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Published on: November 7, 2020
Arterial complications after living-related liver transplantation: single-center experience from West China
1Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Insights
Vascular complications after living-related liver transplantation (LRLT) are infrequent but serious. Prompt surgical intervention or endovascular treatments effectively manage these complications, ensuring patient survival.
Area of Science:
- Hepatology
- Transplant Surgery
- Vascular Surgery
Background:
- Vascular complications are a significant cause of morbidity and mortality in liver transplant recipients.
- Living-related liver transplantation (LRLT) presents unique challenges due to complex vascular reconstructions, potentially increasing complication rates.
Purpose of the Study:
- To evaluate the incidence and management of vascular complications following living-related liver transplantation (LRLT).
- To assess the outcomes of surgical and endovascular interventions for hepatic artery complications in LRLT patients.
Main Methods:
- Retrospective analysis of 33 consecutive LRLT cases performed between July 2001 and December 2005.
- Detailed review of vascular complications, including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), and hepatic artery pseudoaneurysm (HAP).
- Documentation of interventions such as thrombectomy, balloon angioplasty, stent placement, and embolization.
Main Results:
- A vascular complication rate of 9.09% (3/33 patients) was observed, affecting the hepatic artery in all cases.
- One patient experienced HAT, another HAS, and a third HAP. No portal or hepatic vein complications occurred.
- Successful management was achieved through thrombectomy, angioplasty with stenting, and embolization, with no deaths attributed to vascular complications.
Conclusions:
- Careful preoperative assessment and meticulous intraoperative microsurgical techniques are crucial for preventing hepatic artery complications in LRLT.
- Acute vascular complications necessitate immediate surgical intervention, while late complications can be effectively managed with endovascular procedures like angioplasty, stenting, or embolization.
Abstract:
Vascular complications after liver transplantation remain a major source of morbidity and mortality for recipients. In particular, patients receiving living-related liver transplantation (LRLT) experience a higher rate of vascular complications owing to the complex vascular reconstruction. Between July 2001 and December 2005, LRLTs were performed in our center on 33 patients with end-stage liver diseases. The 23 men and 10 women had a mean age of 32.6 +/- 11.3 years (range = 5 to 58 years). Of the 33 patients, the percentage of vascular complications was 9.09% (3 cases), including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), or hepatic artery pseudoaneurysm (HAP) in one patient, respectively. No portal vein or hepatic vein complication occurred in our patients. Thrombectomy was performed in the patient with thrombosis. The patient with stenosis was treated with balloon angioplasty and endoluminal stent placement. The pseudoaneurysm was also successfully embolized to restore the blood flow toward the donor liver. Mean follow-up for all patients after LRLT was 18.0 +/- 5.4 months. The overall postoperative 30-day mortality rate was 6.06% (2/33). The 1-year survival rate was 86.36% in 22 patients with benign diseases and 72.73% in 11 patients with malignant diseases. However, no death was associated with vascular complications. Careful preoperative evaluation and intraoperative microsurgical technique for hepatic artery reconstructions are the keys to prevent vascular complications following LRLT. Immediate surgical intervention is required for acute vascular complications, whereas late complications may be treated by balloon angioplasty and endoluminal stent placement. Embolization may be a safe and effective approach in the treatment of a pseudoaneurysm of the hepatic artery.
