Hyperbaric oxygen therapy for hepatic artery thrombosis following liver transplantation: current concepts

Area of Science:

• Transplantation immunology
• Vascular surgery
• Hyperbaric medicine

Background:

• Orthotopic liver transplantation is a life-saving procedure for end-stage liver disease.
• Hepatic artery thrombosis (HAT) is a serious complication following liver transplantation, often leading to graft failure.
• Early detection and effective management of HAT are crucial for patient outcomes.

Observation:

• An infant liver transplant recipient developed post-operative hepatic artery thrombosis.
• Standard treatment with alteplase (TPA) was unsuccessful in restoring blood flow.
• The patient subsequently received systemic heparin and hyperbaric oxygen (HBO) therapy.

Findings:

• After six HBO treatments, the infant's hepatic artery showed significant recanalization on ultrasound.
• Liver function tests normalized, indicating successful graft function recovery.
• No adverse events were associated with the HBO therapy during the treatment period.

Implications:

• Hyperbaric oxygen therapy may be a viable adjunctive treatment for refractory hepatic artery thrombosis after liver transplantation.
• HBO therapy's proposed mechanisms include improved oxygenation, reduced inflammation, and enhanced endothelial function.
• This case highlights a potential strategy to prevent graft loss and the need for retransplantation in pediatric liver transplant recipients with HAT.