ABSTRACT
Hepatic artery thrombosis (HAT), a serious complication after orthotopic liver transplantation (OLT), can lead to patient death in the absence of revascularization or retransplantation. Herein we have presented clinical characteristics, imaging findings, and long-term outcomes of 3 OLT patients with HAT who were treated conservatively and developed hepatic arterial collaterals. These patients underwent transplantation due to hepatitis B cirrhosis, cryptogenic cirrhosis, or hepatitis C infection and alcoholic disease. They presented with bile duct stenosis and/or a bile leak at 1, 3, and 36 months after transplantation, respectively, and were treated with percutaneous drainage and stent placement, endoscopic retrograde cholangio-pancreatography (ERCP), or reanastomosis of the bile duct over a T tube. HAT was confirmed using multidetector computed tomography (MDCT) 3-dimensional (3D) angiography and Doppler sonography. They survive in good condition with normal liver function at 30, 50, and 42 months after OLT, respectively. Development of collateral arterial circulation to the liver graft was detected with MDCT 3D angiography and Doppler sonography. From our experience with 3 patients and a literature review, we believe that there are a number of patients who experience long-term survival after the diagnosis of irreversible HAT and the development of collaterals. Although this group is at high risk for sepsis and biliary complications, these are usually self-limiting complications due to improved treatment regimens. The development of collateral arterial flow may also be beneficial.
Subject(s)
Arterial Occlusive Diseases/etiology , Collateral Circulation , Hepatic Artery/physiopathology , Liver Circulation , Liver Transplantation/adverse effects , Thrombosis/etiology , Adult , Aged , Anastomotic Leak/etiology , Anastomotic Leak/therapy , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/physiopathology , Arterial Occlusive Diseases/therapy , Cholestasis/etiology , Cholestasis/therapy , Hepatic Artery/diagnostic imaging , Humans , Male , Middle Aged , Multidetector Computed Tomography , Thrombosis/diagnosis , Thrombosis/physiopathology , Thrombosis/therapy , Time Factors , Treatment Outcome , Ultrasonography, DopplerABSTRACT
BACKGROUND: Liver transplantation is the treatment of choice for patients with end-stage liver disease; however, it is associated with a multitude of postoperative complications. Herein we have presented our experience with the application of multidetector computed tomography (MDCT) in the follow-up of liver transplant recipients. PATIENTS AND METHODS: Twenty-four liver transplantation patients were examined with triphasic hepatic computed tomography. Both symptomatic and asymptomatic patients were included in the study. Examinations were performed using a multidetector scanner. RESULTS: We documented seven cases of thrombosis, three stenosis, and two hepatic artery (HA) aneurysms. Portal vein (PV) stenosis and PV thrombosis were observed in two cases each. We observed one case of synchronous HA and PV stenosis; one inferior vena cava (IVC) and left renal vein thrombosis, and one IVC thrombosis. In three cases of HA obstruction we observed transplant neovascularization. One HA obstruction and one HA stenosis were accompanied by bilomas. Finally, we discovered three cases of hepatocellular carcinoma. CONCLUSION: In our experience MDCT as a single noninvasive examination, was a sensitive means to detect and evaluate vascular complications after liver transplantation, offering adequate information concerning the liver parenchyma, the rest of the abdomen, and to a lesser extent the biliary tract.
