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

Abstract

This retrospective cohort study aims to review our 18-year experience with early hepatic artery thrombosis (e-HAT) following living-donor liver transplantation (LDLT), as well as to assess the feasibility, efficacy and potential risks of endovascular management of e-HAT in the first 48 hours (hrs) post-LDLT. Medical records of 730 patients who underwent LDLT were retrospectively reviewed. In all cases who had developed e-HAT, treatment modalities employed and their outcomes were evaluated. Thirty-one patients developed e-HAT(4.2%). Definite technical success and 1-year survival rates of surgical revascularization[11/31 cases(35.5%)] were 72.7% & 72.7%, whereas those of endovascular therapy[27/31 cases(87.1%)] were 70.4% & 59.3%, respectively. Endovascular therapy was carried out in the first 48hrs post-transplant in 9/31 cases(29%)[definite technical success:88.9%, 1-year survival:55.6%]. Four procedure-related complications were reported in 3 of those 9 cases(33.3%). In conclusion, post-LDLT e-HAT can be treated by surgical revascularization or endovascular therapy, with comparable results. Endovascular management of e-HAT in the first 48hrs post-LDLT appears to be feasible and effective, but is associated with a relatively higher risk of procedure-related complications, compared to surgical revascularization. Hence, it can be reserved as a second-line therapeutic option in certain situations where surgical revascularization is considered futile, potentially too complex, or potentially more risky.

Redo hepatic artery reconstruction for thrombosis without retransplantation in 1355 adult living donor liver transplantations

“…[21] Moreover, these procedures carry an increased risk of complications such as arterial spasms, hemorrhage, dissection, and anastomotic rupture. [22] Restoration of flow by thrombolysis using urokinase or streptokinase, followed by angioplasty and stent insertion to correct anatomical defects, is performed in most of the studies discussing endovascular treatment for HAT. [14,18,23] However, the liver transplant team in our center prefers mechanical thrombectomy as interventional management to thrombolysis performed with a catheter placed for 12-24 hours.…”

Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching

“…The survival of patients in liver transplantation depends upon the early identification of HAT and in case of life-threatening ischemia and necrosis of the liver, prompt management and repeat OLT is required [ 95 , 96 , 97 ]. According to Dala Riva et al, the presence of hepatic arterial variations increases the risk of thrombosis seven-folds, and the combination of arterial variations with the reconstruction of arterial anastomosis increases the risk of thrombosis by eighteen folds [ 80 ].…”

Neutrophil extracellular traps and complications of liver transplantation

“…Hepatic artery thrombosis is the most common vascular complication, that may lead to non-functional liver graft and acute liver failure, following liver transplantation ( 111 , 112 ). A significant proportion of this is seen in patients with recurrent biliary tract infection or asymptomatic biliary leakage with liver dysfunction ( 113 ).…”