Interventional radiology in the management of the liver transplant patient

Thornburg, Bartley; Katariya, Nitin; Riaz, Ahsun; Desai, Kush; Hickey, Ryan; Lewandowski, Robert J.; Salem, Riad

doi:10.1002/lt.24828

Cited by 16 publications

(19 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These differences may be due to immunosuppression, poorer healing, and/or greater fragility of the biliary system in transplanted livers, whose vascular supply is dependent solely on hepatic arterial supply. 14,15 It is hard to fully attribute whether the increased rate of complications after PTBD placement is due to the drain itself versus related to the liver transplant. However, complications such as bleeding, bile leaks, and sepsis postprocedure are more likely to be associated with the drain placement due to the timing of the complications.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Biliary Drain Complications in Transplanted versus Native Liver: A Comparative Retrospective Study

Stumbras

Quencer

Kaufman

2021

The Arab Journal of Interventional Radiology

View full text Add to dashboard Cite

Purpose The aim of this study was to assess the rate of complications of percutaneous transhepatic biliary drain in transplanted versus native livers. Materials and Methods A retrospective chart review was performed of all percutaneous transhepatic biliary drains completed at our institution from 2009 to 2018. Chart review of complications and interventions was recorded. Chi-squared and Fisher’s exact tests were used to compare percutaneous transhepatic biliary drains performed in patients with liver transplants (n = 62) to those with native livers (n = 285). Results There was a statistically significant difference in the frequency of complications of percutaneous transhepatic biliary drains in patients with liver transplants (61%) compared with those with native livers (13%), χ2(1) = 9.59, p<0.01. There was a statistically significant increased frequency of worsening liver function, sepsis, bile leak, arterial and portal venous bleeds, and secondary complications in those with liver transplants. The median number of days until the complication occurred for those with liver transplants was nearly three times longer than those with native livers. The most common subsequent intervention for patients with liver transplants was placement of a new drain (53%), whereas those with native livers was drain upsize (70%). Conclusion Complications including vascular injury, sepsis, bile leak, and worsening liver function after percutaneous transhepatic biliary drains occurred more commonly in patients with liver transplants versus native livers.

show abstract

Section: Discussionmentioning

confidence: 99%

Percutaneous Biliary Drain Complications in Transplanted versus Native Liver: A Comparative Retrospective Study

Stumbras

Quencer

Kaufman

2021

The Arab Journal of Interventional Radiology

View full text Add to dashboard Cite

show abstract

“…They include inflow complications related to portal vein or hepatic artery, outflow complications related to hepatic vein or inferior vena cava, biliary leaks or strictures, postoperative collections or abscesses, graft rejection, or posttransplant malignancy. [2,3] Interventional radiology has an important role toward the management of each of these, and on most occasions, it can circumvent a major surgery or even retransplantation. [2,3] Hepatic artery complications have been reported in 4%-25% of patients [4][5][6] with life-threatening HAT noted in 3%-9% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…[2,3] Interventional radiology has an important role toward the management of each of these, and on most occasions, it can circumvent a major surgery or even retransplantation. [2,3] Hepatic artery complications have been reported in 4%-25% of patients [4][5][6] with life-threatening HAT noted in 3%-9% of patients. [7,8] The risk factors for HAT include surgical technique, ischemic reperfusion injury, small donor artery, hepatic artery stenosis, and rejection.…”

Section: Discussionmentioning

confidence: 99%

Extrinsic Compression of Transplant Hepatic Artery by a Hemostatic Agent: “Surgiceloma”

Tariq

Landis

Kotru

et al. 2019

The Arab Journal of Interventional Radiology

View full text Add to dashboard Cite

A 38-year-old man who underwent liver transplantation was found to have absent vascular flow in the common hepatic artery (CHA) on Doppler ultrasound and angiogram 1 day after surgery. Surgical reexploration revealed a mass of expanded Surgicel compressing the CHA. Surgicel is an absorbable hemostatic agent used to control intraoperative bleeding. Blood flow was restored once the mass was removed, and the patient recovered uneventfully. Interventional radiologists need to recognize this finding of extrinsic vascular compression on hepatic angiogram to avoid unnecessary interventions. Furthermore, increased awareness of the clinical and imaging findings associated with compression of an artery by a "Surgiceloma" may increase the consideration of this phenomenon as a differential in the setting of postoperative impaired perfusion.

show abstract

“…Portal vein stenosis occurs in approximately 3% of liver transplantations but occurs in approximately 3.4% to 14% of split liver transplantations; early detection and treatment are essential for long-term graft survival [34,35]. Recently, some studies [36][37][38] highlighted the key role of interventional radiology in treating the stenosis safely and successfully with balloon angioplasty with stenting. In addition, patients could actively learn self-management and healthy exercise after liver transplantation.…”

Section: Principal Findingsmentioning

confidence: 99%

Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study

Tian¹,

Wang²,

Xue³

et al. 2021

JMIR Med Inform

View full text Add to dashboard Cite

Background Technical capabilities for performing liver transplantation have developed rapidly; however, the lack of available livers has prompted the utilization of edge donor grafts, including those donated after circulatory death, older donors, and hepatic steatosis, thereby rendering it difficult to define optimal clinical outcomes. Objective We aimed to investigate the efficacy of telemedicine for follow-up management after liver transplantation. Methods To determine the efficacy of telemedicine for follow-up after liver transplantation, we performed a clinical observation cohort study to evaluate the rate of recovery, readmission rate within 30 days after discharge, mortality, and morbidity. Patients (n=110) who underwent liver transplantation (with livers from organ donation after citizen's death) were randomly assigned to receive either telemedicine-based follow-up management for 2 weeks in addition to the usual care or usual care follow-up only. Patients in the telemedicine group were given a robot free-of-charge for 2 weeks of follow-up. Using the robot, patients interacted daily, for approximately 20 minutes, with transplant specialists who assessed respiratory rate, electrocardiogram, blood pressure, oxygen saturation, and blood glucose level; asked patients about immunosuppressant medication use, diet, sleep, gastrointestinal function, exercise, and T-tube drainage; and recommended rehabilitation exercises. Results No differences were detected between patients in the telemedicine group (n=52) and those in the usual care group (n=50) regarding age (P=.17), the model for end-stage liver disease score (MELD, P=.14), operation time (P=.51), blood loss (P=.07), and transfusion volume (P=.13). The length and expenses of the initial hospitalization (P=.03 and P=.049) were lower in the telemedicine group than they were in the usual care follow-up group. The number of patients with MELD score ≥30 before liver transplantation was greater in the usual care follow-up group than that in the telemedicine group. Furthermore, the readmission rate within 30 days after discharge was markedly lower in the telemedicine group than in the usual care follow-up group (P=.02). The postoperative survival rates at 12 months in the telemedicine group and the usual care follow-up group were 94.2% and 90.0% (P=.65), respectively. Warning signs of complications were detected early and treated in time in the telemedicine group. Furthermore, no significant difference was detected in the long-term visit cumulative survival rate between the two groups (P=.50). Conclusions Rapid recovery and markedly lower readmission rates within 30 days after discharge were evident for telemedicine follow-up management of patients post–liver transplantation, which might be due to high-efficiency in perioperative and follow-up management. Moreover, telemedicine follow-up management promotes the self-management and medication adherence, which improves patients’ health-related quality of life and facilitates achieving optimal clinical outcomes in post–liver transplantation.

show abstract

Interventional radiology in the management of the liver transplant patient

Cited by 16 publications

References 98 publications

Percutaneous Biliary Drain Complications in Transplanted versus Native Liver: A Comparative Retrospective Study

Percutaneous Biliary Drain Complications in Transplanted versus Native Liver: A Comparative Retrospective Study

Extrinsic Compression of Transplant Hepatic Artery by a Hemostatic Agent: “Surgiceloma”

Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study

Contact Info

Product

Resources

About