Abdominal aortic aneurysm in liver transplant recipients

To analyze the incidence, clinical features, expansion rate of, and clinical approach to abdominal aortic aneurysm in patients who had undergone orthotopic liver transplantation. To our knowledge, this is the first report on this issue in liver transplant recipients.

Among 172 patients undergoing 185 liver transplantations at our institution over the last 10-year period, we identified three patients (1.7%) with infrarenal aortic aneurysm. They had all undergone routine pre-liver transplant ultrasonography screening for aortic aneurysm.

All three patients were symptom free at the time of the discovery of a mild infrarenal abdominal enlargement before ( n=2) and after liver transplantation ( n=1), and were closely monitored by ultrasonography in the follow-up period (3.1-4.3 years). The mean aneurysm expansion rate was 0.73 cm/year. All patients underwent aneurysm repair after their aneurysm expanded significantly under observation, with a mean diameter of 5.1 cm at the time of repair. All three patients are alive and well (median follow-up: 19 months).

Our data suggest that careful ultrasonographic surveillance is warranted in any liver transplant recipient, because of the apparent propensity for a more rapid aneurysm expansion and potentially aggressive course than in the untransplanted population. Early repair of the infrarenal aneurysm is recommended in transplant recipients, given that excellent perioperative and late outcomes can be achieved.