Venous complications after orthotopic liver transplantation

Settmacher, Utz; Nüssler, Natascha C.; Glanemann, Matthias; Haase, Roland; Heise, Michael; Bechstein, Wolf O.; Neuhaus, P.

doi:10.1034/j.1399-0012.2000.140309.x

Cited by 186 publications

(146 citation statements)

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“…2 (a) During the examination with SonoVue, the absence of enhancement within the lumen of the hepatic artery was suggestive of thrombosis, which was subsequently confirmed on angiography (b). variceal hemorrhage, and splenomegaly) [16]. If the thrombosis develops gradually, it may lead to the formation of a cavernoma.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Bonini

Pezzotta

Morzenti

et al. 2007

Journal of Ultrasound

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KEYWORDSSplit liver; Pediatric liver transplantation; Complications; Contrast-enhanced sonography.Abstract Purpose: To evaluate the utility of contrast-enhanced sonography in the study of pediatric liver transplant recipients and its potential impact in reducing the need for invasive diagnostic procedures. Materials and methods: From October 2002 to December 2003 we performed routine color Doppler ultrasound and contrast-enhanced ultrasound studies on 30 pediatric patients who had undergone liver transplantation. Findings indicative of complications were confirmed with invasive studies (angiography, computed tomography, and PTC). Results: Contrast-enhanced sonography correctly identified four of the five cases of hepatic artery thrombosis and all those involving the portal (n Z 6) and hepatic vein (n Z 3) thrombosis. It failed to identify one case of hepatic artery thrombosis characterized by collateral circulation arising from the phrenic artery and the single case of hepatic artery stenosis. The latter was more evident on color Doppler, which revealed a typical tardus parvus waveform. The use of contrast offered no significant advantages in the study of biliary complications although it did provide better visualization of bile leaks. Conclusions: Contrast-enhanced sonography improves diagnostic confidence and reduces the need for more invasive imaging studies in the postoperative follow-up of pediatric liver transplant recipients.Sommario Scopo: Valutare l'utilità dell'ecografia con mezzo di contrasto (Mdc) ecografico di II generazione nel paziente pediatrico trapiantato di fegato, in particolare al fine di ridurre il ricorso a metodiche diagnostiche invasive. ha fornito dati falsamente negativi in un caso di trombosi dell'arteria epatica, ricanalizzata da rami provenienti dall'arteria frenica, e nell'unico caso di stenosi anastomotica dell'arteria epatica della nostra casistica, nel quale è stato indicativo il pattern ''tardus parvus'' osservato all'esame eco-Doppler. Nel caso delle complicanze biliari l'esame eco-contrastografico non ha apportato significativi vantaggi, se non una migliore definizione dei margini e dell'estensione delle raccolte biliari post-intervento. Conclusioni: L'esame ecografico con Mdc è metodica in grado di incrementare la confidenza diagnostica dell'operatore, consentendo una riduzione al ricorso ad esami radiologici invasivi; ciò è particolarmente importante nel caso di pazienti a rischio, quali i bambini sottoposti a trapianto epatico. ª 2007 Published by Elsevier Masson.

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Bonini

Pezzotta

Morzenti

et al. 2007

Journal of Ultrasound

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“…The overall frequency of both complications is reported to be less than 3%. 1,2 When PVS or PVT develop early after LT, the occlusion of the portal vein can have catastrophic consequences to the graft including acute liver failure and graft loss. Late PVT/PVS are asymptomatic in 50% of the cases 2 and mainly diagnosed by a routine ultrasound.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 When PVS or PVT develop early after LT, the occlusion of the portal vein can have catastrophic consequences to the graft including acute liver failure and graft loss. Late PVT/PVS are asymptomatic in 50% of the cases 2 and mainly diagnosed by a routine ultrasound. Symptomatic postshunt hepatic encephalopathy (HE) is a very infrequent condition after LT that has been scarcely reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic encephalopathy in a liver transplant recipient with stable liver function

et al. 2013

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SummaryPostshunt hepatic encephalopathy after liver transplantation (LT) is an infrequent condition and is commonly associated with portal occlusion or stenosis and the presence of a patent portosystemic shunt. Portal vein stenosis (PVS) or thrombosis (PVT) are uncommon complications after LT. The overall frequency of both complications is reported to be less than 3%. 1,2 When PVS or PVT develop early after LT, the occlusion of the portal vein can have catastrophic consequences to the graft including acute liver failure and graft loss. Late PVT/PVS are asymptomatic in 50% of the cases 2 and mainly diagnosed by a routine ultrasound. Symptomatic postshunt hepatic encephalopathy (HE) is a very infrequent condition after LT that has been scarcely reported in the literature. 3,4 We present here the case of a liver recipient with normal graft function who presented with hepatic encephalopathy 3 months after LT with stable liver function but a severe portal stenosis and the presence of a spontaneous portosystemic shunt whose successful endovascular treatment was followed by the complete resolution of the HE. Case ReportA 58-year-old man with cryptogenic cirrhosis (Child-Pugh score A, MELD 9) was listed for LT in June 2010 due to an early stage 2.5 cm hepatocellular carcinoma. He also had experienced a few episodes of grade 2 episodic HE which were properly treated with lactulose. He underwent an LT with a deceased-donor liver graft on January 2011. The patient had an uneventful postsurgical evolution and was discharged on a cyclosporine-based immunosuppression protocol. Four weeks after LT a severe stenosis of the biliary anastomosis was diagnosed and successfully treated employing an endoscopic approach.Two months later, the patient was admitted because of evident bradypsychia, confusion, and flapping tremor. Serum ammonia levels were raised (80 lmol/ L, normal range 16-60). Liver function tests were in the normal range with preserved synthetic and excretory function and renal function was normal. Also, common precipitating factors of HE (infection, constipation, gastrointestinal bleeding, not-prescribed medications, etc.) were excluded. At admission his 2-hour postdose cyclosporine blood level (C2) was 601 ng/mL, which ruled out calcineurin inhibitor-related neurotoxicty. A brain magnetic resonance imaging (MRI) only showed high signal intensity in the globus pallidum on T1-weighted images with no other abnormalities. An abdominal MRI showed a normal liver graft but a severe stenosis of the portal anastomosis and a patent splenorenal shunt (Fig. 1), which was confirmed by angiography ( Fig. 2A). Persistent isolated small type 1 gastric varices (diagnosed before LT) were visualized with an upper digestive endoscopy. Employing a balloon, an endovascular dilation of the stenosis was successfully performed. Simultaneously, the splenorenal shunt was successfully occluded with a plug Amplatzer II and metallic coils (Fig. 2B). Twenty-four hours after the procedure, neurological examination was completely normal with no flap...

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“…The reduction of the portal vein flow severely compromises allograft and patient survival. 4,5 In patients who have not undergone OLT, acute portal or mesenteric vein thrombosis is usually managed with anticoagulation alone, and this leads to recanalization in more than 90% of patients. 6 Alternatively, thrombolysis or thrombectomy is performed, but this has not been widely reported and is not the standard of care.…”

Section: To the Editorsmentioning

confidence: 99%

Thrombolysis of portal vein thrombosis after splenectomy following liver transplantation

et al. 2013

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TO THE EDITORSSplenectomy is indicated after orthotopic liver transplantation (OLT) for various reasons, including leftsided portal hypertension, trauma, and hemorrhage prevention in patients with splenic artery aneurysms. Complications of splenectomy may include infections, bleeding, and portal vein thrombosis (PVT). The incidence of symptomatic postsplenectomy PVT ranges from 0.7% to 2%, 1,2 whereas the incidence of asymptomatic PVT can reach 7% to 10%. 3 There is, however, limited literature pertaining to postsplenectomy PVT in recipients of OLT. The sequelae of PVT are particularly serious in OLT recipients. The reduction of the portal vein flow severely compromises allograft and patient survival. 4,5 In patients who have not undergone OLT, acute portal or mesenteric vein thrombosis is usually managed with anticoagulation alone, and this leads to recanalization in more than 90% of patients. 6 Alternatively, thrombolysis or thrombectomy is performed, but this has not been widely reported and is not the standard of care. 7 There are few studies addressing the management of postsplenectomy PVT in OLT recipients.Here we describe a case of acute postsplenectomy PVT in an OLT recipient who was successfully treated with both mechanical thrombolysis and directed and systemic anticoagulation.The patient was a 54-year-old male who suffered from end-stage liver disease secondary to complications from hepatitis C and alcohol abuse. He underwent OLT on March 5, 2007. The piggyback technique was used with a biliary duct-to-duct anastomosis. The operation and the postoperative course both went well without complications.Approximately 2 years later, he presented with increasing left upper quadrant pain. A computed tomography (CT) scan revealed an enlarged spleen with a calcified cyst that measured 17 cm. Therapeutic options were discussed with the patient, and splenectomy was planned. He received subcutaneous heparin perioperatively as deep venous thrombosis prophylaxis. The operation lasted 2 hours and was performed through an extension of the left subcostal incision from the initial OLT. An Endo GIA stapler was used to divide the hilum. Pathology revealed a 960-g spleen measuring 18.2 cm 3 14.3 cm 3 10.2 cm with capsular fibrosis indicating perisplenitis.Postoperative laboratory tests revealed a 5-fold rise in transaminase levels. An ultrasound examination of the liver was performed and revealed an absence of flow in the portal vein. Dual-phase CT of the liver showed complete thrombosis of the splenic and portal veins with extension into both right and left portal vein branches. The superior mesenteric vein was spared. An intravenous infusion of heparin was initiated. Complete thrombosis of the intrahepatic portal vein branches precluded percutaneous transhepatic cannulation of the portal system. The patient was taken immediately to the operating room in an attempt to salvage the hepatic allograft. A peripheral mesenteric venous branch was located and cannulated with a 5-Fr Fogarty catheter. An initial portogram confirmed...

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Venous complications after orthotopic liver transplantation

Cited by 186 publications

References 12 publications

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Hepatic encephalopathy in a liver transplant recipient with stable liver function

Thrombolysis of portal vein thrombosis after splenectomy following liver transplantation

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