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Prevention and treatment of hepatic artery thrombosis after liver transplantation
Shu-Sen Zheng1, Zhi-Yong Yu, Ting-Bo Liang
1Centre of Organ Transplantation and Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou 310003, China.
Insights
Hepatic artery thrombosis (HAT) after liver transplantation is reduced by using interrupted sutures for hepatic arterial anastomosis. Early detection via routine ultrasonography is crucial for managing this complication and improving outcomes.
Area of Science:
- Transplantation Surgery
- Vascular Surgery
- Hepatology
Background:
- Hepatic artery thrombosis (HAT) is a critical complication following orthotopic liver transplantation (OLT), frequently leading to graft loss.
- Effective strategies for HAT prevention, diagnosis, and management are essential in OLT procedures.
Purpose of the Study:
- To review experiences in preventing, diagnosing, and managing HAT in liver transplant recipients.
- To evaluate the impact of different surgical techniques on HAT incidence.
Main Methods:
- A retrospective analysis of 198 OLT patients from April 1993 to September 2003.
- Comparison of HAT rates between continuous (n=96) and interrupted (n=102) suture techniques for hepatic artery anastomosis.
- Daily postoperative ultrasonography for two weeks, followed by selective imaging.
Main Results:
- HAT occurred in 6.3% of patients with continuous sutures versus 1% with interrupted sutures (P=0.045).
- Mortality among patients with HAT was 57.1% (4/7), with complications including biliary issues, liver failure, and renal failure.
- Interrupted suture technique significantly reduced HAT incidence.
Conclusions:
- Hepatic arterial anastomosis technique is pivotal in preventing HAT post-OLT.
- Routine ultrasonography is vital for early HAT detection.
- Biliary complications are a significant adverse outcome following HAT management.
Background:
Hepatic artery thrombosis (HAT) which is a serious complication after orthotopic liver transplantation (OLT) remains a significant cause of graft loss. The purpose of this study was to sum up our experiences in the prevention, diagnosis and management of HAT after liver transplantation.
Methods:
From April 1993 to September 2003, a total of 198 patients underwent OLT at our hospital. The hepatic artery was anastomosed using 7/0 prolane with running continuous suture in 96 patients (group 1) and with interrupted suture in 102 (group 2). Ultrasonography was performed every day in two weeks after operation and selectively afterwards.
Results:
HAT occurred in 6 patients (6.3%, 6/96) of group 1, and in 1 (1%, 1/102) of group 2 (X2=4.027, P=0.045). Six patients received emergency thrombectomy, and 1 conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 patients after thrombectomy of whom 2 died of liver failure and one waited for retransplantation. In the other 3 patients after thrombectomy, 1 died of renal failure, and 2 survived. The mortality of patients with HAT was 57.1% (4/7).
Conclusions:
The technique of hepatic arterial anastomosis is the key factor for the prevention of HAT. Routine ultrasonography is very important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.
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