Post–liver transplant mycotic aneurysm of the hepatic artery

Update on donor-derived infections in liver transplantation

“…In one series, 14% of donors were bacteremic at the time of procurement: S. aureus accounted for 15% of these, and P. aeruginosa accounted for 3.1% . Posttransplant sepsis and mycotic aneurysms have previously been described, but generally as rare occurences . When there is potential transmission of particularly virulent organisms, guidelines recommend that the recipient receive 2 to 4 weeks of active therapy .…”

Diagnosis and management of mycotic aneurysms

“…Presentation Massive upper gastrointestinal bleeding from a ruptured IAA affecting a visceral artery [27,28], severe sepsis in the setting of chronic pancreatitis [29], and intra-abdominal bleeding and shock can all be presentations of visceral IAAs [30][31][32]. More likely clinical scenarios for these problems include patients who are immunosuppressed, undergo organ transplantation, or are otherwise in need of chronic immunosuppression [30,33].…”

“…More likely clinical scenarios for these problems include patients who are immunosuppressed, undergo organ transplantation, or are otherwise in need of chronic immunosuppression [30,33].…”

“…Open [27], hybrid [30], and endovascular [28] methods for repair of visceral IAAs have been described, tailored to each scenario. They all share the general advantages and disadvantages of open (invasive) and endovascular (minimally invasive) methods in the different anatomic regions.…”

“…A patient with massive upper gastrointestinal bleeding from a ruptured superior mesenteric artery (SMA) aneurysm-duodenal fi stula 1 month after cardiac surgery was found to have a ruptured SMA trunk and a duodenal perforation, requiring an emergent interposition vein graft SMA repair and a duodenojejunal Roux-en-Y anastomosis [27]. Jones et al [30] identifi ed two children affl icted by IAAs among patients who underwent liver transplantation over a 21-year period. The fi rst was a boy who underwent liver transplantation owing to biliary atresia; he died from a ruptured hepatic artery IAA at the anastomotic site before he could be offered repair surgery.…”