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Vascular Complications After Liver Transplantation
Ibrahim Astarcıoglu1, Tufan Egeli, Aytac Gulcu
1From the Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University Faculty of Medicine, Narlıdere, Izmir, Turkey.
Insights
Vascular complications after liver transplant are serious but manageable. Early diagnosis and prompt treatment, including endovascular procedures or surgery, improve patient outcomes, especially in pediatric cases.
Area of Science:
- Hepatology
- Transplant Surgery
- Vascular Surgery
Background:
- Vascular complications represent a significant threat to liver transplant recipients, potentially leading to lethal outcomes.
- Early detection and aggressive diagnostic strategies are crucial for timely intervention and improved survival rates.
Purpose of the Study:
- To analyze the incidence and characteristics of vascular complications following liver transplantation.
- To evaluate treatment modalities and outcomes for these complications in adult and pediatric patients.
Main Methods:
- Retrospective analysis of 607 liver transplant procedures performed between February 1997 and June 2018.
- Patients were categorized by age, donor type, complication type, treatment, and survival.
- Statistical analysis of complication rates based on age and donor type.
Main Results:
- Vascular complications occurred in 4.1% of patients (25/607), with hepatic artery (2.1%) and portal vein (1.5%) being most common.
- Pediatric patients exhibited a significantly higher rate of vascular complications (11.4% vs. 3.3%; P = .007).
- Endovascular treatment was used in 48.8% of cases, with surgery and retransplantation also employed.
Conclusions:
- Vascular complications are severe post-liver transplant events requiring vigilant monitoring of vascular anastomoses.
- Prompt diagnosis and emergent treatment, utilizing endovascular techniques, surgery, or retransplantation, are essential for managing these critical complications.
Objectives:
Vascular complications after liver transplant can be lethal. High levels of suspicion and aggressive use of diagnostic tools may help with early diagnosis and treatment. Here, we share our experiences regarding this topic.
Materials And Methods:
Adult and pediatric patients who had liver transplant between February 1997 and June 2018 in our clinic were included in the study. Patients were grouped according to age (pediatric patients were those under 18 years old), male versus female, indication for transplant, type of liver transplant, type of vascular complication, treatment, and survival aftertreatment.We analyzed the statistical incidence of vascular complications according to age, male versus female, and type of liver transplant.
Results:
Our analyses included 607 liver transplant procedures, including 7 retransplants, with 349 (57.4%) from living donors and 258 (42.6%) from deceased donors. Of total patients, 539 were adults (89.8%) and 61 were children (10.2%). Vascular complications occurred in 25 patients (4.1%), with hepatic artery complications seen in 13 patients (2.1%) (10 adults [1.8%] and 3 children [4.9%]), portal vein complications seen in 9 patients (1.5%) (6 adults [1.1%] and 3 children [4.9%]), and hepatic vein complications seen in 3 patients (0.5%) (2 adults [0.36%] and 1 child [1.6%]). Rate of vascular complications was statistically higher in pediatric patients (11.4% vs 3.3%; P = .007) and higher but not statistically in recipients of livers from living donors (5.2% vs 2.7%; P = .19). Twelve patients (48.8%) were treated with endovascular approach, and 11 (0.44%)required surgicaltreatment. Two patients underwent immediate retransplant due to hepatic artery thrombosis.
Conclusions:
Because vascular complications are the most severe complications afterlivertransplant,there must be close follow-up of vascular anastomoses, particularly early postoperatively, with radiologic methods. In cases of vascular complications, emergent treatment, including endovascular interventions, surgery, and retransplant, must be performed.
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