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Pu Y, Luo Y. Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection: A case report. World J Gastrointest Surg 2024; 16:1430-1435. [PMID: 38817294 PMCID: PMC11135292 DOI: 10.4240/wjgs.v16.i5.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Spontaneous visceral artery dissection (SVAD) is a rare condition that affects the visceral arteries, such as the celiac, superior mesenteric, and inferior mesenteric arteries, without involving the aorta. Organ ischemia or hemorrhage from vessel rupture can occur in SVAD; therefore, prompt detection and management is essential. Contrast-enhanced computed tomography (CECT) has been used to diagnose most of the previous cases, but few studies have explored the potential of contrast-enhanced ultrasound (CEUS) for early detection of this disease. CASE SUMMARY A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months. He had previously undergone transabdominal splenectomy, esophagogastric devascularization, and cholecystectomy for gallstones and severe portal hypertension. Liver ultrasound was performed in our department to assess liver status. An abnormal hepatic artery spectrum was observed, and dissection involving both the celiac artery and the common hepatic artery was observed. A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen, and dissection was subsequently confirmed by CECT. The patient was asymptomatic; therefore, treatment to control the blood pressure was provided, and follow-up was recommended. After 6 months of follow-up, the celiac artery was found to be dilated with an adherent thrombus visible in the wall, and the common hepatic artery was occluded with the presence of collateralization. Despite these findings, no significant changes in liver function were observed. CONCLUSION Multi-modal imaging is effective in diagnosing SVAD, and conservative treatment is a choice for asymptomatic patients.
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Affiliation(s)
- Yang Pu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Luo
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, Kim J, Sinn DH, Joo DJ, Choi Y, Lee JH, Choi HJ, Yoon KT, Yim SY, Park CS, Kim DG, Lee HW, Choi WM, Chon YE, Kang WH, Rhu J, Lee JG, Cho Y, Sung PS, Lee HA, Kim JH, Bae SH, Yang JM, Suh KS, Al Mahtab M, Tan SS, Abbas Z, Shresta A, Alam S, Arora A, Kumar A, Rathi P, Bhavani R, Panackel C, Lee KC, Li J, Yu ML, George J, Tanwandee T, Hsieh SY, Yong CC, Rela M, Lin HC, Omata M, Sarin SK. Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int 2024; 18:299-383. [PMID: 38416312 DOI: 10.1007/s12072-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines.
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Affiliation(s)
- Dong-Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Republic of Korea
| | - Sun Young Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheon-Soo Park
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deok-Gie Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Won-Mook Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Eun Chon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Woo-Hyoung Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Ilsan, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Soek Siam Tan
- Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Zaigham Abbas
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ananta Shresta
- Department of Hepatology, Alka Hospital, Lalitpur, Nepal
| | - Shahinul Alam
- Crescent Gastroliver and General Hospital, Dhaka, Bangladesh
| | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Pravin Rathi
- TN Medical College and BYL Nair Hospital, Mumbai, India
| | - Ruveena Bhavani
- University of Malaya Medical Centre, Petaling Jaya, Selangor, Malaysia
| | | | - Kuei Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jun Li
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming-Lung Yu
- Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | - H C Lin
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Bunkyo City, Japan
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Karataş C, Alim A, Tirnova I, Demir B, Akbulut A, Kanmaz T. Hepatic Artery Intimal Dissection During Living Donor Liver Transplantation: A New Modified Approach. Transplant Proc 2023; 55:379-383. [PMID: 36948956 DOI: 10.1016/j.transproceed.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/09/2023] [Accepted: 02/02/2023] [Indexed: 03/24/2023]
Abstract
Ensuring optimal arterial flow in solid organ transplantation is very important. Insufficient flow causes important problems such as bile duct problems, intrahepatic abscess formation, and organ loss. Arterial intimal dissection is an important factor that negatively affects organ blood flow. In this study, hepatic artery dissections that we detected in patients who underwent living donor liver transplantation in our clinic were defined, and the microvascular intima-adventitial fixation technique, which can be considered a new approach, was described.
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Affiliation(s)
- Cihan Karataş
- Department of Liver Transplantation, Koc University Hospital, Istanbul, Turkey.
| | - Altan Alim
- Department of Liver Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Ismail Tirnova
- Department of Liver Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Barış Demir
- Department of Liver Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Akın Akbulut
- Department of Liver Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Turan Kanmaz
- Department of Liver Transplantation, Koc University Hospital, Istanbul, Turkey
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Lin TS, Lin CH, Kuo PJ, Yang JCS, Chiang YC, Li WF, Wang SH, Lin CC, Liu YW, Yong CC, Chen CL, Cheng YF, Wang CC. Management of difficult hepatic artery reconstructions to reduce complications through continual technical refinements in living donor liver transplantations. Int J Surg 2022; 104:106776. [PMID: 35872182 DOI: 10.1016/j.ijsu.2022.106776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hepatic artery reconstruction (HAR) for liver transplantation is crucial for successful outcomes. We evaluated transplantation outcome improvement through continual technical refinements. MATERIALS AND METHODS HAR was performed in 1448 living donor liver transplants by a single plastic surgeon from 2008 to 2020. Difficult HARs were defined as graft or recipient hepatic artery ≤2 mm, size discrepancy (≥2 to 1), multiple hepatic arteries, suboptimal quality, intimal dissection of graft or recipient hepatic artery (HA), and immediate redo during transplantation. Technique refinements include early vessel injury recognition, precise HA dissection, the use of clips to ligate branches, an oblique cut for all HARs, a modified funneling method for size discrepancy, liberal use of an alternative artery to replace a pathologic HA, and reconstruction of a second HA for grafts with dual hepatic arteries in the graft. RESULTS Difficult HARs were small HA (21.35%), size discrepancy (12.57%), multiple hepatic arteries (11.28%), suboptimal quality (31.1%), intimal dissection (20.5%), and immediate redo (5.18%). The overall hepatic artery thrombosis (HAT) rate was 3.04% in this series. The average HAT rate during the last 4 years (2017-2020) was 1.46% (6/408), which was significantly lower than the average HAT rate from 2008 to 2016 (39/1040, 3.8%) with a statistical significance (p = 0.025). Treatment for posttransplant HAT included anastomosis after trim back (9), reconstruction using alternatives (19), and nonsurgical treatment with urokinase (9). CONCLUSION Careful examination of the HA under surgical microscope and selection of the appropriate recipient HA are key to successful reconstruction. Through continual technical refinements, we can reduce HA complications to the lowest degree.
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Affiliation(s)
- Tsan-Shiun Lin
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cen-Hung Lin
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Jen Kuo
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Johnson Chia-Shen Yang
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Cheng Chiang
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Feng Li
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ho Wang
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Wei Liu
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chee-Chien Yong
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Liver Transplantation Center and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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5
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Sneiders D, Boteon APCS, Lerut J, Iesari S, Gilbo N, Blasi F, Larghi Laureiro Z, Orlacchio A, Tisone G, Lai Q, Pirenne J, Polak WG, Perera MTPR, Manzia TM, Hartog H. Transarterial chemoembolization of hepatocellular carcinoma before liver transplantation and risk of post-transplant vascular complications: a multicentre observational cohort and propensity score-matched analysis. Br J Surg 2021; 108:1323-1331. [PMID: 34611694 DOI: 10.1093/bjs/znab268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) in patients with hepatocellular cancer (HCC) on the waiting list for liver transplantation may be associated with an increased risk for hepatic artery complications. The present study aims to assess the risk for, primarily, intraoperative technical hepatic artery problems and, secondarily, postoperative hepatic artery complications encountered in patients who received TACE before liver transplantation. METHODS Available data from HCC liver transplantation recipients across six European centres from January 2007 to December 2018 were analysed in a 1 : 1 propensity score-matched cohort (TACE versus no TACE). Incidences of intraoperative hepatic artery interventions and postoperative hepatic artery complications were compared. RESULTS Data on postoperative hepatic artery complications were available in all 876 patients (425 patients with TACE and 451 patients without TACE). Fifty-eight (6.6 per cent) patients experienced postoperative hepatic artery complications. In total 253 patients who had undergone TACE could be matched to controls. In the matched cohort TACE was not associated with a composite of hepatic artery complications (OR 1.73, 95 per cent c.i. 0.82 to 3.63, P = 0.149). Data on intraoperative hepatic artery interventions were available in 825 patients (422 patients with TACE and 403 without TACE). Intraoperative hepatic artery interventions were necessary in 69 (8.4 per cent) patients. In the matched cohort TACE was not associated with an increased incidence of intraoperative hepatic artery interventions (OR 0.94, 95 per cent c.i. 0.49 to 1.83, P = 0.870). CONCLUSION In otherwise matched patients with HCC intended for liver transplantation, TACE treatment before transplantation was not associated with higher risk of technical vascular issues or hepatic artery complications.
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Affiliation(s)
- D Sneiders
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A P C S Boteon
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - J Lerut
- Institute for Experimental and Clinical Research (IREC), Université catholique de Louvain UCL, Brussels, Belgium
| | - S Iesari
- Institute for Experimental and Clinical Research (IREC), Université catholique de Louvain UCL, Brussels, Belgium.,Kidney Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - N Gilbo
- Laboratory of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Surgery Science, Diagnostic and Interventional Unit, University Hospital Tor Vergata, Rome, Italy
| | - F Blasi
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Z Larghi Laureiro
- Department of Surgery Science, Transplantation and HPB Unit, University Hospital Tor Vergata, Rome, Italy
| | - A Orlacchio
- General Surgery and Organ Transplant Unit, Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Umberto I Policlinic of Rome, Rome, Italy
| | - G Tisone
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Q Lai
- Department of Surgery Science, Transplantation and HPB Unit, University Hospital Tor Vergata, Rome, Italy
| | - J Pirenne
- Department of Surgery Science, Diagnostic and Interventional Unit, University Hospital Tor Vergata, Rome, Italy
| | - W G Polak
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M T P R Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - T M Manzia
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - H Hartog
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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6
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Hepatic Artery Reconstruction in Living Donor Liver Transplantation With the Radial Artery Interpositional Graft. Transplant Proc 2021; 53:1659-1664. [PMID: 33641934 DOI: 10.1016/j.transproceed.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/26/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Reconstitution of hepatic artery inflow is essential for a successful liver transplantation. Living donor transplantation presents additional challenges in the form of a short and small donor vessel stump, exacerbating the poor surgical access for microsurgery. Few reports have described the use of the radial artery as an interposition graft in liver transplantation; we present a series of 6 cases and discuss the technical merits of this procedure. METHODS Retrospective review of consecutive patients undergoing living donor liver transplantation from December 2015 to December 2019 was performed. Demographics, operative details, and postoperative outcomes were reviewed. RESULTS Twenty-two patients underwent living donor liver transplantation. Radial artery interposition grafting was used in 6 cases, including 1 salvage case for hepatic artery thrombosis. One patient developed hepatic artery stenosis (2 weeks postoperatively) that was conservatively managed. After radial artery grafting, all patients had normal resistive indices on duplex ultrasonography at up to 20 months postoperatively. The mean follow-up was 15.2 months. CONCLUSION When faced with a significantly short vessel stump or caliber mismatch, radial artery interpositional grafting is a safe and useful technique for reducing tension and overcoming vessel size mismatch in hepatic artery reconstruction.
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Shimata K, Sugawara Y, Irie T, Sambommatsu Y, Kadohisa M, Ibuki S, Kawabata S, Isono K, Honda M, Yamamoto H, Hibi T. Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports. BMC Gastroenterol 2020; 20:378. [PMID: 33183260 PMCID: PMC7664099 DOI: 10.1186/s12876-020-01528-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background Hepatic artery dissection after liver transplantation is an uncommon morbidity. The onset mechanism and management for this disorder remain unclear. The present report describes the cases of two patients with hepatic artery dissection after living-donor liver transplantation (LDLT) with simultaneous splenectomy and provides new insight into the onset mechanism of this disorder. Case presentation: Case 1 A 51-year-old man with liver cirrhosis caused by hepatitis B virus underwent LDLT with a right lobe graft and splenectomy simultaneously. The recipient’s right hepatic artery had partial dissection at the anastomosis site; therefore, his left hepatic artery was anastomosed. Contrast-enhanced computed tomography (CT) on postoperative day (POD) 27 showed dissection from his celiac artery to his left hepatic artery with bleeding in the false lumen. There was a risk of rupture of the false lumen; therefore, emergency interventional radiology and coil embolization of the false lumen were performed. The patient was doing well at 6 months after LDLT. Case 2 A 58-year-old woman with liver cirrhosis caused by primary biliary cholangitis underwent LDLT with a left lobe graft and splenectomy simultaneously. Her hepatic artery had a dissection that extended from her left hepatic artery to the proper hepatic artery. The gastroduodenal artery was anastomosed. Contrast-enhanced CT on POD 8 revealed dissection from the celiac artery to the common hepatic artery as well as a pseudoaneurysm at the celiac artery. We managed the patient with conservative treatment and performed daily follow-ups with Doppler ultrasonography examination and serial contrast-enhanced CT. At the time of writing this report, the patient was doing well at 34 months after LDLT. Conclusions Patients who have an intimal dissection at the anastomosis site and/or simultaneous splenectomy are at a higher risk of hepatic artery dissection. Most patients with asymptomatic hepatic artery dissections can be treated conservatively. Blood flow in the intrahepatic artery should be checked frequently using Doppler ultrasonography or contrast-enhanced CT soon after diagnosis.
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Affiliation(s)
- Keita Shimata
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Yasuhiko Sugawara
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tomoaki Irie
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuzuru Sambommatsu
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masashi Kadohisa
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Sho Ibuki
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Seiichi Kawabata
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kaori Isono
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hidekazu Yamamoto
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Taizo Hibi
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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8
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Agarwal S, Dey R, Pandey Y, Verma S, Gupta S. Managing Recipient Hepatic Artery Intimal Dissection During Living Donor Liver Transplantation. Liver Transpl 2020; 26:1422-1429. [PMID: 32737947 DOI: 10.1002/lt.25857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
Recipient hepatic artery intimal dissection (HAD) followed by hepatic artery thrombosis (HAT) is a serious complication of liver transplantation. Once this is recognized intraoperatively, the accepted approach is to use an alternative arterial inflow, which may not be possible in all patients. We describe a new classification and technique for the management of HAD during living donor liver transplantation. On the basis of the longitudinal extent of intimal dissection, HAD was classified into 4 types. Management was based on the type of dissection, availability of an adequate length of hepatic artery (HA), and an alternate source of inflow. The dissected HA itself was used for arterial anastomosis in patients with preserved pulsatile flow in the dissected artery and a lack of an alternative source of arterial inflow. The technique of using the dissected artery was based on close approximation of the tunica intima to the media with the first 2 sutures of the arterial anastomosis. Of 47 (2.4%) patients who developed HAD, 22 (46.8%) had a type 2 dissection for whom the other (right or the left) undissected HA was used for the anastomosis, and 20 (42.6%) had major (type 3 or 4) dissection. The dissected artery was used for the anastomosis in 9 (45%) of these patients. Postoperative HAT developed in only 1 of 9 patients. Pre-existing portal vein thrombosis and prior transarterial embolization were found to be major risk factors for the development of HAD. Using the technique described, the dissected artery can be successfully used for a satisfactory HA anastomosis with low thrombosis rates.
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Affiliation(s)
- Shaleen Agarwal
- Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
| | - Rajesh Dey
- Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
| | - Yuktansh Pandey
- Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
| | - Sapana Verma
- Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
| | - Subash Gupta
- Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
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9
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Wallace D, Cowling TE, Walker K, Suddle A, Gimson A, Rowe I, Callaghan C, Sapisochin G, Mehta N, Heaton N, van der Meulen J. Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma. Br J Surg 2020; 107:1183-1191. [DOI: 10.1002/bjs.11559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/05/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Abstract
Abstract
Background
Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study.
Methods
Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics.
Results
In total, 385 of 968 patients (39·8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235).
Conclusion
TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.
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Affiliation(s)
- D Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - T E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - K Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Suddle
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - A Gimson
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - I Rowe
- Liver Unit, St James's Hospital and University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - C Callaghan
- Department of Nephrology and Transplantation, Renal Unit, Guy's Hospital, London, UK
| | - G Sapisochin
- Multi-Organ Transplant, Toronto General Surgery, Toronto, Ontario, Canada
- Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - N Mehta
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California, USA
| | - N Heaton
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - J van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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10
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Iesari S, Inostroza Núñez ME, Rico Juri JM, Ciccarelli O, Bonaccorsi-Riani E, Coubeau L, Laterre PF, Goffette P, De Reyck C, Lengelé B, Gianello P, Lerut J. Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain. Hepatobiliary Pancreat Dis Int 2019; 18:132-142. [PMID: 30850341 DOI: 10.1016/j.hbpd.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 02/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Liver transplantation is the treatment for end-stage liver diseases and well-selected malignancies. The allograft shortage may be alleviated with living donation. The initial UCLouvain experience of adult living-donor liver transplantation (LDLT) is presented. METHODS A retrospective analysis of 64 adult-to-adult LDLTs performed at our institution between 1998 and 2016 was conducted. The median age of 29 (45.3%) females and 35 (54.7%) males was 50.2 years (interquartile range, IQR 32.9-57.5). Twenty-two (34.4%) recipients had no portal hypertension. Three (4.7%) patients had a benign and 33 (51.6%) a malignant tumor [19 (29.7%) hepatocellular cancer, 11 (17.2%) secondary cancer and one (1.6%) each hemangioendothelioma, hepatoblastoma and embryonal liver sarcoma]. Median donor and recipient follow-ups were 93 months (IQR 41-159) and 39 months (22-91), respectively. RESULTS Right and left hemi-livers were implanted in 39 (60.9%) and 25 (39.1%) cases, respectively. Median weights of right- and left-liver were 810 g (IQR 730-940) and 454 g (IQR 394-534), respectively. Graft-to-recipient weight ratios (GRWRs) were 1.17% (right, IQR 0.98%-1.4%) and 0.77% (left, 0.59%-0.95%). One- and five-year patient survivals were 85% and 71% (right) vs. 84% and 58% (left), respectively. One- and five-year graft survivals were 74% and 61% (right) vs. 76% and 53% (left), respectively. The patient and graft survival of right and left grafts and of very small (<0.6%), small (0.6%-0.79%) and large (≥0.8%) GRWR were similar. Survival of very small grafts was 86% and 86% at 3- and 12-month. No donor died while five (7.8%) developed a Clavien-Dindo complication IIIa, IIIb or IV. Recipient morbidity consisted mainly of biliary and vascular complications; three (4.7%) recipients developed a small-for-size syndrome according to the Kyushu criteria. CONCLUSIONS Adult-to-adult LDLT is a demanding procedure that widens therapeutic possibilities of many hepatobiliary diseases. The donor procedure can be done safely with low morbidity. The recipient operation carries a major morbidity indicating an important learning curve. Shifting the risk from the donor to the recipient, by moving from the larger right-liver to the smaller left-liver grafts, should be further explored as this policy makes donor hepatectomy safer and may stimulate the development of transplant oncology.
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Affiliation(s)
- Samuele Iesari
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Olga Ciccarelli
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
| | - Eliano Bonaccorsi-Riani
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
| | - Laurent Coubeau
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
| | - Pierre-François Laterre
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Goffette
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Chantal De Reyck
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
| | - Benoît Lengelé
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Gianello
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Jan Lerut
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium.
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11
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Reese T, Raptis DA, Oberkofler CE, de Rougemont O, Györi GP, Gosteli-Peter M, Dutkowski P, Clavien PA, Petrowsky H. A systematic review and meta-analysis of rescue revascularization with arterial conduits in liver transplantation. Am J Transplant 2019; 19:551-563. [PMID: 29996000 DOI: 10.1111/ajt.15018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/08/2018] [Accepted: 07/03/2018] [Indexed: 02/06/2023]
Abstract
Although aortohepatic conduits (AHCs) provide an effective technique for arterialization in liver transplantation (LT) when the native recipient artery is unusable, various publications report higher occlusion rates and impaired outcome compared to conventional anastomoses. This systematic review and meta-analysis investigates the published evidence of outcome and risk of AHCs in LT using bibliographic databases and following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Primary and secondary outcome were artery occlusion as well as graft and patient survival. Twenty-three retrospective studies were identified with a total of 22 113 patients with LT, of whom 1900 patients (9%) received an AHC. An AHC was used in 33% of retransplantations. Early artery occlusion occurred in 7% (3%-16%) of patients with AHCs, compared to 2% (1%-3%) without conduit (OR 3.70; 1.63-8.38; P = .001). The retransplantation rate after occlusion was not significantly different in both groups (OR 1.46; 0.67-3.18; P = .35). Graft (HR 1.38; 1.17-1.63; P < .001) and patient (HR 1.57; 1.12-2.20; P = .009) survival was significantly lower in the AHC compared to the nonconduit group. In contrast, graft survival in retransplantations was comparable (HR 1.00; 0.82-1.22; P = .986). Although AHCs provide an important rescue option, when regular revascularization is not feasible during LT, transplant surgeons should be alert of the potential risk of inferior outcome.
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Affiliation(s)
- Tim Reese
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri A Raptis
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.,Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK
| | - Christian E Oberkofler
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Olivier de Rougemont
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Georg P Györi
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.,Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Philipp Dutkowski
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Henrik Petrowsky
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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12
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Lin TS, Vishnu Prasad NR, Chen CL, Yang JCS, Chiang YC, Kuo PJ, Wang CC, Wang SH, Liu YW, Yong CC, Cheng YF. What happened in 133 consecutive hepatic artery reconstruction in liver transplantation in 1 year? Hepatobiliary Surg Nutr 2019; 8:10-18. [PMID: 30881961 DOI: 10.21037/hbsn.2018.11.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The immediate challenges during microvascular reconstruction of hepatic artery (HAR) during liver transplantation (LT) can be many. Hence, in order to give a cross sectional view of these problems this study over a period of 1 year, showing our routine practice, was taken up. Methods From January 2015 to December 2015, a total of 133 LTs were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. All hepatic artery (HA) reconstructions were performed by a microvascular surgeon under an operating microscope. Results In the 133 patients, one artery was anastomosed in 123 (92.5%) patients, two in 9 (6.8%) patients and three in 1 (0.7%) of the patient. Eleven (8.3%) arteries were less than 2 mm in size (1-1.9 mm). There were intimal dissections (IDs) involving either the donor or the recipient arteries of mild to severe nature in 9 (6.8%) patients. Immediately following graft arterial anastomosis, either there was no flow or an intraoperative hepatic artery thrombosis (HAT) was found in nine (7.1%-8 LDLT, 4.8%-1 DDLT) patients. Immediate re-do anastomosis was done in all of these patients who did well in the follow-up. The overall post-operative success rate was 99.2%. One patient (0.8%) developed postoperative HAT due to infection during follow up and died due to sepsis. Conclusions Small vessels or HA injury are the frequently encountered problems by a micro vascular surgeon. The other problems could be ID, need to do multiple reconstructions, immediate HAT and ability to re-do the HAR immediately.
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Affiliation(s)
- Tsan-Shiun Lin
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nelamangala Ramakrishnaiah Vishnu Prasad
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Johnson Chia-Shen Yang
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Cheng Chiang
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Jen Kuo
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ho Wang
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Wei Liu
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chee-Chien Yong
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Liver Transplantation Program and Departments of Surgery, and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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13
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Ozer A, Aktas H, Eren N, Karakayalı H, Emiroglu R. Hepatic Arterial Reconstruction Using Right Gastroepiploic Artery in Living Donor Liver Transplantation. Transplant Proc 2018; 50:3559-3561. [DOI: 10.1016/j.transproceed.2018.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
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14
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Systematic Review and Meta-Analysis of Posttransplant Hepatic Artery and Biliary Complications in Patients Treated With Transarterial Chemoembolization Before Liver Transplantation. Transplantation 2018; 102:88-96. [PMID: 28885493 DOI: 10.1097/tp.0000000000001936] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hepatic artery complications are feared complications after liver transplantation and may compromise the biliary tract, graft, and patient survival. The objective of this systematic review and meta-analysis was to compare risk of hepatic artery and biliary complications after liver transplantation in patients who underwent neoadjuvant transarterial chemoembolization (TACE) versus no TACE. METHODS Comprehensive searches were performed in Embase, MEDLINE OvidSP, Web of Science, Google Scholar, and Cochrane databases to identify studies concerning hepatocellular cancer patients undergoing preliver transplantation TACE. Quality assessment of studies was done by the validated checklist of Downs and Black. Meta-analyses were performed to evaluate the incidence of all hepatic artery complications, hepatic artery thrombosis, and biliary tract complications, using binary random-effect models. RESULTS Fourteen retrospective studies, representing 1122 TACE patients, met the inclusion criteria. Postoperative hepatic artery complications consisted of hepatic artery thrombosis, stenosis, and (pseudo)-aneurysms. Preliver transplantation TACE was significantly associated with occurrence of posttransplant hepatic artery complications (odds ratio, 1.57; 95% confidence interval, 1.09-2.26; P = 0.02). No significant association between neoadjuvant TACE and hepatic artery thrombosis alone or biliary tract complications was found. CONCLUSIONS Patients treated with TACE before liver transplantation may be at increased risk for development of hepatic artery complications after liver transplantation.
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15
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Oberkofler CE, Reese T, Raptis DA, Kuemmerli C, de Rougemont O, De Oliveira ML, Schlegel A, Dutkowski P, Clavien PA, Petrowsky H. Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease? Liver Transpl 2018; 24:790-802. [PMID: 29493895 DOI: 10.1002/lt.25044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/14/2018] [Accepted: 02/05/2018] [Indexed: 12/11/2022]
Abstract
Although the type of hepatic artery revascularization technique is known to have an impact on patency rates, independent perioperative risk factors on patient outcomes are poorly defined. All consecutive adult patients undergoing cadaveric liver transplantation (n = 361) from July 2007 to June 2016 in a single institution were analyzed. Primary outcomes were early (<30 days) hepatic artery occlusion and primary hepatic artery patency rate. A multivariate model was used to identify independent risk factors for occlusion and the need of arterial conduit, as well as their impact on graft and patient survival. Arterial revascularization without additional reconstruction (end-to-end arterial anastomosis [AA]) was performed in 77% (n = 279), arterial reconstruction (AR) in 15% (n = 53), and aortohepatic conduit (AHC) in 8% (n = 29) of patients. AHC had the highest mean intraoperative flow (275 mL/minute; P = 0.02) compared with AA (250 mL/minute) and AR (200 mL/minute; P = 0.02). There were 43 recipients (12%) who had an occlusive event with successful revascularization in 20 (47%) recipients. One-year primary patency rates of AA, AR, and AHC were 97%, 88%, and 74%, respectively. Aortic calcification had an impact on early occlusion. AR (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.26-10.75; P = 0.02) and AHC (OR, 6.21; 95% CI, 2.02-18.87; P = 0.001) were independent risk factors for early occlusion. Dyslipidemia additionally independently contributed to early occlusion (OR, 2.74; 95% CI, 0.96-7.87; P = 0.06). The 1- and 5-year graft survival rates were 83% and 70% for AA, 75% and 69% for AR, and 59% and 50% for AHC (P = 0.004), respectively. In conclusion, arterial patency is primarily determined by the type of vascular reconstruction rather than patient or disease characteristics. The preoperative lipid status is an independent risk factor for early occlusion, whereas overall occlusion is only based on the performed vascular reconstruction, which is also associated with reduced graft and patient survival. Liver Transplantation 24 790-802 2018 AASLD.
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Affiliation(s)
- Christian E Oberkofler
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Tim Reese
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri A Raptis
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Kuemmerli
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Olivier de Rougemont
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Michelle L De Oliveira
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Schlegel
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Philipp Dutkowski
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Henrik Petrowsky
- Swiss HPB and Transplant Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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16
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Onizuka H, Sueyoshi E, Ishimaru H, Sakamoto I, Uetani M. Arterial injury during transcatheter arterial chemoembolization for hepatocellular carcinoma: predictors of risk and outcome. Abdom Radiol (NY) 2017; 42:2544-2550. [PMID: 28493072 DOI: 10.1007/s00261-017-1168-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate clinical features and results of follow-up in patients with arterial injury during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma. METHODS From 2005 to 2015, 2219 TACE procedures were performed in 906 patients in our hospital. Iatrogenic arterial injury occurred during 38 TACE procedures (sessions) in 35 patients (24 men, 11 women; mean age 71.8 years). The incidence of arterial injury was 1.7%. We evaluated the characteristics of arterial injury, and evaluated the risk factors for incomplete recanalization of the injured artery at follow-up angiography conducted after 1-11 months (mean 102.5 days). RESULTS Iatrogenic arterial injury was caused by the microcatheter in 34 of 38 cases (86.8%). There were 15 cases (39.5%) in which the replaced hepatic artery or the extrahepatic artery was the parasitic supply. Extravasation occurred in five cases. In 36 of 38 cases, follow-up angiography was performed. We divided 36 cases into two groups: complete reopening (n = 24) and non-complete reopening (n = 12). The two groups were compared regarding the factors associated with incomplete recanalization of the injured artery at follow-up. Injury length >3 cm (p = 0.0002) and proximal arterial injury (proximal to the segmental artery; p = 0.03) were significant risk factors for non-complete reopening of the injured artery. CONCLUSION Iatrogenic arterial injury frequently occurred in the extrahepatic artery or replaced hepatic artery. Recanalization rate of arterial injury was high; however, injury length >3 cm and proximal arterial injury were risk factors for non-complete reopening of the injured artery.
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Affiliation(s)
- Hironori Onizuka
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Eijun Sueyoshi
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Hideki Ishimaru
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Ichiro Sakamoto
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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17
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Gilbo N, Van Praet L, Jochmans I, Sainz-Barriga M, Verslype C, Maleux G, Laleman W, van der Merwe S, Cassiman D, Nevens F, Monbaliu D, Pirenne J. Pre-operative trans-catheter arterial chemo-embolization increases hepatic artery thrombosis after liver transplantation - a retrospective study. Transpl Int 2017; 31:71-81. [DOI: 10.1111/tri.13046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Nicholas Gilbo
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
| | - Laura Van Praet
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
| | - Ina Jochmans
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
| | - Mauricio Sainz-Barriga
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
| | - Chris Verslype
- Department of Gastroenterology and Hepatology; KU Leuven; Leuven Belgium
| | - Geert Maleux
- Department of Radiology; KU Leuven; Leuven Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology; KU Leuven; Leuven Belgium
| | | | - David Cassiman
- Department of Gastroenterology and Hepatology; KU Leuven; Leuven Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology; KU Leuven; Leuven Belgium
| | - Diethard Monbaliu
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
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18
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Si T, Chen Y, Ma D, Gong X, Guan R, Shen B, Peng C. Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta-analysis. J Gastroenterol Hepatol 2017; 32:1286-1294. [PMID: 28085213 DOI: 10.1111/jgh.13727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/28/2016] [Accepted: 01/08/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM A debate exists over whether using preoperative transarterial chemoembolization for patients with hepatocellular carcinoma before liver transplantation. Numerous studies have been investigating on this, but there is still no unanimous conclusion about the effect of preoperative transarterial chemoembolization. We conducted the meta-analysis of all available studies to systematically evaluate the influence of preoperative transarterial chemoembolization on liver transplant. METHODS A systematic search was performed by two authors (Si TF. and Guan RY.) through PubMed, Embase, Cochrane, and Science Citation Index Expanded, combined with Manual Retrieval and Cited Reference Search. The searching cut-off date was 2016/07/31, and all the data obtained were statistically analyzed using Review Manager version 5.1 software (Copenhagen, The Nordic Cochrane Center, The Cochrane Collaboration, 2011) recommended by Cochrane Collaboration. RESULTS The study showed that there was no difference between the experimental group and the control group on perioperative mortality (RR = 1.10, 95% confidence interval (CI) = [0.49-2.48], P = 0.82) or biliary complications (RR = 0.96, 95%CI = [0.66-1.39], P = 0.83). Preoperative transarterial chemoembolization had no obvious effect on improving overall survival (HR = 1.05, 95%CI = [0.65-1.72], P = 0. 83) but would result in a higher rate of vascular complications (RR = 2.01, 95%CI = [1.23-3.27], P = 0.005) and a reduction of disease free survival (HR = 1.66, 95%CI = [1.02-2.70], P = 0.04). Subgroup analysis also revealed that patients from transarterial chemoembolization group in Asia had a much lower overall survival rate (HR = 2.65, 95%CI = [1.49-4.71], P = 0.0009) compared with the control group. CONCLUSIONS Considering the possible adverse impacts on liver transplantation and the variation in sensitivity to transarterial chemoembolization, clinicians should be more cautious when considering transarterial chemoembolization as the bridging therapy for patients in the waiting list.
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Affiliation(s)
- Tengfei Si
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongjun Chen
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Di Ma
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoyong Gong
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruoyu Guan
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Boyong Shen
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chenghong Peng
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Hepatic Artery Reconstruction With Autologous Inferior Mesenteric Artery Graft in Living Donor Liver Transplant Recipients. Transplant Proc 2017; 49:566-570. [PMID: 28340834 DOI: 10.1016/j.transproceed.2017.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In living donor liver transplantation (LDLT), hepatic arterial continuity is crucial to avoid biliary leakage, biliary stricture, cholangitis, and graft and patient loss. Sometimes there exist factors making anastomosis difficult or even impossible. In these cases, a vascular graft may be needed to bridge the two arteries for revascularization. METHOD Medical records of 297 patients who underwent LDLT between June 2000 and July 2016 at the Hepatopancreatobiliary Surgery and Liver Transplantation Unit of Dokuz Eylul University Hospital were reviewed retrospectively. Twenty-eight (9%) patients younger than the age of 18 were excluded from the study. The remaining 269 patients were included in the study. We analyzed data of patients who developed hepatic arterial complications during or after LDLT and underwent revascularization using autologous interposed inferior mesenteric artery (IMA) grafts. RESULTS In 8 (2.9%) of the 269 patients who underwent LDLT and were included in the study, autologous interposed IMA grafts were used for the hepatic artery revascularization. All of the patients were males. Their mean age was 42 (range, 25-57). The mean duration of follow-up was 83.25 months (range, 3-144 months). One patient developed intraoperative hepatic arterial thrombosis (HAT) after autologus IMA reconstruction and this patient needed retransplantation. No arterial complications developed in the other 7 patients. CONCLUSION Autologous interposed IMA graft could be used as an alternative vascular graft in hepatic artery revascularization to provide tension-free hepatic arterial continuity.
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Ma L, Chen K, Lu Q, Ling W, Luo Y. Case report of hepatic artery dissection secondary to hepatic artery pseudoaneurysm after living donor liver transplantation. BMC Gastroenterol 2016; 16:44. [PMID: 27036207 PMCID: PMC4818394 DOI: 10.1186/s12876-016-0458-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/19/2016] [Indexed: 02/06/2023] Open
Abstract
Background Hepatic artery pseudoaneurysm (HAP) and Hepatic artery dissection are rare vascular complications after living donor liver transplantation (LDLT), which may lead to graft loss and death of the recipients. Conventional gray-scale and Doppler ultrasound, as well as contrast-enhanced ultrasound (CEUS), play important roles in identifying vascular complications in the early postoperative period and during follow-up. We report a case of hepatic artery dissection secondary to HAP after LDLT, which was diagnosed and followed for one year by ultrasound. To the best of our knowledge, few studies have reported similar cases after liver transplantation in the English literature. Case presentation A 43-year-old man underwent right-lobe LDLT for treatment of a severe acute hepatitis B infection and was followed up with ultrasound examinations for one year. Conventional gray-scale and Doppler ultrasound combined with contrast-enhanced ultrasound (CEUS) accurately revealed the occurrence of HA dissection secondary to HAP and accompanied by thrombosis and collateral circulation, as well as secondary biliary complications, which provided a prompt diagnosis and guidance for the treatment. Conclusion Our case suggests that ultrasound can help detect hepatic artery pseudoaneurysm and dissection, as well as secondary biliary lesions after LDLT in an accurate and timely manner and provide useful information for the treatment chosen. CEUS shows potential as an important complementary technique to gray-scale and Doppler ultrasound.
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Affiliation(s)
- Lin Ma
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Kefei Chen
- Department of liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China.
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21
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Preoperative transarterial chemoembolization does not increase hepatic artery complications after liver transplantation: A single center 12-year experience. Clin Res Hepatol Gastroenterol 2015; 39:451-7. [PMID: 25623860 DOI: 10.1016/j.clinre.2014.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/30/2014] [Accepted: 12/08/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND As a bridge to liver transplantation or downstaging therapy for hepatocellular carcinoma (HCC) patients, preoperative transarterial chemoembolization (TACE) has potential risks in causing damage to hepatic artery (HA), resulting in severe postoperative complications. AIM To evaluate the impact of pre-TACE on postoperative hepatic artery complications (HAC) for HCC patients in a single liver transplant center. MATERIALS AND METHODS Clinical data of 450 HCC patients undergoing orthotopic liver transplantation (OLT) from January 2001 to December 2013 were retrospectively analyzed. Patients were divided into Group 1 (with pre-TACE) and Group 2 (without pre-TACE). Preoperative characteristics and postoperative HAC were compared. RESULTS One hundred and eleven patients (69 men; median age, 37±9.9 years) in Group 1 were compared with 339 patients (244 men; median age, 38.8±8.0 years) in Group 2. Patients were comparable in donor/recipients characteristics between groups. Histological review for native liver samples showed that Edema was the most often seen complication following pre-OLT TACE (troncluar: 87 vs 9; segmental: 91 vs 10; liver parenchyma: 93 vs 8; P=0.000). Fibrosis, thrombosis and aneurysm were only seen in Group 1. There were no significant difference in postoperative HAC (5/111 (4.5%) vs 5/339 (1.5%), P=0.131) between groups. CONCLUSION Our single institution experience showed that it might be safe to perform pre-TACE in HCC patients before OLT. It would not increase postoperative HAC risk.
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Vachhani PG, Copelan A, Remer EM, Kapoor B. Iatrogenic hepatopancreaticobiliary injuries: a review. Semin Intervent Radiol 2015; 32:182-94. [PMID: 26038625 DOI: 10.1055/s-0035-1549377] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Iatrogenic hepatopancreaticobiliary injuries occur after various types of surgical and nonsurgical procedures. Symptomatically, these injuries may lead to a variety of clinical presentations, including tachycardia and hypotension from hemobilia or hemorrhage. Iatrogenic injuries may be identified during the intervention, immediately afterwards, or have a delayed presentation. These injuries are categorized into nonvascular and vascular injuries. Nonvascular injuries include biliary injuries such as biliary leak or stricture, pancreatic injury, and the development of fluid collections such as abscesses. Vascular injuries include pseudoaneurysms, arteriovenous fistulas, dissection, and perforation. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and digital subtraction angiography are critical for proper diagnosis of these conditions. In this article, we describe the clinical and imaging presentations of these iatrogenic injuries and the armamentarium of minimally invasive procedures (percutaneous drainage catheter placement, balloon dilatation, stenting, and coil embolization) that are useful in their management.
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Affiliation(s)
| | - Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Erick M Remer
- Department of Abdominal Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Baljendra Kapoor
- Department of Interventional Radiology, Cleveland Clinic, Cleveland, Ohio
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23
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Goel A, Terrault N. Reply: To PMID 25045002. Liver Transpl 2015; 21:416. [PMID: 25530165 DOI: 10.1002/lt.24066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Aparna Goel
- Department of Medicine, University of California San Francisco, San Francisco, CA
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Panaro F, Guiu B, Navarro F. Transarterial chemoembolization and radiological vascular complications. Liver Transpl 2015; 21:415. [PMID: 25408435 DOI: 10.1002/lt.24046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 10/31/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Fabrizio Panaro
- Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France
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A Secure Technique for Microvascular Anastomosis in Arteries with Intimal Dissection: Intimal Sleeve Fold-Over Technique. Ann Plast Surg 2014; 76:420-3. [PMID: 25422981 DOI: 10.1097/sap.0000000000000384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intimal dissection can cause an irregular internal surface with intimal flaps and subendothelial collagen exposure. This has been associated with a high risk of thrombosis. Trimming the artery to a healthy level is routinely recommended to avoid intimal dissection. However, this method is limited when there is inadequate vascular length to work with. METHODS We dealt with an artery exhibiting severe intimal dissection by using a new suture technique: the intimal sleeve fold-over technique. Severe arterial intimal dissections were observed in 9 (6.9%) of 130 arterial microvascular anastomoses in free flap reconstruction for oral cancer patients from January 2013 to December 2013. We used this technique in 6 of the 9 patients. RESULTS All 6 patients were discharged as scheduled without perioperative problems and complications during follow-ups. The mean diameters of the recipient and pedicle arteries with intimal dissection were 2.13 and 2.20 mm. The mean time for performing sleeve fold-over procedure of on each artery was 5.1 minutes. CONCLUSIONS A secure intima-to-intima contact can be achieved using this technique. This technique can provide an alternative method to intimal dissection when the length of the artery is limited.
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26
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Panaro F, Ramos J, Gallix B, Mercier G, Herrero A, Niampa H, Pageaux GP, Navarro F. Hepatic artery complications following liver transplantation. Does preoperative chemoembolization impact the postoperative course? Clin Transplant 2014; 28:598-605. [DOI: 10.1111/ctr.12358] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Fabrizio Panaro
- Department of General and Liver Transplant Surgery; University of Montpellier; Hôpital Saint Eloi; Montpellier-Cedex 5 France
| | - Jeanne Ramos
- Department of Pathology and Laboratory Medicine; University of Montpellier; Hôpital Gui de Chauliac; Montpellier-Cedex 5 France
| | - Benoit Gallix
- Department of Abdominal Imaging; University of Montpellier; Hôpital Saint Eloi; Montpellier-Cedex 5 France
| | - Grégoire Mercier
- Statistical Analysis Unit; University of Montpellier; Montpellier-Cedex 5 France
| | - Astrid Herrero
- Department of General and Liver Transplant Surgery; University of Montpellier; Hôpital Saint Eloi; Montpellier-Cedex 5 France
| | - Halidou Niampa
- Department of General and Liver Transplant Surgery; University of Montpellier; Hôpital Saint Eloi; Montpellier-Cedex 5 France
| | - Georges-Philippe Pageaux
- Department of Hepatology; University of Montpellier; Hôpital Saint Eloi; Montpellier-Cedex 5 France
| | - Francis Navarro
- Department of General and Liver Transplant Surgery; University of Montpellier; Hôpital Saint Eloi; Montpellier-Cedex 5 France
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Mousa AY, Abu-Halimah S, Alhalbouni S, Hass SM, Yang C, Gill G, AbuRahma AF, Bates M. Amyloidosis and spontaneous hepatic bleeding, transcatheter therapy for hepatic parenchymal bleeding with massive intraperitoneal hemorrhage: a case report and review of the literature. Vascular 2013; 22:356-60. [PMID: 23929426 DOI: 10.1177/1708538113492725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hepatic hemorrhage can be devastating, especially in patients with underlying hepatic pathology. This is a case report of a 50-year-old man who presented to the emergency room with Stage 3 shock as evidenced by a systolic blood pressure of 90 mmHg, a heart rate of 125 beats per minute, respiration of 32, with delayed capillary refill and agitation. At this time, he was found to have a massive spontaneous intra-abdominal hemorrhage with an advanced stage of amyloidosis with multiple organ malfunctions. The initial diagnosis was based on an abdominal computed tomography scan and the patient was taken expeditiously to a hybrid angiography suite for a celiac angiogram. An intraoperative diagnosis of extravasation from amyloid related vasculopathy was made based on the angiographic appearance of hepatic circulation. Coil embolization of the feeding branch of the bleeder was achieved using the interlock coil system and a completion angiogram was done showing complete cessation of active bleeding. The postoperative phase was uneventful and the patient was discharged home on postoperative day three. His postoperative visit at five months later was unremarkable.
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Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Shadi Abu-Halimah
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Saadi Alhalbouni
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Stephen M Hass
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Calvin Yang
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Gurpreet Gill
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Ali F AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Mark Bates
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
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Wildgruber M, Matevossian E, Stock K, Umgelter A, Kornberg A, Berger H. Dissection of the hepatic artery and the celiac trunk after a liver transplant: description of a complication and endovascular management. EXP CLIN TRANSPLANT 2013; 11:565-8. [PMID: 23718575 DOI: 10.6002/ect.2012.0252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dissection of the common hepatic artery is a rare complication after orthotopic liver transplant. Subsequent thrombosis and occlusion of the transplant artery can result in graft failure requiring retransplant. We describe a case of hepatic artery dissection, occurring on the basis of primary vasculopathy, extending into the celiac trunk, with subtotal occlusion of the vessel through accompanying thrombosis. An attempt of endovascular rescue led to successful recanalization of the vessel and graft survival.
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Affiliation(s)
- Moritz Wildgruber
- Department of Radiology, Division of Interventional Radiology, Technische Universität München, Munich, Germany
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29
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Li WF, Lin TS, Chen CL, Concejero A, Wang SH, Lin CC, Liu YW, Yong CC, Lin TL, Wang CC. Using Ileocolic Artery for Successful Graft Salvage in a Recipient With Hepatic Artery Thrombosis After Living Donor Liver Transplantation: Case Report. Transplant Proc 2012; 44:581-2. [DOI: 10.1016/j.transproceed.2012.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Lee JH, Oh DY, Seo JW, Moon SH, Rhie JW, Ahn ST. Versatility of right gastroepiploic and gastroduodenal arteries for arterial reconstruction in adult living donor liver transplantation. Transplant Proc 2011; 43:1716-9. [PMID: 21693264 DOI: 10.1016/j.transproceed.2011.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/23/2011] [Accepted: 03/09/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND In cases where there is severe intimal dissection in the recipient hepatic artery (HA), or if the HA has been used already and additional operations are needed due to graft rejection or arterial occlusion, an alternative is necessary. In the present study, we have reported the feasibility of using the right gastroepiploic artery (RGEA) and gastroduodenal artery (GDA) in various situations where the HA is not a feasible option. METHODS Among 463 patients who underwent primary adult-to-adult living donor liver transplantation from January 2002 to July 2010, eight subjects required alternative vessels. Four recipients displayed severe intimal injury associated with previous transarterial chemoembolization (TACE); two, required a salvage operation due to hepatic artery thrombosis (HAT); and two, retransplantations due to chronic rejection. The RGEA was used in five and the GDA in three patients. RESULTS Postoperative Doppler ultrasonography and three-dimensional computed tomography showed patent arterial flow in all patients. However, HAT recurred in one patient who underwent a salvage operation with the RGEA; she died 2 months later. Two other patients died due to wound infection and respiratory failure within 3 months despite intact hepatic arterial flow. Four patients had no further complications during follow-up (mean = 33 months). CONCLUSION Although there was a discrepancy in the diameter of the HA and the RGEA (or GDA), there was no problem with mobilization and microanastomosis. We therefore believe that these vessels can be good alternatives when the hepatic artery is unavailable.
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Affiliation(s)
- J H Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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31
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Banshodani M, Tashiro H, Onoe T, Ide K, Ohdan H. Long-Term Outcome of Hepatic Artery Reconstruction during Living-Donor Liver Transplantation. Transplant Proc 2011; 43:1720-4. [DOI: 10.1016/j.transproceed.2011.03.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 03/22/2011] [Indexed: 12/26/2022]
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32
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Chan KM, Yu MC, Chou HS, Wu TJ, Lee CF, Lee WC. Significance of tumor necrosis for outcome of patients with hepatocellular carcinoma receiving locoregional therapy prior to liver transplantation. Ann Surg Oncol 2011; 18:2638-46. [PMID: 21584831 DOI: 10.1245/s10434-011-1779-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Locoregional therapy has been advocated as an effective treatment for patients with unresectable hepatocellular carcinoma (HCC), and the majority of patients with HCC receive locoregional therapy prior to liver transplantation (LT). We herein aim to determine the prognostic factors affecting the outcome in patients who receive pretransplantation therapy. METHODS We conducted a retrospective study of the prospective data of patients who received locoregional therapy before undergoing LT for HCC. The clinicopathologic features of the patients were studied using univariate and multivariate analysis to determine prognostic factors. RESULTS Univariate and multivariate analysis of clinicopathologic features identified mean tumor necrosis (TN) ≥60% as the sole independent factor associated with lower HCC recurrence following LT. Further, the groups of patients with mean TN ≥60% who were within the University of California, San Francisco (UCSF) criteria and whose tumors beyond UCSF criteria were downstaged by TN following locoregional therapy had significantly better survival rates than the opposite groups. In-depth exploration of treatment modalities and pathological features indicated that HCC showed marked TN, while tumor nodules were well treated by locoregional therapy, and no viable tumors could be detected on radiological examination. CONCLUSIONS Mean TN ≥60% of tumor by locoregional therapy could offer better outcomes for patients with HCC undergoing LT. Therefore, locoregional therapy should be considered for patients with HCC awaiting LT or potential candidates for LT in order to induce TN as well as leading to diminished viable tumor burden and reducing the odds of HCC recurrence following LT.
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Affiliation(s)
- Kun-Ming Chan
- Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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