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Almeida JD, Waisberg DR, Martino RB, Rocha-Santos V, Pinheiro RS, Arantes RM, Ducatti L, Nacif LS, Lee AD, Haddad LB, Song AT, Silva MS, Alvarez J, Marin-Castro P, Vieira IF, Galvão FH, Carneiro-D'Albuquerque LA, Andraus W. Retransplantation for Late Hepatic Artery Thrombosis: Results from a Single Center. Transplant Proc 2024:S0041-1345(24)00262-8. [PMID: 38862364 DOI: 10.1016/j.transproceed.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/30/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Hepatic artery thrombosis is the most common vascular complication of liver transplantation. When occurring late in the postoperative course, it may have no clinical repercussions, and conservative treatment may be implemented. Some patients, however, will develop severe biliary complications due to ischemic cholangiopathy and require retransplantation. The aim of this study is to report the outcomes of retransplantation in this population. METHODS This is a single-center retrospective study involving all adult patients who underwent liver retransplantation due to late hepatic artery thrombosis from January/2010 to December/2022. RESULTS During the study period, 1378 liver transplants were performed in our center; 147 were retransplantations, with 13 cases of late hepatic artery thrombosis (0.94%). All had symptomatic ischemic cholangiopathy. Twelve of them had already presented previous cholangitis, bilomas, or liver abscesses and had undergone biliary stenting or percutaneous drainage. The median time between the first liver transplant and late hepatic artery thrombosis diagnosis and between this diagnosis and retransplantation were 73 and 50 days, respectively. Arterial reconstruction using splenic artery, celiac trunk, or arterial conduit from the aorta was performed in 7 cases, whereas biliary reconstruction was mostly done with choledochojejunostomy (n = 8). There were 4 perioperative deaths, 2 due to primary non-function and 2 due to refractory shock after exceedingly complex retransplants. CONCLUSION Liver retransplantation due to late hepatic artery thrombosis is a rare condition that should be offered to patients who develop severe biliary complications and recurrent infections. It is nonetheless a challenging procedure associated with significant perioperative mortality.
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Affiliation(s)
- Juliani Dourado Almeida
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Daniel Reis Waisberg
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil.
| | - Rodrigo Bronze Martino
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Vinicius Rocha-Santos
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Rafael Soares Pinheiro
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Rubens Macedo Arantes
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Liliana Ducatti
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Lucas Souto Nacif
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Andre Dong Lee
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Luciana Bertocco Haddad
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil; Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Alice Tung Song
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Maciana Santos Silva
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Jhosimar Alvarez
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Pedro Marin-Castro
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Igor Ferreira Vieira
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Flávio Henrique Galvão
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil; Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Luiz Augusto Carneiro-D'Albuquerque
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil; Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Wellington Andraus
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil; Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
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Bricogne C, Halliday N, Fernando R, Tsochatzis EA, Davidson BR, Harber M, Westbrook RH. Donor-recipient human leukocyte antigen A mismatching is associated with hepatic artery thrombosis, sepsis, graft loss, and reduced survival after liver transplant. Liver Transpl 2022; 28:1306-1320. [PMID: 35313059 PMCID: PMC9541857 DOI: 10.1002/lt.26458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 01/13/2023]
Abstract
Human leukocyte antigen (HLA) matching is not routinely performed for liver transplantation as there is no consistent evidence of benefit; however, the impact of HLA mismatching remains uncertain. We explored the effect of class I and II HLA mismatching on graft failure and mortality. A total of 1042 liver transplants performed at a single center between 1999 and 2016 with available HLA typing data were included. The median follow-up period was 9.38 years (interquartile range 4.9-14) and 350/1042 (33.6%) transplants resulted in graft loss and 280/1042 (26.9%) in death. Graft loss and mortality were not associated with the overall number of mismatches at HLA-A, HLA-B, HLA-C, HLA-DR, and HLA-DQ loci. However, graft failure and mortality were both increased in HLA mismatching on graft failure and mortality the presence of one (p = 0.004 and p = 0.01, respectively) and two (p = 0.01 and p = 0.04, respectively) HLA-A mismatches. Elevated hazard ratios for graft failure and death were observed with HLA-A mismatches in univariate and multivariate Cox proportional hazard models. Excess graft loss with HLA-A mismatch (138/940 [14.7%] mismatched compared with 6/102 [5.9%] matched transplants) occurred within the first year following transplantation (odds ratio 2.75; p = 0.02). Strikingly, transplants performed at a single all grafts lost due to hepatic artery thrombosis were in HLA-A-mismatched transplants (31/940 vs. 0/102), as were those lost due to sepsis (35/940 vs. 0/102). In conclusion, HLA-A mismatching was associated with increased graft loss and mortality. The poorer outcome for the HLA-mismatched group was due to hepatic artery thrombosis and sepsis, and these complications occurred exclusively with HLA-A-mismatched transplants. These data suggest that HLA-A mismatching is important for outcomes following liver transplant. Therefore, knowledge of HLA-A matching status may potentially allow for enhanced surveillance, clinical interventions in high-risk transplants or stratified HLA-A matching in high-risk recipients.
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Affiliation(s)
- Christopher Bricogne
- Sheila Sherlock Liver UnitRoyal Free London NHS Foundation Trust and Institute for Liver and Digestive HealthUniversity College LondonLondonUK
| | - Neil Halliday
- Sheila Sherlock Liver UnitRoyal Free London NHS Foundation Trust and Institute for Liver and Digestive HealthUniversity College LondonLondonUK
| | - Raymond Fernando
- The Anthony Nolan Research InstituteRoyal Free London NHS Foundation TrustLondonUK
| | - Emmanuel A. Tsochatzis
- Sheila Sherlock Liver UnitRoyal Free London NHS Foundation Trust and Institute for Liver and Digestive HealthUniversity College LondonLondonUK
| | - Brian R. Davidson
- UCL Division of Surgery and Interventional SciencesRoyal Free HospitalLondonUK
| | - Mark Harber
- Kidney UnitRoyal Free London NHS Foundation TrustLondonUK
| | - Rachel H. Westbrook
- Sheila Sherlock Liver UnitRoyal Free London NHS Foundation Trust and Institute for Liver and Digestive HealthUniversity College LondonLondonUK
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3
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Capelli R, Allard M, Ciacio O, Pittau G, Golse N, Vibert E, Sa Cunha A, Castaing D, Cherqui D, Adam R. Late hepaticartery thrombosis after liver transplantation: which strategy? A single‐center retrospective study. Transpl Int 2019; 32:473-480. [DOI: 10.1111/tri.13394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/22/2018] [Accepted: 12/12/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Rafaela Capelli
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
| | - Marc‐Antoine Allard
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Unités Mixtes de Recherche en Santé 1193 Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - Oriana Ciacio
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
| | - Gabriella Pittau
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
| | - Nicolas Golse
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Unités Mixtes de Recherche en Santé 1193 Villejuif France
| | - Eric Vibert
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Unités Mixtes de Recherche en Santé 1193 Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - Antonio Sa Cunha
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - Denis Castaing
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Unités Mixtes de Recherche en Santé 1193 Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - Daniel Cherqui
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - René Adam
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
- Unités Mixtes de Recherche en Santé 985 INSERM Villejuif France
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Ischemic Cholangiopathy 11 Years after Liver Transplantation from Asymptomatic Chronic Hepatic Artery Thrombosis. ACG Case Rep J 2018; 5:e75. [PMID: 30426033 PMCID: PMC6202426 DOI: 10.14309/crj.2018.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/06/2018] [Indexed: 11/17/2022] Open
Abstract
Hepatic artery thrombosis is a concerning complication of orthotopic liver transplantation, and it most often occurs early in the posttransplant period. However, on rare occasions it can occur at a time remote from transplant. We present a case of ischemic cholangiopathy complicated by stricture and anastomotic bile leak from chronic hepatic artery thrombosis that occurred 11 years after the transplant. The initial biliary stenting helped with the resolution of the leak but she was found to have stones, sludge and copious pus at the time of stent exchange. Hepatic arteriography demonstrated complete occlusion of the transplant hepatic artery with periportal collaterals reconstituting intrahepatic hepatic arterial branches. The patient was subsequently referred for repeat liver transplantation.
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5
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Ischemic Cholangiopathy 11 Years after Liver Transplantation from Asymptomatic Chronic Hepatic Artery Thrombosis. ACG Case Rep J 2018. [DOI: 10.14309/02075970-201805000-00075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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6
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Ischemic Cholangiopathy 11 Years after Liver Transplantation from Asymptomatic Chronic Hepatic Artery Thrombosis. ACG Case Rep J 2018. [DOI: 10.14309/02075970-201805100-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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7
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Collateral Development in Thrombosis of the Hepatic Artery After Transplantation. Transplant Proc 2017; 48:3006-3009. [PMID: 27932132 DOI: 10.1016/j.transproceed.2016.07.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 07/27/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The authors sought to identify strictures or hepatic artery obstruction with posterior collateral transformation in our series of liver transplantation, treatment, and evolution. The thrombosis or severe hepatic artery stenosis sometimes presents a compensation mechanism, the collateral transformation of the artery. MATERIAL AND METHODS From April 2002 to December 2011 we collected 18 cases of collateral transformation. We analyzed data regarding the transplantation, diagnosis, treatment, clinical evolution, liver function, and Doppler-ultrasound. RESULTS The main indication was alcoholic cirrhosis, followed by hepatocellular carcinoma - hepatitis C virus. The mean cold ischemia time was 292.2 minutes mean hot ischemia was 48.8. The anastomosis was performed on the gastroduodenal-splenic patch donor in 14 cases, the celiac trunk in 2 cases, and on grafts to the aorta in another 2. Doppler ultrasound showed 8 cases without complications, 8 with low flows, and 2 cases with alterations of the right hepatic artery. Computed tomographic (CT) angiography was performed in patients with impaired eco-Doppler and found 4 obstructions, 2 cases with kinking, 1 stenosis, and 3 normal cases. Three patients with low flows were re-operated and another re-transplanted. After diagnosis of collateral transformation, all were treated with antiplatelet agents. Two cases of angioplasty were associated. The collaterals were diagnosed 1 month to 44.8 months after transplantation. Five patients died. In the latest data, 10 patients do not have analytical alteration. The Doppler ultrasound shows 7 cases being normal and 6 with flow but low resistances. CONCLUSIONS In our series, all patients with collateral transformation, except one who was transplanted, maintain good liver function with permeable vessels.
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8
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Lyu SQ, Ren J, Zheng RQ, Meng XC, Huang MS, Wang P. Contrast-Enhanced Sonography for Diagnosing Collateral Transformation of the Hepatic Artery After Liver Transplantation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1591-1598. [PMID: 26254152 DOI: 10.7863/ultra.15.14.08079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 09/04/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine the contrast-enhanced sonographic features of hepatic artery collateral transformation in patients with hepatic artery complications after liver transplantation. METHODS Ninety-nine liver transplant recipients who underwent contrast-enhanced sonography were recruited from April 2004 to May 2014. The reference standards were conventional angiography and computed tomographic angiography. The contrast-enhanced sonographic features of the hepatic artery in patients with and without collateral arteries were retrospectively analyzed. RESULTS All 15 patients with hepatic artery collateral transformation had hepatic artery thrombosis (10 of 15) or hepatic artery stenosis (5 of 15). The collateral artery detection rate on contrast-enhanced sonography was 100%. The peripheral hepatic artery could not be visualized by contrast-enhanced sonography in most of the patients with hepatic artery collateral transformation (14 of 15). Additionally, many small tortuous collateral arteries in the porta hepatis region were visualized during the arterial and early portal phases, showing reticulated/patchy (15 of 15) and striped (3 of 15) enhancement patterns on contrast-enhanced sonography. CONCLUSIONS Collateral transformation of the hepatic artery in patients with hepatic artery complications after liver transplantation appears to have characteristic features on contrast-enhanced sonography, especially a reticulated or patchy enhancement pattern in the porta hepatis region during the arterial and early portal phases combined with the absence of the peripheral hepatic artery. Contrast-enhanced sonography may be a novel method for diagnosing hepatic artery collateral transformation, which may be a highly specific sign of hepatic artery thrombosis or stenosis.
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Affiliation(s)
- Su-Qin Lyu
- Departments of Medical Ultrasonics (S.-Q.L., J.R., R.-Q.Z., P.W.) and Radiology (X.-C.M., M.-S.H.), Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Ren
- Departments of Medical Ultrasonics (S.-Q.L., J.R., R.-Q.Z., P.W.) and Radiology (X.-C.M., M.-S.H.), Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rong-Qin Zheng
- Departments of Medical Ultrasonics (S.-Q.L., J.R., R.-Q.Z., P.W.) and Radiology (X.-C.M., M.-S.H.), Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Xiao-Chun Meng
- Departments of Medical Ultrasonics (S.-Q.L., J.R., R.-Q.Z., P.W.) and Radiology (X.-C.M., M.-S.H.), Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming-Sheng Huang
- Departments of Medical Ultrasonics (S.-Q.L., J.R., R.-Q.Z., P.W.) and Radiology (X.-C.M., M.-S.H.), Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Wang
- Departments of Medical Ultrasonics (S.-Q.L., J.R., R.-Q.Z., P.W.) and Radiology (X.-C.M., M.-S.H.), Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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9
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Argüelles García B, Redondo Buil P. [Collateral transformation of the hepatic artery after liver transplantation]. RADIOLOGIA 2013; 56:564-6. [PMID: 23433631 DOI: 10.1016/j.rx.2012.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 12/21/2012] [Accepted: 12/23/2012] [Indexed: 11/18/2022]
Affiliation(s)
- B Argüelles García
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España.
| | - P Redondo Buil
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
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Leithead JA, Smith MR, Materacki LB, Sagar VM, Gunson BK, Bramhall SR, Mutimer DJ, Shah T. Intercurrent infection predicts mortality in patients with late hepatic artery thrombosis listed for liver retransplantation. Liver Transpl 2012; 18:1353-60. [PMID: 22847840 DOI: 10.1002/lt.23518] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/01/2012] [Indexed: 01/12/2023]
Abstract
Liver retransplantation for late hepatic artery thrombosis (HAT) is considered the treatment of choice for select patients. Nevertheless, there is a paucity of data to aid decision making in this setting. The aims of this single-center study of patients listed for late HAT were (1) to determine variables associated with wait-list mortality, (2) to describe survival after retransplantation, and (3) to determine variables associated with mortality after retransplantation. Seventy-eight patients were diagnosed with late HAT (incidence = 3.9%). Of the 49 patients listed for retransplantation, 9 died on the waiting list and 36 were retransplanted. The estimated 1-year survival after listing for retransplantation was 53.7%. Only multidrug-resistant (MDR) bacteria-positive cultures were predictive of wait-list mortality (P = 0.01). After retransplantation, the estimated 1- and 5-year patient survival was 71.9% and 62.5%, respectively. Increasing Model for End-Stage Liver Disease score (overall P = 0.007), MDR bacteria-positive cultures (P = 0.047), and continued antibiotic therapy (P = 0.001) at the time of retransplantation were risk factors for post retransplant death. In conclusion, patients who undergo liver retransplantation for late HAT have satisfactory outcomes. However, the presence of active infection and MDR bacteria-positive cultures should be taken into account when risk stratifying such patients.
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Affiliation(s)
- Joanna Agnes Leithead
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; National Institute for Health Research Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom.
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11
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Liver transplantation using University of Wisconsin or Celsior preserving solutions in the portal vein and Euro-Collins in the aorta. Transplant Proc 2010; 42:429-34. [PMID: 20304157 DOI: 10.1016/j.transproceed.2010.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Orthotopic liver transplantation (OLT) is today the gold standard treatment of the end-stage liver disease. Different solutions are used for graft preservation. Our objective was to compare the results of cadaveric donor OLT, preserved with the University of Wisconsin (UW) or Celsior solutions in the portal vein and Euro-Collins in the aorta. METHODS We evaluated retrospectively 72 OLT recipients, including 36 with UW solution (group UW) and 36 with Celsior (group CS). Donors were perfused in situ with 1000 mL UW or Celsior in the portal vein of and 3000 mL of Euro-Collins in the aortia and on the back table managed with 500 mL UW or Celsior in the portal vein, 250 mL in the hepatic artery, and 250 mL in the biliary duct. We evaluated the following variables: donor characteristics, recipient features, intraoperative details, reperfusion injury, and steatosis via a biopsy after reperfusion. We noted grafts with primary nonfunction (PNF), initial poor function (IPF), rejection episodes, biliary duct complications, hepatic artery complications, re-OLT, and recipient death in the first year after OLT. RESULTS The average age was 33.6 years in the UW group versus 41 years in the CS group (P = .048). There was a longer duration of surgery in the UW group (P = .001). The other recipient characteristics, ischemia-reperfusion injury, steatosis, PNF, IPF, rejection, re-OLT, and recipient survival were not different. Stenosis of the biliary duct occured in 3 (8.3%) cases in the UW group and 8 (22.2%) in the CS (P = .19) with hepatic artery thrombosis in 4 (11.1%) CS versus none in the UW group (P = .11). CONCLUSION Cadaveric donor OLT showed similar results with organs preserved with UW or Celsior in the portal vein and Euro-Collins in the aorta.
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12
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Indicaciones y resultados de retrasplante hepático: experiencia del hospital universitario La Fe (1.181 pacientes). Cir Esp 2010; 87:356-63. [DOI: 10.1016/j.ciresp.2009.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 10/07/2009] [Indexed: 12/23/2022]
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13
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Singhal A, Stokes K, Sebastian A, Wright HI, Kohli V. Endovascular treatment of hepatic artery thrombosis following liver transplantation. Transpl Int 2009; 23:245-56. [PMID: 20030796 DOI: 10.1111/j.1432-2277.2009.01037.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatic artery thrombosis (HAT) is the most frequent vascular complication following orthotopic liver transplantation. Urgent retransplantation has been considered as the mainstay therapy. Surgical revascularization is an effective alternative in asymptomatic patients. Endovascular therapies including intra-arterial thrombolysis, percutaneous transluminal angioplasty (PTA), and stent placement have shown encouraging results in recent years; however, their use remains controversial because of potential risk of hemorrhage. Until June 2009, 69 cases were published in 16 reports describing therapeutic potential of endovascular modalities. Interventions were performed as early as within 4 h to as late as 120 days in patients ranging from 4 months to 64 years of age. Majority of published reports suggested the use of urokinase. Thrombolysis was successful in 47 out of 69 (68%) patients. Bleeding was the most common complication including fatal intra-abdominal hemorrhage in three patients. Twenty-nine out of 47 (62%) patients underwent further intervention in the form of PTA, stenting, or both. The follow-up patency ranged from 1 month to 26 months. In conclusion, whenever possible, efforts should be made to rescue the liver grafts through urgent revascularization (surgical and/or endovascular) depending on patient's condition and interventional expertise at the transplant center; reserving the option of retransplantation for failure, complications, and cases with severe clinical symptoms or allograft dysfunction.
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Affiliation(s)
- Ashish Singhal
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, USA
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14
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Moya-Herraiz Á, Torres-Quevedo R, San Juan F, López-Andújar R, Montalvá E, Pareja E, Rivera J, Mir J. Indicaciones y resultados del retrasplante hepático. Cir Esp 2008; 84:246-50. [DOI: 10.1016/s0009-739x(08)75915-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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15
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Collateral Transformation of the Hepatic Artery After Liver Transplantation. AJR Am J Roentgenol 2008; 191:546-9. [DOI: 10.2214/ajr.07.3625] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Garcia JHP, Vasconcelos JBM, Gonçalves BPA, Costa PEG, Barros MAP, Viana CFG, Brasil IRC, Lopes PM, Rocha TD, Forte CRF, Coelho GR. A new biliodigestive anastomosis technique after hepatic artery thrombosis as bridge to liver retransplantation: a case presentation. Transplant Proc 2007; 39:3523-6. [PMID: 18089427 DOI: 10.1016/j.transproceed.2007.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 04/21/2007] [Accepted: 09/13/2007] [Indexed: 11/30/2022]
Abstract
Arterial complications after liver transplantation are frequent. Hepatic artery thrombosis (HAT) is usually associated with biliary complications. Herein we have reported a case of a patient who was admitted for jaundice, itch, and elevated aspartate aminotransferase and alanine aminotransferase levels at 6 weeks after liver transplantation. HAT associated with a biloma was diagnosed and an urgent operation performed requiring a new biliodigestive anastomosis technique. Fourteen months after the first transplant, the patient was retransplanted. The operation performed may be an alternative to treat biliary complications due to late HAT.
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Horrow MM, Blumenthal BM, Reich DJ, Manzarbeitia C. Sonographic diagnosis and outcome of hepatic artery thrombosis after orthotopic liver transplantation in adults. AJR Am J Roentgenol 2007; 189:346-51. [PMID: 17646460 DOI: 10.2214/ajr.07.2217] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The objective of our study was to determine the timing and frequency of symptomatic hepatic artery thrombosis in an adult orthotopic liver transplant population, the sensitivity of Doppler sonography for this diagnosis, and the clinical and sonography outcomes in this population. MATERIALS AND METHODS The subjects included all adult recipients with orthotopic liver transplants during a 10.5-year period. A retrospective review of all cases of hepatic artery thrombosis detected on angiography or at surgery was correlated with sonography findings at diagnosis. Clinical and sonography outcomes were recorded. Patients were divided into early (< 1 week) and late hepatic artery thrombosis groups. Hepatic artery thrombosis was considered primary or secondary due to treatment of other hepatic artery complications. RESULTS Of 522 transplants, 25 (4.8%) developed hepatic artery thrombosis that was primary in 18 (3.5%), with five early (1.0%) and 13 late (2.5%), and secondary in seven (1.3%). Sensitivities of sonography compared with angiography were 100% for detection of early hepatic artery thrombosis and 72.7% for late hepatic artery thrombosis. Seventeen patients (68%) with an episode of hepatic artery thrombosis are currently alive, 11 of whom have irreversible hepatic artery thrombosis; in 10 of the 11 cases, sonography showed that collateral arterial flow had developed. The mean survival was 51.4 months in the patients with irreversible hepatic artery thrombosis, eight of whom had documented biliary or septic complications (or both). CONCLUSION Hepatic artery thrombosis is uncommon after liver transplantation in adults. Sonography is extremely sensitive for the detection of hepatic artery thrombosis in symptomatic patients during the immediate postoperative period. Sonography becomes less sensitive as the interval between transplantation and diagnosis of hepatic artery thrombosis increases due to collateral arterial flow. Patients with irreversible hepatic artery thrombosis typically develop interval arterial collaterals that can be seen on sonography. Biliary and septic complications are common but usually are self-limited.
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Affiliation(s)
- Mindy M Horrow
- Department of Radiology, Albert Einstein Medical Center, 5501 Old York Rd., Philadelphia, PA 19141-3098, USA.
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Ulusal BG, Cheng MH, Ulusal AE, Lee WC, Wei FC. Collaboration with microsurgery prevents arterial complications and provides superior success in partial liver transplantation. Microsurgery 2006; 26:490-7. [PMID: 17006957 DOI: 10.1002/micr.20276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hepatic artery thrombosis is the most common technical complication in liver transplantation. The objective of this study was to investigate the arterial complications of partial liver transplantation using microsurgical technique. At a period of 31-months, we participated in a total of 42 right lobes, 7 left lobes, and 1 whole-liver liver transplantations from cadaveric (n = 20) or living (n = 30) donors. Hepatic artery anastomosis was performed using microsurgical techniques. All anastomoses were accomplished successfully. Fifteen patients expired postoperatively and 35 hepatic artery anastomoses remained patent at a mean follow-up period of 10.6 +/- 8.4 months. The mean diameters of the donor and recipient hepatic arteries were 2.9 +/- 1.2 mm and 3.2 +/- 1.1 mm, respectively. Specific technical challenges were encountered during operation in eight cases (16%). We have found that microsurgical techniques are not only useful for a superior anastomosis but also reliable to adapt to vascular anomalies with less arterial complications. complications.
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Affiliation(s)
- Betul Gozel Ulusal
- Depatment of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
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