Risk Factors for Hepatic Artery Thrombosis After Microsurgical Vascular Reconstruction in Liver Transplantation

Miyagi, Shigehito; Kawagishi, Naoki; Nakanishi, Waka; Fujio, Atsushi; Miyazawa, Kohtaro; Maida, Kai; Kashiwadate, Toshiaki; Hara, Yasuyuki; Sekiguchi, Satoshi; Ohuchi, Noriaki; Satoh, Susumu

doi:10.1016/j.transproceed.2012.12.030

Cited by 19 publications

(13 citation statements)

References 7 publications

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“…Nafamostat is also useful as an anticoagulant during continuous venous hemodialysis and it attenuates postreperfusion syndrome during liver transplantation . Likewise, gabexate appears to be pharmacologically useful in pancreatitis, liver transplantation, and hemodialysis anticoagulation . Both drugs are also potentially beneficial in the treatment of DIC …”

Section: Plasmin Inhibitors As Antifibrinolyticsmentioning

confidence: 99%

Recent Advances on Plasmin Inhibitors for the Treatment of Fibrinolysis‐Related Disorders

Al‐Horani

Desai

2014

Medicinal Research Reviews

101

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Growing evidence suggests that plasmin is involved in a number of physiological processes in addition to its key role in fibrin cleavage. Plasmin inhibition is critical in preventing adverse consequences arising from plasmin overactivity, e.g., blood loss that may follow cardiac surgery. Aprotinin was widely used as an antifibrinolytic drug before its discontinuation in 2008. Tranexamic acid and ε-aminocaproic acid, two small molecule plasmin inhibitors, are currently used in the clinic. Several molecules have been designed utilizing covalent, but reversible, chemistry relying on reactive cyclohexanones, nitrile warheads, and reactive aldehyde peptidomimetics. Other major classes of plasmin inhibitors include the cyclic peptidomimetics and polypeptides of the Kunitz and Kazal-type. Allosteric inhibitors of plasmin have also been designed including small molecule lysine analogs that bind to plasmin's kringle domain(s) and sulfated glycosaminoglycan mimetics that bind to plasmin's catalytic domain. Plasmin inhibitors have also been explored for resolving other disease states including cell metastasis, cell proliferation, angiogenesis, and embryo implantation. This review highlights functional and structural aspects of plasmin inhibitors with the goal of advancing their design.

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Section: Plasmin Inhibitors As Antifibrinolyticsmentioning

confidence: 99%

Recent Advances on Plasmin Inhibitors for the Treatment of Fibrinolysis‐Related Disorders

Al‐Horani

Desai

2014

Medicinal Research Reviews

101

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“…15 Previous studies have demonstrated that the risk of HAT is increased in patients who weigh < 10 kg, are aged < 3 years, are female, have a graft with multiple arteries, and have a hepatic artery with a diameter < 2 mm. 16,17 Although 29% patients in this study had < 10 kg body weight, HAT was observed only in 12.2%.…”

Section: Discussionmentioning

confidence: 66%

Untitled

2015

Exp Clin Transplant

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Objectives: Liver transplant is an established curative therapy for children with chronic end-stage liver disease or acute liver failure. In this study, we aimed to evaluate pediatric liver transplant in terms of outcomes, complications, and long-term followup results. Materials and Methods: Pediatric patients who had liver transplant in our institution were included. We retrospectively evaluated demographic features including body weight, Child-Pugh score, etiology of liver disease, graft source, perioperative outcomes, perioperative complications, postoperative complications, and long-term results. Outcomes of treatment of complications and revision transplant were evaluated. Results: Between September 2001 and December 2013, there were 188 pediatric liver transplants performed in our institution. Most grafts (90.9%) were obtained from living-related donors. There were 13 patients (6.9%) who had an intervention because of a hemorrhage postoperatively. Biliary leakage was observed in 33 patients (17.5%) and biliary stricture during follow-up was observed in 32 patients (17%). Thrombosis rates in the hepatic artery and portal vein were 12.3% and 0.5%. Revision transplant was performed in 11 patients (5.8%); reason for revision transplant was rejection in 50% patients. The remaining children were alive with good graft functioning after treatment of complications and revision transplant. The overall 5-and 10-year survival rates were 82.3% and 78.9%. Conclusions:The overall outcomes of pediatric liver transplant at our center are very promising. With improved care of younger children and the combined efforts of the parents and medical team, the number of the children receiving transplants will increase in the future.

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“…However, after the third week, we performed only nonroutine ultrasonography a few times a week, because it has been reported that HAT often occurred 6 to 10 days after surgery [4,7]. We also think that monitoring for HAT is not so important from the third week forward.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, hepatic artery thrombosis (HAT) can be a lethal complication. To avoid these difficulties, we used the back-wall support suture technique with double needle sutures, which reportedly has a protective effect on the intima [3,4]. However, in LDLT, there may be cases in which it is difficult to reconstruct the arteries, such as with dissection of the recipient common hepatic artery or median arcuate ligament syndrome (MALS), even using this technique.…”

Section: Introductionmentioning

confidence: 99%

The Reconstruction of Hepatic Arteries Using Extra-Anatomical Free Autografts in Living Donor Liver Transplantation

Miyagi¹,

Shimizu²

2016

J Transplant Technol Res

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Objectives: In living-donor liver transplantation (LDLT), microsurgical reconstruction of a hepatic artery is essential but requires challenging techniques, because graft arteries are short and usable vessel grafts are limited. Furthermore, hepatic artery thrombosis can be a lethal complication. Extra-anatomical jump graft reconstruction using free grafts is reported to have a high reocclusion rate. However, this technique is necessary when there is no other option. We report 4 cases of LDLT that required extra-anatomical reconstruction technique using free autografting from the aorta to the hepatic artery. In this technique, we used the systemic administration of gabexate mesilate that is the strong serine protease inhibitor. Methods:From 1991 to 2015, we performed 164 LDLTs. We retrospectively investigated 4 cases of extraanatomical reconstruction of the hepatic artery using free autografting from the aorta to the hepatic artery.Results: Two cases initially underwent anatomical reconstruction, but the arteries occluded early, because of the dissection of recipient's artery. There was no arterial graft, so we performed extra-anatomical reconstruction by using free autografting from the aorta to the hepatic artery. In the other two cases, the recipient arteries could not be used. Therefore, we initially performed extra-anatomical reconstruction by using radial artery free autografting as jump grafts from the aorta to the hepatic artery. In all cases, we used the systemic administration of gabexate mesilate, and could rescue all cases. Conclusion:We experienced and were able to salvage 4 cases that required free autografts. When there is no other means of reconstructing arteries, it is necessary to perform this procedure, depending on the condition of the intima of the recipient artery.

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Risk Factors for Hepatic Artery Thrombosis After Microsurgical Vascular Reconstruction in Liver Transplantation

Cited by 19 publications

References 7 publications

Recent Advances on Plasmin Inhibitors for the Treatment of Fibrinolysis‐Related Disorders

Recent Advances on Plasmin Inhibitors for the Treatment of Fibrinolysis‐Related Disorders

Untitled

The Reconstruction of Hepatic Arteries Using Extra-Anatomical Free Autografts in Living Donor Liver Transplantation

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