semi-quantitative method capable of detecting vascular abnormalities by estimating the resistance to arterial blood flow, quantified through the Resistive Index (RI). In order to detect early acute HAT, DUS is performed on the first post-transplant week. The aim of this study was to evaluate the association of RI parameters of DUS performed on the first post-transplant week with graft survival of transplanted livers.

Intra-arterial thrombolysis for early hepatic artery thrombosis following liver transplantation: a case report

Intra-arterial thrombolysis for early hepatic artery thrombosis following liver transplantation: a case report

S1277 The Selection of Donors in Living Donors of Liver Transplantation Based on Results of Thrombophilia Screening Tests and Prophylactic Strategy for Venous Thromboembolic Events (VTE)

Introduction: Vascular events after living donor liver transplantation (LDLT) are one of the most feared complications that usually lead to graft and donor loss. The main aim of this study was to determine the frequency of hereditary thrombophilia in the Pakistani population and share our centers’ safety and venous thromboembolic events (VTE) prophylaxis protocols in the borderline and high-risk groups in live liver donors. Methods: This prospective, observational study included thrombophilia testing, which was done on 567 living donor candidates between July 2018 and April 2021. Donors were divided into the normal, border-line, and high-risk groups according to the Caprini scoring system. Usual prophylaxis with enoxaparin along with elastic stockings and intermittent pneumatic compression (IPC) was given postoperatively to donors in the borderline and high-risk groups. The safety endpoints were VTE occurrence, bleeding complications, or mortality. Results: Among 567 donors, 21 (3.7%) donors were deficient in protein C, 14(2.5%) were deficient in anti-thrombin-III and 45(7.9%) were having Leiden factor-V mutation. 31/416 (7.45%) were deficient in factor-II. IgM & IgG Anti-phospholipids antibodies were positive in 2/567(0.4%) and 2/567(0.4%) respectively. Donor operation was performed on 44 candidates in the borderline group and 7 in the high-risk group. Complications after surgery were comparable between the 2 groups (p >0.05). One donor in the normal donor group developed pulmonary embolism, but none of the donors in either borderline or high-risk group developed VTE. (Table) Conclusion: Early hepatic artery thrombosis (eHAT), deep venous thrombosis, and pulmonary embolism are one of the most common vascular events after liver transplantation.The majority of LDLT centers exclude donors from high-risk groups (according to the Caprini scoring system) and are used to give low molecular weight heparin in borderline donor groups. But we are the only LDLT center where not only did we perform right lobe hepatectomy on high-risk donor group on thrombophilia screening tests, but we also gave usual prophylaxis with enoxaparin (rather than low molecular weight heparin) along with elastic stockings, and intermittent pneumatic compression (IPC) postoperatively to donors in the borderline and high-risk groups (Fifty-one donors ) to decrease the risk of VTE. Table 1. - Comparison of demographics, surgical features, and postoperative complications of LLDs in donor groups Variables Normal Group (n=516) Borderline Group (n=44) High-Risk Group (n=7) P-value Mean age (Years) 23.43 ± 5.53 23.91± 5.25 26.86 ± 6.54 0.17 Mean BMI (Kg/m2) 21.40 ± 7.99 20.5 ± 2.71 21.53 ± 3.29 0.69 GenderMaleFemale 290(56.2%)226(43.7%) 24(54.5%)20(45.4%) 4(57.1%)3(42.8%) 0.97 Marital statusUnmarriedMarried 351(68.1%)165 (31.9%) 25(56.9%)19 (43.1%) 5(71.4%)2(28.5%) 0.06 Donor's relation to recipientsSonBrotherNephewDaughterSisterFatherSwapOthersType of Graft Modified right lobe graftModified extended right lobe graftLeft lobe graftLeft lateral segment graftGRWRMean warm ischemia time (minutes)Mean operation time (hours)Mean blood loss (ml)Blood transfusions (no of patients/ %) 63 (12.2%)99 (19.1%)25 (4.8%)35 (6.7%)32 (6.2%)88 (17.1%)10 (1.9%)157(30.4%)437 (84.6%)62 (12.0%)4 (0.7%)11 (2.1%)6(1.1%)1.26 ± 0.6310.99 ± 6.09407.94 ± 64.86516 6 (13.6%)5 (11.3%)5(11.3%)5 (11.3%)5 (11.3%)3 (6.8%)011 (25.0%)36 (81.8%)8 (18.1%)7 (15.9%)001.4 ± 0.6810.68 ± 4.08412.27 ± 89.1144 1(14.2%)2(28.5%)1(14.2%)00003(42.8%)6(85.7%)1(14.2%)001.2 ± 0.6313.86 ± 7.26422.86 ± 62.377 0.008NSNSNS0.76 Personal History of Thrombosis 0 0 0 _ Total number of complications 62 (12.0%) 15 (34.1%) 2(28.5%) 0.43 Grade 1 & 2 Wound infections Wound hematoma UTI Fever Paralytic ileus 20 (3.8%)2 (0.3%)4 (0.7%)3 (0.5%)2 (0.3%) 3 (6.8%)1 (2.2%)2 (4.5%)2 (4.5%)1 (2.2%) 2(28.5%)0000 0.12 Grade 3A Bile leakage Bile duct stricture Post-op bleeding Pleural effusion/Aspiration ERCP & Stenting 6 (1.1%)3(0.5%)3 (0.5%)9 (1.7%)3 (0.5%) 1 (2.2%)01 (2.2%)1 (2.2%)1 (2.2%) 00000 0.15 Grade 3B Re-open 6(1.1%) 1 (2.2%) 0 0.45 Grade 4A Need ICU care/ ventilatorGrade 4B Multi-organ failure 1 (0.1%)0 1 (2.2%)0 00 0.95-- Grade 5 0 0 0 -- Mean ICU stay (Days) 3 ± 1 2.53 ± 1 3 ± 1 0.15 Mean hospital stay (Days) 6 ± 2 5 ± 2 6 ± 2 0.17 Mortality 0 0 0 -- Abbreviations: BMI: body mass index; GRWR= graft to recipient weight ratio; ICU: Intensive care unit; UTI: Urinary tract infection.

S3212 Very Late Hepatic Artery Thrombosis After Orthotopic Liver Transplantation

Introduction: Hepatic artery thrombosis (HAT) is a serious complication after orthotopic liver transplantation (OLT) and is the most common vascular complication. It is often categorized into early HAT which is defined as occurring < 30 days after liver transplantation & late HAT defined as occurring > 30 days post transplantation. The etiology of HAT is often related to surgical factors, such as vessel kinking, anastomotic stenosis, and intimal dissection, but can factors such as hypercoagulability, elderly donors, and rejection episodes can contribute. Symptoms can often be vague with common complaints being abdominal pain, fever, nausea, & emesis. Case Description/Methods: A 68-year-old male with OLT (20 years prior to presentation) for primary sclerosing cholangitis (PSC), ulcerative colitis presented with 1 month history of nausea, emesis, and weakness. He was afebrile & hemodynamically stable. On physical exam, abdomen was soft, nontender, nondistended, and patient was jaundice. Laboratory data was notable for a two-month elevation of alkaline phosphatase, ALT, AST, direct bilirubin. An ultrasound of the liver with doppler evaluation was obtained that demonstrated an absence of flow in the left and right hepatic arteries within the liver. A computed tomography angiography (CTA) of the abdomen was obtained that confirmed these findings (Figure 1). Due to the history of PSC, a magnetic resonance cholangiopancreatography was obtained that showed no biliary dilation or evidence of recurrent PSC. A liver biopsy demonstrated paucicellular ductopenia with cholestasis consistent with chronic arterial insufficiency and no significant fibrosis. Transplant surgery and interventional radiology were consulted for potential recanalization. However, due to prolonged elevations in liver enzymes >4 weeks, both teams determined that recanalization would likely provide no benefit yet held greater risk. Discussion: This case highlights an uncommon, very late presentation of HAT. In the literature, late HAT has been described in the order of months, not years as it was in this case. It is usually associated with a less fulminant presentation and a milder course, in comparison to cases of HAT that present earlier in the post-transplant course. This case highlights the importance of considering HAT as a diagnosis in a patient with history of OLT who presents with abdominal pain, nausea, and emesis.Figure 1.: Focal filling defect in the hepatic artery seen in this venous phase CTA.

Evaluation of Early and Late Effects of Surgical Treatment of Early Hepatic Artery Thrombosis After Liver Transplantation

Hepatic artery thrombosis (HAT) is the most severe vascular complication after liver transplantation and one of the major causes of early graft loss and mortality after transplantation. The number of retransplantations and recipient deaths can be decreased with an urgent thrombectomy of the hepatic artery. The aim of the study was to analyze the early and long-term outcomes of the surgical revascularization of early hepatic artery thrombosis after liver transplantation. Four hundred eleven orthotopic liver transplantations in 380 patients were performed at our center between 2005 and 2020. A Doppler evaluation of the graft vessels patency was performed daily for the first 5 days after transplantation in all recipients. After angio-computed tomography confirmation, most of the cases of HAT qualified for surgical revascularization. Early HAT was diagnosed in 20 cases (4.9%), occurring most frequently between the first and third day after transplantation. Sixteen patients underwent revascularization surgery. Among them, in the early post-transplantation period, 4 died and 2 more had retransplantation. Of the remaining 10 recipients, 2 had no biliary complications, 1 had bile leakage, and 7 had common bile duct stenosis, all treated endoscopically. Among 4 nonoperated patients, 1 died and the other 2 had retransplantation in the early post-transplantation period; the last of these 4 recipients had bile duct stenosis. The urgent surgical revascularization in liver recipients with early HAT allows the avoidance of early retransplantation. However, these patients require intensified surveillance owing to the high risk of biliary complications that may affect shortened graft and patient survival.

A Long Graft Artery is a Safe and Reproducible Procedure for Arterial Reconstruction In Liver Transplantation

Although a short and nonredundant anastomosis is most often performed in liver transplantation, there is no strong evidence in the literature about the ideal arterial reconstruction. We describe here the "long-artery" technique that enables a wide side-to-end anastomosis and preserves arterial length. We present the results between 2011 and 2019 of the "long-artery" technique performed in our center. Patients with a split liver transplantation or aortohepatic conduits were not included. This technique uses the whole arterial axis of the graft. A side-to-end anastomosis is performed between the common and/or proper hepatic artery of the recipient, and the celiac trunk with an aortic patch of the graft, while the gastroduodenal artery of the recipient is preserved. An omental flap is positioned under the graft artery to prevent kinking. Eight hundred thirty-two transplant patients were included in the analysis. Early hepatic artery thrombosis was diagnosed in 22 (2.6%) patients and occurred within the first 10 days after the procedure. A thrombectomy was performed in 7 patients, which was successful in 4 patients, and 18 patients were retransplanted. Seven patients (0.8%) developed a late hepatic artery thrombosis, including 2 patients who were retransplanted. The "long-artery" technique is a safe and efficient technique for arterial reconstruction in liver transplantation and does not seem to increase the rate of early hepatic artery thrombosis.

Multimodality Imaging after Liver Transplant: Top 10 Important Complications.

Patients who have undergone liver transplant are now regularly seen in day-to-day radiology practice. All surgical techniques for liver transplant require arterial, portal venous, hepatic venous and caval, and biliary anastomoses. This review is focused on the 10 "not to be missed" complications of liver transplant that affect the health and life of the graft and graft recipient. Arterial complications are the most common and devastating. Early hepatic artery thrombosis may be catastrophic because the biliary tree is solely dependent on the hepatic artery after transplant and collateral vessels have not yet formed. In contrast, delayed hepatic artery thrombosis may be more insidious as collateral arteries develop. US findings of delayed hepatic artery thrombosis may be similar to those of hepatic artery stenosis and celiac artery stenosis. Splenic artery steal syndrome is an increasingly recognized cause of graft ischemia. Venous complications are much less common. Hepatic venous and caval complications are notable for their increased incidence in living-donor and pediatric transplants. Biliary complications often result from arterial ischemia. Biliary cast syndrome is a notable example in which ischemic biliary mucosa sloughs into and obstructs the duct lumens. Neoplasms also may occur within the hepatic graft and may be due to recurrent malignancy, posttransplant lymphoproliferative disorder, or metastases. US is the initial imaging modality of choice, particularly in the acute postoperative setting. Further evaluation with contrast-enhanced US, CT, or MRI; catheter angiography; endoscopic retrograde cholangiopancreatography; and/or nuclear medicine studies is performed as needed. An invited commentary by Bhargava is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Hepatic Artery Thrombosis After Orthotopic Liver Transplant: Experience in the Last 10 Years

Hepatic artery thrombosis (HAT) is the second cause of graft failure, after primary disfunction. It has a significant morbidity, with a retransplant and mortality rate in early hepatic artery thrombosis of 50%. The incidence of this event goes from 2% to 9% in the adult population. The objective is to assess the incidence of HAT in a third-level hospital. The study design is an observational retrospective study, collecting data of the transplant recipient from 2010 to 2020. Incidence of HAT was 5.33% (39/732). A statistical difference was found with the blood intraoperative administration (P=.002) and with the presence of anatomic abnormalities in the hepatic artery between the HAT and the non-HAT group. We did not find any statistical difference with portal thrombosis (P=.73) between the groups. HAT is a fatal complication after an orthotopic liver transplant, which can lead to graft loss and even recipient death. For these reasons, we should early identify risk factors associated with this event early and try to minimize them to avoid the devastating consequences.

Early Hepatic Artery Thrombosis After Living Donor Liver Transplant: A 13-Year Single-Center Experience in Jordan.

Early hepatic artery thrombosis is a serious complication that may follow living donor liver transplant. Acute graft loss and patient morbidity and mortality are possible consequences. The therapeutic algorithm includes surgical or interventional revascularization, conservative approaches, or retransplantation. Among 155 patients who underwent living donor liver transplant at our transplant center from 2004 to 2020, there were 5 who developed hepatic artery thrombosis. From our 13- year experience, we herein present their demographic and clinical characteristics, radiological imaging findings, perioperative courses, and the postoperative follow-up. All patients displayed advanced liver disease with a Child-Pugh score of C and a mean Model for End-Stage Liver Disease score of 32. Underlying causes for end-stage liver disease included hepatitis B and C infection and cryptogenic liver cirrhosis. The mean patient age was 49 years; 2 patients were female. Living donor liver transplant was performed with donor tissue from immediate kin, according to Jordanian allocation rules. The diagnosis of hepatic artery thrombosis was made by Doppler ultrasonography and confirmed via computed tomography. After surgical revision of the anastomosis, our first patient experienced thrombotic recurrence. All patients received interventional catheterization with local thrombolysis and subsequently developed rethrombosis. Despite prevalent thrombosis, 4 patients achieved long-term survival without further deterioration of liver function. Cumulative 1-year, 5-year, and 10-year survival rates were 80%, 80%, and 60%, respectively. Spontaneous recanalization of the hepatic artery was observed in 1 patient. Favorable long-term outcomes are achievable in patients with persistent hepatic artery thrombosis. When retransplant is not feasible and interventional approaches fail, conservative treatment with careful observation of liver function should be implemented. Attentive observation of collateral circulation toward the liver, distal of the thrombosis, may be beneficial to both graft and patient survival.

Rescue Thrombectomy for Early Hepatic Artery Thrombosis Using Stent Retriever in a Child Post Combined Deceased Donor Liver and Renal Transplant

AbstractWe report this case of a 5-year-old child post combined liver and renal transplant for primary hyperoxaluria. Patient developed hepatic artery thrombosis on day 3 posttransplant that was managed by reexploration and reanastomosis of the hepatic artery. On day 4, the patient again developed hepatic artery thrombosis that failed to revascularize by surgical exploration and reanastomosis. Tissue plasminogen activator was injected into the hepatic artery intraoperatively to lyse any clot; however, no revascularization could be achieved. Subsequently, catheter angiogram confirmed no flow in the hepatic artery. A4 × 22 mm revive stent retriever was deployed across the site of occlusion and retrieved after 5 minutes of indwell time. Two such passes were made and complete recanalization of the hepatic artery was achieved. The hepatic artery remained patent as confirmed on serial Doppler images post intervention.

Management of early hepatic artery thrombosis following living-donor liver transplantation: feasibility, efficacy and potential risks of endovascular therapy in the first 48 hours post-transplant-a retrospective cohort study.

This retrospective cohort study aims to review our 18-year experience with early hepatic artery thrombosis (e-HAT) following living-donor liver transplantation (LDLT), as well as to assess the feasibility, efficacy and potential risks of endovascular management of e-HAT in the first 48hours (hrs) post-LDLT. Medical records of 730 patients who underwent LDLT were retrospectively reviewed. In all cases who had developed e-HAT, treatment modalities employed and their outcomes were evaluated. Thirty-one patients developed e-HAT(4.2%). Definite technical success and 1-year survival rates of surgical revascularization[11/31 cases(35.5%)] were 72.7% & 72.7%, whereas those of endovascular therapy[27/31 cases(87.1%)] were 70.4% & 59.3%, respectively. Endovascular therapy was carried out in the first 48hrs post-transplant in 9/31 cases(29%) [definite technical success:88.9%, 1-year survival:55.6%]. Four procedure-related complications were reported in 3 of those 9 cases(33.3%). In conclusion, post-LDLT e-HAT can be treated by surgical revascularization or endovascular therapy, with comparable results. Endovascular management of e-HAT in the first 48hrs post-LDLT appears to be feasible and effective, but is associated with a relatively higher risk of procedure-related complications, compared to surgical revascularization. Hence, it can be reserved as a second-line therapeutic option in certain situations where surgical revascularization is considered futile, potentially too complex, or potentially more risky.

Intra-arterial thrombolysis for early hepatic artery thrombosis after liver transplantation.

BACKGROUNDEarly hepatic artery thrombosis (E-HAT) is a serious complication after liver transplantation (LT), which often results in graft failure and can lead to patient deaths. Treatments such as re-transplantation and re-anastomosis are conventional therapeutic methods which are restricted by the shortage of donors and the patient’s postoperative intolerance to re-laparotomy. Due to the advances in interventional techniques and thrombolytics, endovascular treatments are increasingly being selected by more and more centers. This study reviews and reports our single-center experience with intra-arterial thrombolysis as the first choice therapy for E-HAT after deceased donor LT.AIMTo evaluate the feasibility and reasonability of intra-arterial thrombolysis for E-HAT after deceased donor LT.METHODSA total of 147 patients who underwent deceased donor LT were retrospectively reviewed in our hospital between September 2011 and December 2016. Four patients were diagnosed with E-HAT. All of these patients underwent intra-arterial thrombolysis with alteplase as the first choice therapy after LT. The method of arterial anastomosis and details of the diagnosis and treatment of E-HAT were collated. The long-term prognosis of E-HAT patients was also recorded. The median follow-up period was 26 mo (range: 23 to 30 mo).RESULTSThe incidence of E-HAT was 2.7% (4/147). E-HAT was considered when Doppler ultrasonography showed no blood flow signals and a definite diagnosis was confirmed by immediate hepatic arterial angiography when complete occlusion of the hepatic artery was observed. The patients were given temporary thrombolytics (mainly alteplase) via a 5-Fr catheter which was placed in the proximal part of the thrombosed hepatic artery followed by continuous alteplase using an infusion pump. Alteplase dose was adjusted according to activated clotting time. The recanalization rate of intra-arterial thrombolysis in our study was 100% (4/4) and no thrombolysis-related mortality was observed. During the follow-up period, patient survival rate was 75% (3/4), and biliary complications were present in 50% of patients (2/4).CONCLUSIONIntra-arterial thrombolysis can be considered first-line treatment for E-HAT after deceased donor LT. Early diagnosis of E-HAT is important and follow-up is necessary even if recanalization is successful.

Early hepatic arterial thrombosis after pediatric living donor liver transplantation: a single-center experience.

Early hepatic arterial thrombosis after pediatric living donor liver transplantation: a single-center experience.

Long Graft Artery and Arterial Anomalies Are Associated with Hepatic Artery Thrombosis after Orthotopic Liver Transplantation

Introduction: Hepatic artery thrombosis is one of the most feared surgical complications after orthotopic liver transplantation (OLT). The aim of this study was to analyse factors involved in global, early (less than a month) and late (more than a month) hepatic artery thrombosis (HAT) after OLT. Methods: Inclusion criteria: patients who underwent OLT between November 2001 and December 2018. Exclusion criteria: liver retransplantation. Several preoperative and intraoperative variables were analysed. Graft artery was classified as long or short when the section was located distal or proximal to the proper/common hepatic artery bifurcation. In the same way, recipient patch for arterial anastomosis was classified as distal or proximal to the proper/common hepatic artery bifurcation. Student's T for continuous variables and Chi-Square for discrete variables were used for univariate analysis. Logistic regression was used for multivariate analysis (MVA). Results: Finally, 588 patients were eligible for statistical analysis. Global, early and late HAT appeared in 53 (9.01%), 35 (5.95%) and 18 (3,06%) patients, respectively. For global HAT, two variables proved to be significant after MVA: hepatocellular carcinoma as indication for OLT (p=0.035) and long graft artery (p=0.007). For early HAT, two variables turned out to be significant after MVA: hepatocellular carcinoma as indication for OLT (p=0.012) and arterial anomalies (p=0.036). For late HAT, only long graft artery reached statistical significance after MVA (p=0.026). Conclusion: Technical factors involving arterial anastomosis, as the presence of arterial anomalies and the length of the graft artery, seem to be essential risk factors for HAT after OLT.

Intensive Doppler Ultrasonography for Early Detection of Hepatic Artery Thrombosis After Adult Living Donor Liver Transplantation.

BackgroundEarly hepatic artery thrombosis (eHAT) is a severe arterial complication leading to biliary complications and graft failure in living donor liver transplantation (LDLT). This study sought to early identify the abnormal waveforms of eHAT by using intensive Doppler ultrasonography (DUS) after LDLT and to assess the clinical outcome in these eHAT patients.Material/MethodsDUS for 419 adult LDLT recipients was performed twice after vascular anastomosis during liver transplantation and once a day at the bedside for at least 2 weeks.ResultsNine adult LDLT recipients with eHAT were identified by using bedside DUS with subsequent computed tomography angiography (CTA). All eHAT cases were noted in the first 2 weeks. Five patients with CTA findings of partial thrombus with the small visualized intrahepatic hepatic artery (HA) were treated with intravenous thrombolysis (IVT) (medical group). Another 4 patients with CTA findings of extrahepatic HA occlusion and nonvisualization of intrahepatic HAs were treated by arterial re-anastomosis (surgical group). The prevalence of long-term non-anastomotic biliary strictures was 33.3% in the surgical group. Intensive post-LDLT DUS is a convenient and sensitive tool for eHAT detection.ConclusionsSubsequent CTA gives valid information on occluded arteries and associated findings, which impact decision-making and are correlated with patient outcome. Our protocol of DUS has high sensitivity and diagnostic accuracy for use in in eHAT patients with partial occlusion, and it can be applied for IVT treatment, avoiding the need for reoperation and preventing long-term biliary complications.