Association of early CMV viraemia with hepatic arterial thrombosis

Pastacaldi, Sabrina; Grasso, Alessandro; Teixeira, R.; Montalto, Paolo; Dagher, Lucy; Vlachogiannakos, John; Rehim, M. I. Abdel; Patch, D.; Rolles, K; Davidson, Brian; Burroughs, A.K.

doi:10.1016/s0168-8278(00)80548-6

Cited by 3 publications

(2 citation statements)

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“…Moreover, in a series of 51 patients undergoing re-OLT, we recently showed that CMV viremia occurs early in those who undergo re-OLT for HAT (median time, 32.5 days), but not in other indications for re-OLT (median time, 189.5 days; P ϭ .004). 46 These data suggest a possible involvement of CMV in the development of HAT.…”

Section: Infectionsmentioning

confidence: 80%

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

et al. 2001

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Section: Infectionsmentioning

confidence: 80%

Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes

et al. 2001

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“…Interestingly, in our center, CMV viremia occurred earlier in patients who underwent re-OLT for HAT compared with those who underwent re-OLT at the same time after OLT for other reasons. 16 The thrombogenic effect of some viruses could be linked to the production of soluble factors or a change in some surface proteins. 6 CMV infection of endothelial cells is followed by a rapid procoagulant response.…”

Section: Discussionmentioning

confidence: 99%

Late hepatic artery thrombosis after orthotopic liver transplantation

Günşar

Rolando

Pastacaldi

et al. 2003

Liver Transplantation

156

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Late hepatic artery thrombosis (HAT) is a rare complication after orthotopic liver transplantation (OLT), conventionally described as occurring more than 30 days after surgery. Only a few reports document its course. In a consecutive series of 634 OLTs (704 grafts), 11 patients (1.7%) had late HAT, diagnosed a median of 6 months (range, 1.8 to 79 months) after OLT. Clinical variables were compared with those of 415 patients without HAT who had a complete database and follow-up, including cytomegalovirus (CMV) surveillance. At presentation, 11 patients had fever, 4 patients had jaundice. Hepatic abscesses were present in 6 patients (3 patients with biliary leak), 4 patients had biliary tree necrosis (2 patients with biliary leak), and 1 patient had no biliary complications. Five patients (45%) underwent accessory hepatic artery anastomosis versus 73 patients (17%) without HAT (P < .05). Five patients (45%) with late HAT had CMV infection versus 14% without HAT (P < .05). Two episodes of late HAT (11 and 79 months) occurred in patients who underwent re-OLT for early HAT (3.9%). Re-OLT was performed in 8 patients a median of 11 days (range, 3 to 37 days) after diagnosis (preceded by intravenous antibiotics and percutaneous drainage). The other 3 patients underwent partial hepatectomy (1 patient), external percutaneous drainage as unfit for surgery (1 patient), and antibiotic therapy only (1 patient). Death occurred in 4 patients who underwent re-OLT (50%) because of septicemia at 11, 23, and 60 days after re-OLT and 17 days after a third OLT. There was one late death (30 months) after partial hepatectomy (hepatitis C recurrence) and one death 6 months after long-term biliary drainage because of sepsis. The 5 survivors have good health with normal liver function test results at a median 52 months (range, 6 to 57 months). In conclusion, late HAT presents with fever caused by hepatic abscesses or biliary leak associated with biliary ischemia and necrosis. CMV infection and accessory hepatic artery anastomosis are risk factors for late HAT in our cohort. Early intervention followed by re-OLT can salvage patients. (Liver Transpl 2003;9: 605-611.) H epatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT) is a potentially lifethreatening complication that occurs in 1.6% to 10.5% of adult liver transplant recipients and 10% to 25% of pediatric cadaver recipients. 1-3 HAT carries a mortality rate of 27% to 58%. 1,4,5 When re-OLT is not performed, the mortality rate increases to 73%. 5 HAT occurring early after OLT is associated with acute fulminant hepatic failure, biliary tract necrosis and leaks, or relapsing bacteremia and results in a high rate of graft loss and patient mortality. Late HAT generally is associated with a milder clinical course than acute HAT. [6][7][8] The time that divides early and late HAT has not been agreed on. Because technical aspects and surgical complications are associated with HAT development in the first 30 days after OLT, it is common practice to use 1 month from OLT to d...

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