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[Diagnosis and treatment of hepatic artery thrombosis after liver transplantation]
Shu-Sen Zheng1, Ting-Bo Liang, Zhi-Yong Yu
1Centre of Organ Transplantation and Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou 310003, China. zhengss@mail.hz.zj.cn
Insights
Intermittent suture technique for hepatic artery anastomosis significantly reduces hepatic artery thrombosis (HAT) after liver transplantation. Early detection via routine ultrasonography is crucial for managing HAT and preventing severe complications like biliary issues.
Area of Science:
- Transplantation Surgery
- Vascular Surgery
- Hepatology
Background:
- Hepatic artery thrombosis (HAT) is a critical complication following orthotopic liver transplantation (OLT).
- Effective prevention and early diagnosis strategies are essential for improving patient outcomes.
- Surgical techniques for hepatic artery anastomosis may influence HAT incidence.
Purpose of the Study:
- To evaluate the incidence of HAT based on different hepatic artery anastomosis techniques.
- To summarize experiences in the prevention, diagnosis, and management of HAT post-OLT.
- To assess the impact of routine ultrasonography on HAT detection.
Main Methods:
- Retrospective analysis of 198 OLT patients from 1993-2003.
- Comparison of hepatic artery anastomosis using running suture (n=96) versus intermittent suture (n=102).
- Routine daily postoperative ultrasonography for two weeks, followed by selective use.
Main Results:
- The incidence of HAT was significantly lower with intermittent sutures (1.0%) compared to running sutures (6.3%) (P=0.045).
- Color ultrasonography detected HAT in 6 out of 7 cases; one case required exploratory laparotomy.
- Mortality for HAT patients was high (57.1%), with biliary complications occurring in 3 of 6 post-thrombectomy cases.
Conclusions:
- Hepatic artery anastomosis technique is a key factor in preventing HAT.
- Routine ultrasonography plays a vital role in the early detection of HAT after OLT.
- Biliary complications represent a severe outcome secondary to HAT.
Objective:
To summarize the experience in prevention, diagnosis, and management of hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT).
Methods:
The clinical data of 198 patients undergoing OLT from April 1993 to September 2003 were analyzed among which 96 underwent anastomosis of hepatic artery with 7/0 prolene by running suture (group 1) and 102 by intermittent suture (group 2). Ultrasonic examination was routinely performed every day within two weeks after operation and then performed selectively afterwards.
Results:
The incidence rate of HAT in group 2 was 1.0% (1/102), significantly lower than that in group 1 (6.3%, 6/96) (chi(2) = 4.027, P = 0.045). HAT was discovered by color ultrasonography in 6 of the 7 cases, and by exploratory laparotomy in 1 case. Out of the 7 patients with HAT, 6 received emergency thrombectomy, and 1 received conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 out of the 6 cases after thrombectomy of whom 2 died of liver failure and one waited for retransplantation. One of the other 3 cases died of renal failure, and 2 cases survived. The mortality of patients with HAT was 57.1% (4/7).
Conclusion:
The technique of hepatic artery anastomosis is the key factor for the prevention of HAT. Routine ultrasonography is important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.
