Hepatic artery thrombosis after liver transplantation: radiologic evaluation

Abstract

Hepatic artery thrombosis after liver transplantation is a devastating event requiring emergency retransplantation in most patients. Early clinical signs are often nonspecific. Before duplex sonography (combined real-time and pulsed Doppler) capability was acquired in October 1984, 76% of all transplants in this institution referred for angiography with a clinical suspicion of hepatic artery thrombosis had patent arteries. In an effort to reduce the number of negative angiograms, CT, real-time sonography, and pulsed Doppler have been evaluated as screening examinations to determine which patients need angiography. Of 14 patients with focal inhomogeneity of the liver architecture detected by CT and/or real-time sonography, 12 (86%) had hepatic artery thrombosis, one had slow arterial flow with hepatic necrosis, and one had a biloma with a patent hepatic artery. In 29 patients undergoing duplex sonography of the hepatic artery, six (21%) had absence of a Doppler arterial pulse. All six had abnormal angiograms: Four had thrombosis, one had a significant stenosis, and one had slow flow with biopsy-proven ischemia. Of 23 patients with a Doppler pulse, two had hepatic artery thrombosis at surgery. However, realtime sonography demonstrated focal inhomogeneity in the liver in both cases. Our data demonstrate that pulsed Doppler of the hepatic artery combined with real-time sonography of the liver parenchyma currently is the optimal screening test for selecting patients who require hepatic angiography after liver transplantation. A diagnostic algorithm is provided.Hepatic artery thrombosis after liver transplantation is a devastating event that requires immediate therapeutic intervention in most patients. The typical course is hepatic infarction followed by septic hepatic gangrene and septicemia. Emergency hepatic retransplantation is these patients' only hope for survival [1].In 1969, Starzl [2] described two cases of fatal hepatic artery thrombosis that were not initially recognized on the basis of clinical findings or laboratory studies. He concluded, "It is likely that aortography will prove to be the only really decisive way of consistently establishing the diagnosis while there is still time to attempt repair, providing the procedure is done at the first suspicion of a vascular accident." Since then, angiography has been the definitive procedure for evaluation of the hepatic artery after liver transplantation. availability of duplex sonography (combined real-time and pulsed Doppler), 33 angiographic studies (18 children and 15 adults) were performed at the University Health Center of Pittsburgh for the clinical suspicion of hepatic artery thrombosis after liver transplantation. Of these, 11 (61 %) of 18 children and 14 (93%) of 15 adults had patent hepatic arteries. It is clear that clinical criteria alone led us to perform an undesirably large number of normal arteriograms.We now use three noninvasive imaging techniques to evaluate the liver after transplantation: computed tomography (CT), real-time sonography, and...

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

“…After liver transplantation, these collaterals (mainly derived from the phrenic arteries) are initially absent, but have been demonstrated angiographically as early as two weeks after liver transplantation (1). Collaterals probably prevent a disastrous outcome in case of late HAT (1,(10)(11)(12). (5).…”

Complications of Orthotopic Liver Transplantation: Spectrum of Findings with Helical CT

“…Hepatic artery thrombosis, the most common vascular complication of OLT, has a prevalence of 4%-12% in adult recipients and up to 40% in children (1)(2)(3)(4)7,(15)(16)(17) and a mortality rate of 50%-58% (18,19). Unless thrombectomy can be performed, most cases require retransplantation; even after retransplantation, the mortality rate is 27%-30% (18,20).…”

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“…41 Collaterals may prevent a disastrous outcome in patients with late HAT. [42][43][44] Our experience in treating hepatic artery thrombosis In this study, we selected 4 patients who presented with HAT after orthoptic liver transplant. In patients 1, 2, and 3, endovascular options were sought due to lack of availability of a donor for retransplant.…”