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Published on: November 7, 2020
Vascular complications in the first 100 liver transplantations in Saudi Arabia
M S Al-Sebayel1, C Ramirez, K A Ella
1Hepato-biliary Unit at King Khalid Unviersity Hospital, Riyadh, Saudi Arabia.
Insights
Vascular complications significantly impact liver transplant survival. Pediatric age is a risk factor for thrombosis, while low-dose heparin may prevent hepatic artery thrombosis (HAT), a critical complication.
Area of Science:
- Hepatology
- Transplant Surgery
- Vascular Surgery
Background:
- Vascular complications are a major cause of morbidity and mortality after liver transplantation.
- Understanding these complications is crucial for improving patient and graft outcomes.
Purpose of the Study:
- To determine the impact of vascular complications on patient and graft survival following liver transplantation.
- To identify risk factors and effective management strategies for vascular complications.
Main Methods:
- Retrospective analysis of 100 liver transplant procedures performed on 92 patients.
- Detailed review of vascular complications, including hepatic artery thrombosis (HAT), IVC stenosis, and portal vein thrombosis (PVT).
- Evaluation of management strategies such as thrombectomy, retransplantation, angioplasty, and observation.
Main Results:
- Vascular complications occurred in 19% of procedures, with HAT being the most frequent.
- Pediatric age was the only significant risk factor for vascular thrombosis.
- Low-dose heparin showed a protective effect against HAT (P=0.03).
- Overall survival rate for patients with vascular complications was 65%.
Conclusions:
- Hepatic artery thrombosis is the most serious complication, potentially leading to death.
- Timely retransplantation and angioplasty are effective management options for specific vascular complications.
- Further research into preventing and managing vascular complications is warranted.
Abstract:
Vascular complications are a significant cause of morbidity and mortality following liver transplantation. The purpose of this study is to determine the impact of vascular complications on the patient and graft survival. One hundred liver transplant procedures were performed on 92 patients between January 1994 and June 1998 at King Fahad Hospital (Riyadh, Saudi Arabia). Patients' data were analyzed retrospectively with special emphasis on vascular complications. Vascular complication occurred in 19 procedures (19%), including HAT (n = 8), IVC stenosis (n = 3), PVT (n = 2), HAS (n = 2), rupture HA mycotic aneurysm (n = 1), and celiac artery stenosis (n = 1). Combined vascular complication occurred in 2 patients (HAT and PVT, and HAS and IVC stenosis). The only significant risk factor for the development of vascular thrombosis in our study was pediatric age. The use of low-dose heparin was found to be a protective factor against HAT (P = 0.03). Complications were managed by thrombectomy (n = 2), thrombectomy followed by retransplantation (n = 3), retransplantation (n = 2), and revision (n = 2). Nonsurgical approaches included angioplasty (n = 6) and observation (n = 4). The overall survival rate was 65% (13 of 20). HAT is the most serious complication following liver transplantation; it may lead to death. Timely retransplantation may salvage some patients, and angioplasty is useful in the management of vascular stenoses.
