Incidence and outcome of arterial complications after orthotopic liver transplantation

Abstract

Arterial complications can be a major factor in morbidity and mortality after orthotopic liver transplantation (OLT), as they may cause graft failure, sepsis and complications of the biliary tract. From September 1988 to December 1994, 571 OLT were performed in 529 patients. The follow-up period ranged from 8 to 83 months. Actuarial 1-, 3- and 5-year survival figures were 91%, 87% and 85%, respectively. In 12 cases (2.1%) complications of the arterial anastomoses were observed. Early arterial complications occurred in eight cases from various causes, while late arterial complications were exclusively thromboses and developed in four patients 8, 12, 26 and 37 months after surgery, respectively. The main clinical course in patients with arterial thromboses was septic cholangitis with destruction of the biliary tree. Although 70% of the grafts with arterial thrombosis were lost, 30% could, at least temporarily, be salvaged by other treatment options. Provided adequate treatment is carried out, arterial complications do not affect overall patient survival.

A complication of infrarenal arterial conduit following orthotopic liver transplant

“…Donor iliac artery conduit is preferentially brought via an antepancreatic route, rather than retropancreatically, as patency rates and perioperative morbidity are superior [3]. Thrombosis is due to technical error at anastomosis or to flow disturbance [1,2]. In this case the flow disturbance was due to kinking of the infrarenal conduit secondary to herniation of small intestine behind the conduit (following reduction of the bowel and thrombectomy the conduit remained patent).…”

“…Hepatic artery thrombosis is one of the most serious complications of liver transplantation. It may result in sepsis, biliary leak or stricture, and it remains an important cause of graft loss [1]. When the recipient hepatic artery is not available or is unusable, infrarenal aortic revascularisation using donor iliac artery is an effective method of reconstruction with results that are comparable with donor‐to‐recipient common hepatic artery anastomosis [2].…”