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Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy
Published on: April 8, 2018
Hepatic artery stenosis after liver transplantation: is endovascular treatment always necessary?
Carlo Pulitano1, David Joseph, Charbel Sandroussi
1Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia; Centenary Research Institute, University of Sydney, Sydney, Australia.
Insights
Hepatic artery stenosis (HAS) after liver transplant can lead to biliary complications. Endovascular treatment improved outcomes for symptomatic HAS patients, but is not recommended for asymptomatic or late-onset cases.
Area of Science:
- Vascular Surgery
- Transplant Surgery
- Interventional Radiology
Background:
- Hepatic artery stenosis (HAS) is a potential complication after liver transplantation, often linked to ischemic injury and subsequent biliary issues.
- The clinical significance and optimal management of HAS remain incompletely understood, necessitating further investigation into patient outcomes and treatment benefits.
Purpose of the Study:
- To determine the prevalence and clinical outcomes of HAS in liver transplant recipients.
- To identify patient subgroups who may benefit from endovascular treatment for HAS.
Main Methods:
- Prospective analysis of 662 adult liver transplant patients (2000-2011) to identify 54 with HAS (stenosis >70%).
- HAS diagnosis confirmed via multidetector computed tomographic angiography or digital subtraction angiography.
- Propensity score matching used to evaluate the effectiveness of endovascular therapy versus conservative management.
Main Results:
- New biliary complications occurred in 31.4% of HAS patients. Endovascular treatment was provided to 23 patients.
- Propensity score-matched analysis revealed significantly longer biliary stricture-free survival in patients receiving endovascular therapy (P=0.03).
- Late-onset HAS (≥6 months post-transplant) and incidental diagnosis were associated with reduced biliary stricture risk. Symptomatic HAS patients receiving treatment showed improved, though not statistically significant, outcomes compared to conservative management (P=0.11). Asymptomatic HAS patients with normal liver function tests did not develop biliary strictures.
Conclusions:
- Endovascular intervention for HAS is associated with improved biliary stricture-free survival, particularly in symptomatic cases.
- Endovascular treatment is not indicated for patients with late-onset HAS (≥6 months) or asymptomatic HAS with normal liver function tests.
- This study clarifies the management strategy for HAS, emphasizing selective intervention based on symptom presentation and timing post-transplantation.
Abstract:
Hepatic artery stenosis (HAS) is thought to predispose patients to biliary complications secondary to ischemic injury. Despite this, the clinical significance of HAS remains poorly defined. The aims of this study were to determine the prevalence and outcomes of HAS and to define which patients might benefit from endovascular treatment. From a prospective database of 662 adult patients undergoing liver transplantation between 2000 and 2011, we identified 54 patients who developed HAS. HAS was defined as any stenosis > 70% that was seen during multidetector computed tomographic angiography (MDCTA) or digital subtraction angiography. The benefit of endovascular therapy was evaluated with propensity score matching. New biliary complications occurred in 17 patients (31.4%), and 23 of the 54 study patients with HAS received endovascular treatment. Among the propensity score-matched patients, the biliary stricture-free survival time was significantly longer for those who received endovascular therapy (P = 0.03). An incidental diagnosis (P = 0.07) and a time from transplantation > 6 months (P = 0.021) were associated with a reduced risk of developing biliary stricture. Patients with symptomatic HAS who received treatment had better biliary stricture-free survival than patients who were treated conservatively, although no significant difference was recorded (P = 0.11). No patient with asymptomatic HAS and normal liver function tests developed biliary strictures. In conclusion, HAS intervention was associated with improved biliary stricture-free survival. In patients with late-onset HAS (≥6 months) and asymptomatic patients, endovascular treatment is not warranted.
