Continuous Transcatheter Arterial Thrombolysis for Early Hepatic Artery Thrombosis After Liver Transplantation

Zhou, Jian; Fan, Jia; Wang, J.-H.; Wu, Zeyi; Qiu, S.-J.; Shen, Yi; Shi, Yijie; Huang, Xiaoyan; Wang, Z.; Tang, Zhaoqing; Wang, Y.-Q.

doi:10.1016/j.transproceed.2005.10.113

Cited by 34 publications

(35 citation statements)

References 9 publications

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“…In only two centers routine DUS was not performed (3,46 (12,27,28,33,42,44,48,51,52,54,62,65,71,84 (12,16,17,21,25,27,28,33,35,(41)(42)(43)(45)(46)(47)(48)(53)(54)(55)57,59,67,(70)(71)(72)(73)80,82,(84)(85)(86)(87) (12,27,28,33,42,…”

Section: Doppler Ultrasound Screening Protocolsmentioning

confidence: 99%

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Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

Bekker¹,

Ploem

Jong³

2009

American Journal of Transplantation

497

507

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To clarify inconsistencies in the literature we performed a systematic review to identify the incidence, risk factors and outcome of early hepatic artery thrombosis (eHAT) after liver transplantation. We searched studies identified from databases (MEDLINE, EMBASE, Science Citation Index) and references of identified studies. Seventy-one studies out of 999 screened abstracts were eligible for this systematic review. The incidence of eHAT was 4.4% (843/21, 822); in children 8.3% and 2.9% in adults (p < 0.001). Doppler ultrasound screening (DUS) protocols varied from 'no routine' to 'three times a day.' The median time to detection was at day seven. The overall retransplantation rate was 53.1% and was higher in children (61.9%) than in adults (50%, p < 0.03). The overall mortality rate of patients with eHAT was 33.3% (range: 0-80%). Mortality in adults (34.3%) was higher than in children (25%, p < 0.03). The reported risk factors for eHAT were, cytomegalovirus mismatch (seropositive donor liver in seronegative recipient), retransplantation, arterial conduits, prolonged operation time, low recipient weight, variant arterial anatomy, and low volume transplantation centers. eHAT is associated with significant graft loss and mortality. Uniform definitions of eHAT and uniform treatment modalities are obligatory to confirm these results and to obtain a better understanding of this disastrous complication.

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Section: Doppler Ultrasound Screening Protocolsmentioning

confidence: 99%

“…7 Only manuscripts mentioning the outcome are included. I 2,12,16,17,21,27,28,30,35,41,42,45,46,48,[51][52][53][54][55][56][57][58][59]61,62,64,65,[67][68][69][70][71][72][73]77,80,82,[84][85][86][87]16,17,21,25,27,28,33,35,[41][42][43]…”

Section: Doppler Ultrasound Screening Protocolsmentioning

confidence: 99%

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

Bekker¹,

Ploem

Jong³

2009

American Journal of Transplantation

497

507

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“…It is thought to be safe and effective if the infusion catheter is placed inside the thrombus. [10][11][12] Despite its local effect, hemorrhage is the most common complication of intra-arterial thrombolysis; hence, it is necessary to monitor closely by evaluating parameters such as fibrinogen, prothrombin time, or activated partial thromboplastin time. 8 Percutaneous mechanical thrombectomy, which has been successfully used in other vascular beds, 13 also can be used as an alternative treatment for HAT when intra-arterial thrombolysis is contraindicated.…”

Section: Treatment Of Hepatic Artery Thrombosismentioning

confidence: 99%

Untitled

Pereira

Salsamendi²,

Dalal

et al. 2016

Exp Clin Transplant

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Objectives: Hepatic artery thrombosis remains a major complication after orthoptic liver transplant. Treatment of hepatic artery thrombosis is complex and requires a multidisciplinary approach. Retransplant is the procedure of choice. In nonsurgical candidates, endovascular options are evolving. Materials and Methods: Based on our experience at a busy transplant center, we discuss 4 representative cases to explain the potential role of endovascular treatment beyond just attempts at recanalization. From our experience, as well as a review of the literature, we propose a clinical practice algorithm for optimal treatment of hepatic artery thrombosis after orthoptic liver transplant. Results: The primary traditional endovascular interventional options remain thrombectomy, balloon angioplasty, and use of stents with the aim of revascularization. However, these methods have not proven to be effective. Ultrasonography-assisted thrombolysis, which has thus far been relatively less described in the hepatic vasculature, has the potential of producing the same angiographic results but at lower doses of the thrombolytic agent, thus decreasing the potential for hemorrhagic complications. The adjunctive use of splenic artery embolization and prompt treatment of biliary complications are in our opinion useful in "buying time" to allow adequate development of collateral "neovascularization of the liver," thus preventing further ischemia. Conclusions: Although surgical retransplant still remains the standard treatment for hepatic artery thrombosis, organ shortages and high mortality still exist. Endovascular techniques are rapidly evolving, but these techniques are dependent on expertise available and, even in the best hands, have not proven to be effective at reversing hepatic artery thrombosis. The use of a multimodality endovascular approach could salvage the liver allografts, thereby preventing retransplant or facilitating transplant at a more elective setting.

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“…Porrini et al (1) recently demonstrated, in a posthoc analysis, that persistent hyperinsulinemia in the first year posttransplant in nondiabetic renal transplant recipients was a risk factor for increased creatinine clearance and hyperfiltration. Although their findings are interesting and they should be congratulated for their work, it has to be recognized that glycemic metabolism posttransplantation is a dynamic and fluctuating process, and the relationship among insulin, glucose, and glomerular filtration rate may be more complex than imagined.…”

Section: Insulin Glucose and Glomerular Filtration Ratementioning

confidence: 99%

Formation of Collateral Circulation Within Hepatic Parenchyma After Recurrent Hepatic Artery Thrombosis and Thrombolysis Early After Liver Transplantation: Case Report

et al. 2009

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Continuous Transcatheter Arterial Thrombolysis for Early Hepatic Artery Thrombosis After Liver Transplantation

Cited by 34 publications

References 9 publications

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

Untitled

Formation of Collateral Circulation Within Hepatic Parenchyma After Recurrent Hepatic Artery Thrombosis and Thrombolysis Early After Liver Transplantation: Case Report

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