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Hepatic artery complications after orthotopic liver transplantation: interventional treatment or retransplantation?
Yang Yang1, Hua Li, Bin-sheng Fu
1Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
Insights
Optimal treatment for hepatic artery complications after liver transplantation (OLT) depends on individualized regimens. Liver retransplantation is best for hepatic artery thrombosis, while interventions suit late hepatic artery stenosis without complications.
Area of Science:
- Hepatology
- Transplantation Surgery
- Vascular Surgery
Background:
- Hepatic artery complications are significant risks post-orthotopic liver transplantation (OLT).
- Current treatments include thrombolysis, angioplasty, stenting, and retransplantation, but consensus is lacking.
- Prognosis depends on complication type, extent, timing, and treatment selection.
Purpose of the Study:
- To determine optimal treatment strategies for hepatic artery complications following OLT.
- To evaluate the effectiveness of different therapeutic approaches for hepatic artery thrombosis (HAT) and stenosis (HAS).
Main Methods:
- Retrospective review of clinical data from 25 patients with HAT or HAS between 2003 and 2007.
- Analysis of outcomes for patients treated with liver retransplantation versus interventional procedures (thrombolysis, angioplasty, stenting).
Main Results:
- For HAT, retransplantation showed better survival than thrombolysis.
- For early HAS (within 1 month), retransplantation was often necessary due to irreversible liver failure or complications post-stenting.
- For late HAS (after 1 month), interventional management, particularly stent placement, led to recovery in most cases without irreversible liver failure or bile duct ischemia.
Conclusions:
- Individualized treatment is crucial for hepatic artery complications post-OLT.
- Liver retransplantation is the preferred treatment for HAT.
- Interventional therapy is effective for late HAS, while early HAS may necessitate retransplantation.
Background:
The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation (OLT) include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT.
Methods:
The clinical data of 25 patients diagnosed with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement.
Results:
Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients' liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion.
Conclusions:
Individualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.
