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Cholangiographic findings in hepatic artery occlusion after liver transplantation
Insights
Hepatic artery occlusion after liver transplant can cause biliary complications. Nonanastomotic bile leaks or strictures on cholangiography strongly suggest hepatic artery occlusion, requiring prompt evaluation.
Area of Science:
- Transplantation Surgery
- Vascular Surgery
- Gastroenterology
Background:
- The hepatic artery is the sole blood supply to the liver allograft's biliary tree.
- Posttransplantation hepatic artery occlusion is a known risk factor for biliary complications.
Purpose of the Study:
- To investigate the association between hepatic artery occlusion and biliary complications after liver transplantation.
- To identify specific cholangiographic findings indicative of hepatic artery occlusion.
Main Methods:
- Retrospective review of cholangiograms from 31 liver transplant patients with confirmed hepatic artery occlusion (thrombosis or stenosis).
- Analysis of cholangiographic findings, including contrast leakage, strictures, ductal dilatation, and filling defects.
Main Results:
- 84% of patients with hepatic artery occlusion showed abnormal cholangiograms.
- Nonanastomotic contrast leakage (89%) and nonanastomotic strictures (57%) were highly associated with hepatic artery occlusion.
- Biliary anastomotic strictures showed low association (10%) with arterial occlusion.
Conclusions:
- Nonanastomotic contrast leakage and nonanastomotic strictures on cholangiography are significant indicators of hepatic artery occlusion in liver transplant recipients.
- Prompt evaluation for hepatic artery occlusion is recommended in patients presenting with these specific biliary complications.
Abstract:
Because the hepatic artery provides the only blood supply to the biliary tree of a liver allograft, posttransplantation arterial occlusion may result in a biliary complication. Cholangiograms were reviewed retrospectively in 31 transplant patients who had proved complete or partial occlusions of the hepatic artery (thrombosis in 29 and marked stenosis in two). Cholangiograms were abnormal in 26 (84%). The most common abnormality, seen in 16 patients, was nonanastomotic contrast leakage from the donor intra- or extrahepatic bile ducts. Strictures of the donor biliary tree occurred in 14 patients, four of whom also had a nonanastomotic bile leak. In 12 of the 14, the strictures were nonanastomotic. Other findings included poor filling of the intrahepatic bile ducts, generalized donor ductal dilatation and irregularity, and intraductal filling defects. Sixteen (89%) of 18 transplants with nonanastomotic contrast leakage had occlusions of the hepatic artery. Of 21 transplants with nonanastomotic strictures, 12 (57%) had occlusions of the hepatic artery. Only two (10%) of 20 transplants with biliary anastomotic strictures had arterial occlusion. We conclude that liver transplant recipients who exhibit nonanastomotic contrast leakage or nonanastomotic strictures on cholangiography should be evaluated for occlusion of the hepatic artery as the probable cause.