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Objective:To investigate the influencing factors for hepatic artery complica-tions of liver transplantation from donation after citizen's death.Methods:The retrospective cohort study was conducted. The clinicopathological data of 147 recipients who underwent liver transplan-tation from donation after citizen's death in Xijing Hospital of Air Force Military Medical University from January 2015 to June 2020 were collected. There were 109 males and 38 females, aged (46±12)years. All recipients underwent liver transplantation from donation after citizen's death. Observation indicators: (1) surgical situations; (2) occurrence of hepatic artery complications after liver transplantation; (3) analysis of donor related influencing factors for hepatic artery complications after liver transplantation; (4) analysis of recipient related influencing factors for hepatic artery complications after liver transplantation; (5) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect survival of recipients up to June 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Univariate analysis was conducted using the Fisher exact probability, and multivariate analysis was conducted using the COX regression model. Kaplan-Meier method was used to calculate the cumulative survival rate and draw the survival curve. Results:(1) Surgical situations: of the 147 recipients, 108 cases underwent orthotopic liver transplantation, and 39 cases underwent piggyback liver transplantation. The operation time of 147 recipients was (458±101)minutes. (2) Occurrence of hepatic artery complications after liver transplantation: 4 of the 147 recipients had hepatic artery complications, including 3 cases with hepatic artery embolism and 1 case with hepatic artery stenosis. The time to occurrence of hepatic artery complications after liver transplantation was (5±2)days. (3) Analysis of donor related influencing factors for hepatic artery complications after liver transplantation: results of univariate analysis showed that age, atherosclerosis, fatty liver and arterial variation were not donor related factors influencing hepatic artery complications after liver transplantation ( P>0.05). (4) Analysis of recipient related influencing factors for hepatic artery complications after liver transplantation: results of multivariate analysis showed that insufficient hepatic artery blood flow in the recipient was an independent risk factor for hepatic artery complications after liver transplantation ( hazard ratio=10.13, 95% confidence interval as 1.05-97.42, P<0.05). (5) Follow-up: 146 of the 147 recipients were followed up for 1 to 77 months, with a median follow-up time of 34 months. The 1-year cumulative survival rate of the 146 recipients was 92.2%. Conclusion:Insufficient hepatic artery blood flow of the recipient is an independent risk factor for hepatic artery complications after liver transplantation from donation after citizen's death.
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Objective To analyze the optimal threshold of Doppler ultrasonography(DUS)in the diagnosis of hepatic artery stenosis(HAS)after liver transplantation and propose the diagnostic criteria of CT angiography(CTA) or digital subtraction angiography(DSA)for patients with tardus parvus waveform(TPW)in combination with liver dysfunction. Methods Clinical data of 171 patients undergoing liver transplantation, postoperative conventional DUS, liver function test, CTA or DSA were collected. The optimal threshold of resistance index(RI)and systolic acceleration time (SAT)for the diagnosis of HAS were determined by multi-level likelihood ratio(MLR). Different diagnostic criteria were established and the diagnostic efficacy was statistical y compared. Positive TPW was defined as the diagnostic criterion with low confidence, positive TPW+liver dysfunction as the moderate confidences, and positive TPW+liver dysfunction or positive TPW+optimal threshold as the high confidence. Results MLR revealed that RI<0.4 and SAT>0.12 s were the optimal threshold for the diagnosis of HAS. The specificity of diagnostic criteria with moderate and high confidence was significantly higher compared with that of the low confidence(P<0.05). Moreover, the false-positive rate was significantly decreased(P<0.05). The sensitivity of diagnostic criterion with moderate confidence was significantly lower than those of low and high confidence(both P<0.05), whereas the sensitivity did not significantly differ between the diagnostic criteria with low and high confidence(P>0.05). Conclusions For patients with positive TPW detected by DUS after liver transplantation, the optimal threshold of diagnostic criteria combined with liver dysfunction contribute to appropriate clinical decision-making for clinicians.
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Objective Using CT perfusion (CTP) technique,to investigate the graft perfusion changes in patients with hepatic artery stenosis (HAS) with or without ischemic-type biliary lesions (ITBL) after orthotopic liver transplantation (OLT).Methods Thirteen recipients with HAS received CTP scan of the liver,including 8 with ITBL and 5 without ITBL.For all patients,the diagnosis of HAS was made by CTA,and the diagnosis of ITBL by percutaneous transhepatic cholangiography.CT perfusion indices were obtained,including hepatic artery perfusion (HAP),portal vein perfusion (PVP),total liver perfusion (TLP) and hepatic perfusion index (HPI).Results Of the 13 patients with HAS,mean HAP in patients with and without ITBL was 59.8 and 35.1 ml·min-1 ·100 ml-1 (P =0.021,two-tailed paired Student t test) ; mean PVP was 125.4 and 166.2 ml·min-1·100 m1-1 (P =0.016) ; mean TLP was 185.2 and 201.3 ml· min-1 · 100 ml-1 (P =0.306) ; and mean HPI was 33.6 and 18.2 (P =0.005),respectively.Conclusion Using CTP technique,liver perfusion changes were reflected by measuring CTP indices noninvasively.Compared to those without ITBL in this study,HAP and HPI in patients with ITBL were higher and PVP was lower,which may be contributed to biliary inflammation.
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ObjectiveTo determine the risk factors and the optimal management of hepatic artery complications (HAC) after orthotopic liver transplantation.MethodsThe clinical data of 180 orthotopic liver transplantation patients performed between January 2005 and September 2007 was reviewed.The incidence of HAC between primary liver carcinoma and benign diseases of liver was compared.ResultsTwelve (6.7％) episodes of HAC were identified.3 were hepatic artery thrombosis (HAT) and 9 were hepatic artery stenosis (HAS).The incidence of HAC in patients with primary liver carcinoma (6/39) was higher than benign disease (6/141)(P＜0.05).ConclusionsThe keys to management of HAC after orthotopic liver transplantation are to diagnose the complication in time and to select the proper treatment based on the type of HAC.
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Objective To determine the timing for therapy and efficacy for different types of hepatic artery stenosis (HAS) after orthotopic liver transplantation(OLT). Methods From October 2003 to May 2007, a total of 21 patients had hepatic artery stenosis after OLT in this hospital. Of the 21 patients, 19 underwent stent placement in their narrowed hepatic arteries and 2 were regularly followed up. Liver function, clinical outcomes, and the hepatic artery potency were reviewed. Results The occurring rate of HAS was 3.43% (21/613) and its median time of diagnosis was 146 days (range, 2-515 days). Six patients with early HAS were treated with interventions and 2 of them died.For the 4 surviving patients, 2 received retransplantation. For the 15 patients with late HAS, 13 were treated with interventions and 4 of them died. Two patients received retransplantation. Seven surviving patients had abnormality in liver function. Another 2 patients had normal liver function because of hepatic portal form compensatory circulation. Conclusion The presence of ischemic bile duct lesion and whether or not favourable compensatory circulation exists or not should be considered before individualized therapeutic regimens adopted according to postoperative HAS types.
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Objective To investigate the role of contrast-enhanced ultrasound(CEUS) for detection of hepatic artery stenosis(HAS) in recipients following orthotopic liver transplantation(OLT). Methods CEUS was performed in 50 OLT recipients (42 men and 8 women) with abnormal liver function test and/or abnormal findings on color Doppler ultrasound(CDUS). Digital subtraction angiography (DSA), computed tomographic angiography(CTA) or follow-up CDUS was used as the reference standard. The degree (mild,narrowing rate＜50 %; moderate, narrowing rate 50 % ～ 75 %; severe, narrowing rate＞ 75 % ), location and type (single or multiple) of HAS were evaluated. Moderate and severe stenosis were defined as substantial stenosis. Results CTA or DSA depicted substantial HAS in 39 patients, 8 patients with mild HAS or normal HA were depicted on CTA,and the remaining 3 patients were diagnosed as non-substantial HAS on clinical and CDUS follow-up. CEUS depicted substantial HAS in 38 cases. Moreover,CEUS corrected falsepositive findings on CDUS in 9 of 50 cases(18.0% ). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CEUS in diagnosing HAS were 90.0% ,92.3% ,81.8% ,94. 7% and 75.0%,respectively. Conclusions CEUS is able to provide comprehensive information including presence,degree,location and type of HAS, which may facilitate the further interventional procedure or surgical treatment.
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Objective To discuss the perioperative nursing care of patients who is going to receive interventional therapy for hepatic artery stenosis after liver transplantation and to provide useful reference for reducing surgery-related complication and for improving the prognosis of patients. Methods Based on the patient's condition and operative requirement,we provided effective nursing care for 20 patients who were admitted to receive the interventional therapy for hepatic artery stenosis after liver transplantation. The nursing care included preoperative preparation,postoperative nursing and medical guidance at the time of discharge. Results Interventional therapy was successfully performed in all 20 cases,and no hemorrhagic tendency or acute thrombosis occurred. Marked symptomatic improvement was obtained in all patients. Conclusion The interventional therapy is an effective treatment for hepatic artery stenosis after liver transplantation. Intensive perioperative nursing care can well prevent the occurrence of surgery-related complications and can surely improve the therapeutic results.
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Objective To explore the diagnosis and management of arterial complications after orthotopic liver transplantation (OLT). Methods The incidence, diagnosis and management of arterial complications of 180 OLT patients were analyzed retrospectively. Results A 5.0%(9/180)arterial complication rate was identified by selective angiography (8/9) and autopsy (1/9) in the 180 recipients, including 5 cases of hepatic artery thrombosis (HAT),3 cases of hepatic artery stenosis (HAS)and 1 celiac artery stenosis. Diagnostic sensitivity and specificity for arterial complications by color Doppler image (CDI) were 88.9% and 95.9% .The diagnostic sensitivity, specificity, positive and negative predictive value of intraoperative ultrasonography (IOUS) for arterial complications were 100%, 96.0%, 66.7% and 100%, respectively . Interventional procedures, revascularization, retransplantation and conservative treatment were used for 3,3,2 and 1 recipient respectively. Three patients were cured and 6 patients died. Conclusions CDI is a sensitive and specific way of monitoring arterial complications after OLT, and IOUS contributes to the early diagnosis. Revascularization and retransplantation are principal management for the patients with HAS or HAT. The conservative treatment might be effective for some asymptomatic patients, but interventional procedures may not obtain good results.