Hepatic Allograft Rescue Following Arterial Thrombosis: Role of Urgent Revascularization

Langnas, Alan Norman; Marujo, Wagner; Stratta, Robert J.; Wood, Robert; Li, Shujun; Shaw, Byers W.

doi:10.1097/00007890-199101000-00013

Cited by 149 publications

(93 citation statements)

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“…In this study, we confirm the results of Pinna et al, [16] showing the importance of emergency revascularization to avoid a significant percentage of Rtx (9 of 18; 50%) 1161. Furthermore, we demonstrate the value of immediate postoperative ultrasound examination in the early diagnosis of HAT, since a fast diagnosis is of crucial importance for successful and complete revascularization of the graft [9,12,161. Although graft revascularization was successful in 16 of 18 cases, (five finally developed IBL), it is interesting to note that the time until diagnosis was significantly shorter in patients for whom revascularization was not associated with IBL.…”

Section: Discussionmentioning

confidence: 84%

Intrahepatic biliary lesions after orthotopic liver transplantation

Rull¹,

Valdecasas²,

Grande³

et al. 2001

Transplant International

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Intrahepatic biliary lesions (IBL) are rare (2-9 %) after orthotopic liver transplantation (OLT). The aim was to evaluate the incidence, etiology and outcome. In nine years, a total 532 OLTs were performed in 481 patients. Twentyfour patients developed IBL. Eight were due to HAT, seven to ABOI, three to CDR and six to PI. The time until diagnosis of HAT is longest in patients (14 ? 6) with IBL. ABOI is another cause of IBL. CDR is a rare cause of IBL, however when it takes place, patients must undergo Rtx. Finally, PI is a relevant cause of IBL. In order to suppress the incidence of IBL we should consider 1) the systematic use of Doppler-Ultrasound; 2) emergency reoperation of patients with HAT, 3) avoid ABOI in OLT; 4) Rtx in cases of CDR, and 5) OLT should still be performed as an emergency procedure.

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Section: Discussionmentioning

confidence: 84%

Intrahepatic biliary lesions after orthotopic liver transplantation

Rull¹,

Valdecasas²,

Grande³

et al. 2001

Transplant International

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“…The outcome of liver-rescuing thrombectomy depends on the cause, extent, and duration of the thrombotic course. 3 Our patient underwent surgery early after the onset of clinical manifestations, when the thrombotic process was quite recent and confined to the proximal part of the conduit.…”

Section: Discussionmentioning

confidence: 95%

Small-bowel herniation under the infrarenal arterial conduit in a liver transplant recipient

Smyrniotis

Arkadopoulos

Kostopanagiotou

et al. 2001

Liver Transplantation

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“…Sayage et al 22 reported successful revascularization in 4 of 6 patients, with 33.3% having severe biliary complications. Langnas et al 10 avoided retransplantation in 8 (72.7%) of 11 alive patients with early HAT, but 6 of them (75%) subsequently had biliary complications. In 1996, Pinna and coworkers 9 reported 17 hepatic artery revascularizations with a flow reestablishment rate of 88%, biliary complications in 3 of 11 patients who were alive (27.2%), and a high mortality rate (6 patients).…”

Section: A B C Dmentioning

confidence: 99%

“…Nevertheless, the incidence of late biliary complications is elevated. 2,9,10 The purpose of our study was to evaluate the usefulness of routinely performed DUS in the first 3 days after OLT for diagnosing HAT early, even before clinical indications. We also evaluated the implications of diagnosis in the presymptomatic period in the treatment and prognosis of these patients.…”

mentioning

confidence: 99%

Early detection of hepatic artery thrombosis after liver transplantation by Doppler ultrasonography: prognostic implications.

García–Criado

Gilabert

Nicolau

et al. 2001

J of Ultrasound Medicine

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We assessed the usefulness of routine Doppler ultrasonography for early detection of hepatic artery thrombosis after orthotopic liver transplantation and repercussions in patient prognosis. Seventeen confirmed cases of early hepatic artery thrombosis initially diagnosed by Doppler ultrasonography (10 of them before clinical indication) were reviewed. All patients underwent Doppler ultrasonographic studies in the first 3 days after orthotopic liver transplantation. Twelve cases of hepatic artery thrombosis (70.6%) were detected by this early Doppler ultrasonography. All 10 unsuspected cases of hepatic artery thrombosis and 5 of the 7 cases diagnosed after clinical indication were treated by revascularization. Grafts were salvaged in 80% of asymptomatic patients and in 42.8% of symptomatic patients. Furthermore, biliary complications were less serious in the first group. In conclusion, Doppler ultrasonography performed routinely in the first 3 days after orthotopic liver transplantation may permit early detection of hepatic artery thrombosis, even before clinical indications. This allows hepatic artery repermeabilization before liver function damage, improving graft rescue and patient prognosis.

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Hepatic Allograft Rescue Following Arterial Thrombosis: Role of Urgent Revascularization

Cited by 149 publications

References 0 publications

Intrahepatic biliary lesions after orthotopic liver transplantation

Intrahepatic biliary lesions after orthotopic liver transplantation

Small-bowel herniation under the infrarenal arterial conduit in a liver transplant recipient

Early detection of hepatic artery thrombosis after liver transplantation by Doppler ultrasonography: prognostic implications.

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