Hepatic artery thrombosis following living donor liver transplantation: A 14‐year experience at a single center

Abstract

BackgroundHepatic artery thrombosis (HAT) following liver transplantation is a serious complication that may lead to graft loss and ultimately death. Retransplantation and surgical recanalization for HAT have traditionally been the predominant methods of treatment. However, with the development of endovascular therapies, including percutaneous transluminal angioplasty, thrombolysis, and stent insertion, these methods are now mainly used because they allow prompt management.MethodsFrom January 2005 to December 2018, 756 patients underwent liver transplantation at our institution, and 14 of those patients developed early HAT. All patients underwent endovascular arteriography immediately after the diagnosis of thrombosis. We retrospectively reviewed the 14 patients with HAT.ResultsHepatic artery thrombosis following liver transplantation occurred in 14 patients (1.9%) within 1 month after transplantation. The final success rate of radiological intervention was 71.4% (n = 10). Of the four patients in whom intravenous procedures failed, two ultimately underwent retransplantation and one patient underwent surgical revision of the hepatic artery. Bleeding and rebound thrombosis after the intervention occurred in three patients (21.4%) and four patients (28.6%), respectively.ConclusionEndovascular procedures can be safe and provide prompt recovery in early HAT patients following liver transplantation to prevent graft loss and patient mortality despite the presence of hemorrhage and rebound thrombosis. Immediate endovascular procedure after the end of the transplantation is also necessary in intraoperatively developed HAT instead of several trials of arterial anastomoses to revascularization.

Management of early hepatic artery thrombosis following living‐donor liver transplantation: feasibility, efficacy and potential risks of endovascular therapy in the first 48 hours post‐transplant–a retrospective cohort study

“…The authors suggested that endovascular therapy could be an alternative therapeutic option for HA occlusion in the first 24 hrs post-transplant. Our findings also agree with Park et al [26] who reported successful endovascular therapy in 10/13 cases of e-HAT in the first 48hrs post-LDLT, where bleeding occurred in 2/13 cases, prompting endovascular embolization in one patient & laparotomy in the other. Finally, it is worth pointing out that in our LDLT experience, with time, we gradually implemented some additional technical precautions, aiming to minimize the potential risks of endovascular therapy as much as possible.…”

“…Currently, in most LDLT centres around the world, surgical revascularization is the preferred therapeutic approach for dealing with e-HAT in the very early posttransplant period 'the first 48 hrs post-transplant'; but over the past decade, a few reports have described the use of endovascular procedures for treatment of e-HAT at this early stage [4,5,12,15,[23][24][25][26]. For instance, a recent LDLT report by Choi et al [23] has shown that surgical revascularization was the most commonly employed initial treatment modality in the 7 patients who developed e-HAT in the first postoperative week [4 cases (57.1%)/POD1; n = 4/technical success rate: 100%], whereas endovascular therapy was carried out in the remaining 3 cases (42.9%) [POD1; n = 2/technical success rate: 66.7%], two of whom developed graft failure & underwent re-transplantation.…”

“…Another LDLT study by Lee et al [24] has described successful endovascular therapy in 8/10 cases of HA occlusion within 24 hrs post-transplant [IAT (n = 5); stent placement (n = 2); both (n = 3)]. Furthermore, in a recent retrospective review of 756 LDLT procedures by Park et al [26], all the 14 patients who developed e-HAT (1.9%) underwent immediate endovascular therapy, with final success, bleeding and re-thrombosis rates of 71.4% (10/14 cases), 21.4% (3/14 cases) & 28.6% (4/14 cases), respectively. Of note, e-HAT occurred in the first 48 hrs post-transplant in 13 of those patients; and endovascular therapy was successful in 4 out of the 5 cases in whom stent placement was carried out.…”

“…However, over the past decade, a few reports have described the use of endovascular procedures for treatment of e-HAT in the first 48 hrs post-LDLT, but till now, the use of such procedures at this early stage remains controversial, mainly because of the risk of potentially lethal complications (e.g. bleeding, anastomotic disruption) [4,5,12,15,[23][24][25][26]. Now, the question is Is endovascular management of e-HAT feasible, safe and effective in the very early post-LDLT period?…”

Liver Transplantation for Propionic Acidemia: Evidence From a Systematic Review and Meta-analysis

“…Nevertheless, subgroup analysis stratified by type of LT showed that the pooled estimate prevalence of HAT after LDLT in patients with PA at 13% was higher than that reported in other studies. 40,41 However, given the small number of PA patients having received LDLT (n = 18), it is still difficult to conclude that PA patients are more likely to develop HAT posttransplant, but this finding suggests that transplant clinicians should be alert to the potentially high risk of developing HAT in PA patients receiving LDLT. Taken together, LT for treating PA showed an adequate safety profile.…”