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Wang N, Zhu Z, Zheng H, Qi C, Yuan X, Li X, Xu Z, Qin J, Wu W, Wang J, Lu D, Liu W, Liu L, Zhang S, Nashan B. Diagnosis and Treatment of Hepatic Hematoma After Liver Transplantation in a Timely Manner. Transplant Proc 2024; 56:1390-1395. [PMID: 39004579 DOI: 10.1016/j.transproceed.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Hematomas of the liver graft, that is, postintervention, subcapsular or intrahepatic are rare yet potentially fatal complications following liver transplantation (LT), necessitating immediate diagnosis and management to avert devastating outcomes. This study was aimed to introduce our approach to manage graft hematoma subsequent to LT. METHODS Among 131 orthotopic liver transplantations (OLT) conducted at our institution between January 2017 and May 2023, 3 cases of intrahepatic (n = 2) and extrahepatic (n = 1) hematoma were confirmed through computed tomography (CT) within 10 days after LT. The clinical outcomes of various treatment modalities for these three cases were analyzed. RESULTS Three out of 131 (2.3%) LT recipients developed graft hematoma. Patient 1 developed a spontaneous intrahepatic hematoma, without evident predisposing factors, while patient 2 developed an intrahepatic hematoma following endoscopic retrograde cholangiopancreatography (ERCP). The third case that is extrahepatic hematoma was speculated to be a result of minor hepatic parenchymal injury stemming from compressive and volume-reducing manipulation of a large graft, or secondary to focal ischemic necrosis of the liver. Our management protocol was summarized as follows: (1). Immediate ultrasound and CT, particularly enhanced CT; (2). Puncture and percutaneous drainage (PD) of the hematoma; (3). Arterial embolization if the origin could be identified as a ruptured vessel; (4). Surgical evacuation of the hematoma in the presence of bile leakage, to avoid a compartment respectably secondary infection. All three patients responded favorably to treatment and remained alive to date. CONCLUSION Prompt diagnosis and sequential individualized management can successfully deal with intra-/extrahepatic graft hematoma after LT. Our results underscored that an individualized management considering potential future complications into account.
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Affiliation(s)
- Ning Wang
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Zebin Zhu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Hao Zheng
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Can Qi
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaodong Yuan
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Xuefeng Li
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Zhijun Xu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Jiwei Qin
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Wu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Jizhou Wang
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Weiyong Liu
- Department of Ultrasonography, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Lianxin Liu
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Shugeng Zhang
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China.
| | - Björn Nashan
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China.
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Francica G, Meloni MF, Riccardi L, Giangregorio F, Caturelli E, Terracciano F, de Sio I. Role of Contrast-Enhanced Ultrasound in the Detection of Complications After Ultrasound-Guided Liver Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1665-1673. [PMID: 33085814 DOI: 10.1002/jum.15540] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
The role of contrast-enhanced ultrasound (CEUS) in interventional ultrasound-guided procedures in the liver has been increasingly recognized. However, little is known about the capability of CEUS for diagnosing complications after liver biopsy and ablation with special regard to postprocedural hemorrhage. The aim of this Pictorial Essay is to present the CEUS features of a wide spectrum of vascular complications (with or without bleeding) and injuries of the surrounding abdominal and chest wall occurring after liver interventional procedures.
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Affiliation(s)
- Giampiero Francica
- Unità di Ecografia Interventistica, Pineta Grande Hospital, Castel Volturno, Italy
| | - Maria Franca Meloni
- Servizio di Radiologia, Casa di Cura Igea, Milan, Italy
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Laura Riccardi
- Medicina e Interna e Gastroenterologia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | | | | | - Fulvia Terracciano
- Gastroenterologia, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
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Subcapsular hematoma resulting in hepatic ischemia as a complication of necrotizing pancreatitis. Radiol Case Rep 2020; 15:316-320. [PMID: 31988681 PMCID: PMC6971341 DOI: 10.1016/j.radcr.2019.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/25/2019] [Accepted: 12/28/2019] [Indexed: 11/29/2022] Open
Abstract
This report presents a case of necrotizing pancreatitis resulting in a large hepatic subcapsular hematoma that led to development of hepatic ischemia and early stages of liver failure. Following surgical decompression, liver function dramatically improved, but large areas of peripheral hepatic infarction had developed. This case demonstrates the risks of a rapidly expanding hepatic subcapsular hematoma, emphasizes the importance of recognizing and aggressively treating active bleeding, and cautions against administering anticoagulation and tissue-plasminogen activator in this clinical scenario.
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Ohm JY, Ko GY, Sung KB, Gwon DI, Ko HK. Safety and efficacy of transhepatic and transsplenic access for endovascular management of portal vein complications after liver transplantation. Liver Transpl 2017; 23:1133-1142. [PMID: 28152572 DOI: 10.1002/lt.24737] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/07/2016] [Accepted: 01/16/2017] [Indexed: 01/10/2023]
Abstract
The purpose of this article is to evaluate and compare the safety and efficacy of endovascular management of the portal vein (PV) via percutaneous transsplenic access versus percutaneous transhepatic access in liver transplantation (LT) recipients. A total of 18 patients who underwent endovascular management of PV via percutaneous transhepatic (n = 8) and transsplenic (n = 10) access were enrolled. Transsplenic access was chosen if the spleen was located in a normal position, the splenic vein (SpV) was preserved, and the target lesion did not involve confluence of the superior mesenteric and SpVs. Accessibility of the percutaneous transsplenic puncture was confirmed via ultrasound (US) in the angiography suite. All procedures were performed under local anesthesia. Percutaneous transhepatic or transsplenic access was performed using a 21-gauge Chiba needle under US and fluoroscopic guidance, followed by balloon angioplasty, stent placement, or variceal embolization. The access tract was embolized using coils and a mixture (1:2) of glue and ethiodized oil. Transhepatic or transsplenic access was successfully achieved in all patients. A total of 12 patients underwent stent placement; 3 had balloon angioplasty only; 2 had variceal embolization only; and 1 had variceal embolization followed by successful stent placement. Regarding major complications, 1 patient experienced a SpV tear with extravasation during transsplenic balloon angioplasty, which was successfully managed using temporary balloon inflation, followed by transfusion. Clinical success was achieved in 9 of 11 (82%) patients who exhibited clinical manifestations. The remaining 7 patients who underwent prophylactic endovascular management were healthy. In conclusion, endovascular management of PV via percutaneous transsplenic access is a relatively safe and effective alternative that does not damage the liver grafts of LT recipients. Liver Transplantation 23 1133-1142 2017 AASLD.
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Affiliation(s)
- Joon-Young Ohm
- Department of Radiology, Chungnam National University Hospital, Daejeon, South Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Heung Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Johnson M, Kent MS, Khwaja K, Faintuch S. Hepatic capsular avulsion after video-assisted thoracic biopsy of the lung. Ann Thorac Surg 2015; 99:1069-71. [PMID: 25742834 DOI: 10.1016/j.athoracsur.2014.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/23/2014] [Accepted: 05/05/2014] [Indexed: 11/26/2022]
Abstract
We report a life-threatening subcapsular hepatic hemorrhage after VATS, successfully treated with Gelfoam embolization of the right hepatic artery. The postprocedure course was complicated by infarction of the right hepatic lobe.
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Affiliation(s)
- Michael Johnson
- Division of Interventional Radiology, Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, Massachusetts
| | - Michael S Kent
- Division of Thoracic Surgery, Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, Massachusetts
| | - Khalid Khwaja
- Division of Transplant Surgery, Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, Massachusetts
| | - Salomao Faintuch
- Division of Interventional Radiology, Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, Massachusetts.
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Uncommon causes of hepatic congestion in patients after living donor liver transplantation. AJR Am J Roentgenol 2009; 193:772-80. [PMID: 19696292 DOI: 10.2214/ajr.08.1782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to illustrate the radiologic findings of various uncommon conditions that cause hepatic congestion in patients after living donor liver transplantation. CONCLUSION Radiologic findings of hepatic congestion may vary according to the cause and the level of outflow obstruction. It is important for radiologists to be aware of such variations in order to make an early diagnosis of hepatic congestion and to enable timely proper management in recipients after living donor liver transplantation.
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Görög D, Fehérvári I, Doros A, Nemes B, Máthé Z, Kóbori L, Járay J. [Subcapsular hematoma and rupture of the liver graft]. Magy Seb 2008; 61:230-233. [PMID: 18799407 DOI: 10.1556/maseb.61.2008.4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Subcapsular hematoma and/or rupture of the graft is uncommon but serious complication of liver transplantation. It may develop spontaneously or following parenchymal injuries or percutaneous transhepatic invasive procedures. This report describes three cases of subcapsular hematoma and/or rupture of the graft with different courses among 350 liver transplantations. In the first case, the patient died due to graft rupture caused by a pseudoaneurysm after biopsy. In the second case, a small injury of the donor liver resulted in a deep rupture, which required partial resection of the graft. The patient died in sepsis later. The third patient presented with a large subcapsular haematoma during transplantation, which was successfully treated. The authors' strategies developed intraoperatively for the management of hematomas. These involve opening and removing of the haematoma, haemostasis with Argon coagulation, which resulted in an adherent Glisson's capsule to the parenchyma and covering with collagen fleece coated with fibrinogen and thrombin.
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Affiliation(s)
- Dénes Görög
- Semmelweis Egyetem, Altalános Orvostudományi Kar Transzplantációs és Sebészeti Klinika 1082 Budapest Baross u. 23.
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Hong SS, Kim AY. Early postoperative bleeding after living donor liver transplantation. ACTA ACUST UNITED AC 2008; 34:365-70. [PMID: 18483806 DOI: 10.1007/s00261-008-9414-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We discuss the clinical impacts of early postoperative bleedings after LDLT and CT findings or CT angiographic findings compared with angiography according to the various bleeding causes. Sudden development of hematoma as well as extravasation of contrast material on CT scan are thought to be predictive CT findings of early postoperative bleeding in post-hepatic transplant patients. Careful consideration for these findings can prevent the progression into a catastrophic status that requires surgical management.
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Affiliation(s)
- Seong Sook Hong
- Department of Radiology, Soonchunhyang University Hospital, Hannamdong, Yongsangu, Seoul, Korea.
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