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Early hepatic artery thrombosis after liver transplantation: diagnosis and treatment.

Abstract：

BACKGROUND:Hepatic artery thrombosis (HAT) occurs in 3% to 9% of all liver transplantations with acute graft failure as a possible sequel. METHODS:Eleven episodes of HAT were identified among 256 orthotropic liver transplantations (whole, LDCT, split) performed on 253 patients between April 1993 and July 2006. HAT was suspected clinically and confirmed by Doppler ultrasonography, magnetic resonance angiography, angiography, or reexploration. One patient was excluded due to poor follow-up. Treatment options included exploration with HA thrombectomy plus thrombolysis, retransplantation, or conservative treatment of hepatic and biliary complications. RESULTS:Among 11 patients of mean age 29.98 +/- 17.14 years (range, 10 months to 56 years). 2 had split right lobe liver transplantations and 9 received whole organs. None of LDLTs were identified to have HAT. The causes of liver cirrhosis among HAT patients were autoimmune hepatitis (n=3), cryptogenic (n=3), Wilson (n=1), PBC (n=1), biliary atresia (n=1), and HBs (n=1). HAT was diagnosed at 5.9 +/- 4.43 (range, 2 to 16) days after operation. Most patients developed right upper quadrant (RUQ) pain at presentation. Two patients developed acidosis, fever, or SIRS and underwent retransplantation. Four underwent exploration of HA and 1 was treated conservatively. Three cases expired due to HAT complications. CONCLUSION:We found RUQ pain to be the presenting sign of early HAT in majority of cases. RUQ pain has been reported to occur in late HAT. Whenever HAT is confirmed, liver transplanted patients should be revascularized or even retransplanted. Intra-arterial thrombolysis and thrombolytic therapy for HAT should be done cautiously due to the potential risk of hemorrhage.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Nikeghbalian S,Kazemi K,Davari HR,Salahi H,Bahador A,Jalaeian H,Khosravi MB,Ghaffari S,Lahsaee M,Alizadeh M,Rasekhi AR,Nejatollahi SM,Malek-Hosseini SA

doi

10.1016/j.transproceed.2007.02.017

subject

Has Abstract

pub_date

2007-05-01 00:00:00

pages

1195-6

issue

4

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(07)00139-X

journal_volume

39

pub_type

杂志文章

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