Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

Abstract

AIM:To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture. METHODS:Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases. RESULTS:Diffuse intra-and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION: P r o g r e s s i v e , n o n -a n a s t o m o s i s , and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

Intention‐to‐treat analysis of percutaneous endovascular treatment of hepatic artery stenosis after orthotopic liver transplantation

“…As a result, HAS needs to be treated before the development of significant biliary ischemia and graft dysfunction, which could adversely impact the clinical outcome. Percutaneous PTA is the primary therapeutic option for patients with HAS, and it ensures a good HA patency rate of 50%‐90% at 1 year . Though the role of underlying liver disease and the etiology of HAS were not explored in the present study, it is interesting to note that a quarter of the patients had FAP, and all 5 patients who underwent TACE later developed HAS.…”

“…Abbasoglu et al established the need to treat HAS by demonstrating that the patients with HAS were twice as likely to develop biliary complications when compared to those without HAS. Zhao et al reported that PTA significantly improved survival in patients with HAS. Pulitano et al in a recent review suggested that PTA is not warranted in late‐onset HAS and asymptomatic patients.…”

“…Of those 50%, nearly a third die even after re‐LT . The incidence of HAS ranges from 5% to 15%, but the true incidence is difficult to assess because most of the stenosis is discovered at the stage of thrombosis and because of different definitions of HAS being used in different studies . Traditional surgical options of treatment include resection of the stenotic segment with re‐anastomosis, aortic conduit graft, interposition vein or artery graft, or vein patch angioplasty .…”

“…Traditional surgical options of treatment include resection of the stenotic segment with re‐anastomosis, aortic conduit graft, interposition vein or artery graft, or vein patch angioplasty . In the last decade, endovascular treatment by percutaneous transluminal angioplasty ± stenting (PTA) has been developed as the primary treatment of hepatic arterial complications including HAS except in those with very early thrombosis or stenosis (≤7 days from LT) which are treated by surgical revascularization . PTA ensures good arterial patency and improves graft and patient survivals in patients with HAS .…”

Primary stent placement for hepatic artery stenosis after liver transplantation

“…10 Close surveillance is essential to identify HAS postoperatively, because if left untreated, HAS has up to a 65% chance of progressing to HAT #6 months. 11 Zhao et al 12 showed prolonged patient survival of 17 to 30 months in patients who received treatment for HAS compared with patients undergoing expectant management.…”