Management patterns and timing for hepatic artery complications after orthotopic liver transplantation / 中华普通外科杂志

ABSTRACT

Objective To evaluate patterns and timing of management for hepatic artery complications after orthotopic liver transplantation. Methods Between October 2003 and March 2007, the clinical data of 25 patients diagnosed as hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) were retrospectively analyzed. Treatment patterns included liver retransplantation and interventional therapy including thrombelysis, pereutaneous transluminal angioplasty and stent placement. Results There were 5 HAT cases, 3 patients were treated with thrombolysis, one patient recovered, one suffered from recurrent HAT and underwent retransplantation, and died of multiple organ failure, the third one died after thrombolysis. The remaining two HAT cases were treated with retransplantation because of liver failure and recovered. Among the 12 patients presented with HAS within 1 month posttransplantation, 2 patients received liver retransplantation because of graft failure and 10 patients were treated with interventions. 7 patients recovered after stent placement and 4 patients received late liver retransplantaton due to ischemic bile duct lesion. Two patients died of intraeranial hemorrhage and infection respectively among 6 liver retransplantations. Among the 8 patients suffering from late HAS (after 1 month postoperatively), 5 patients were treated with stent placement,and liver function improved. Two patients were treated conservatively and liver function was stable. The remaining one patient receiving late liver retransplantation due to ischemic bile duct lesion died postoperatively. Conclusion Individualized therapeutic regimens should be adopted in treating hepatic artery complications after orthotopic liver transplanatation, according to their periods, types and whether ischemic bile duct lesion exists. Liver retransplantation is the best treatment for HAT patients.Percutaneous interventional management is the first-line therapy for patients without irreversible graft dysfunction due to HAS, but liver retransplantation is the only option for patients with ischemic bile duct lesion due to HAS.