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Li W, Kotsou T, Hartog H, Scheenstra R, de Meijer VE, Stenekes MW, Verhagen MV, Bokkers RPH, van der Doef HPJ. Hepatic artery stenosis after pediatric liver transplantation: The potential role of conservative management. Dig Liver Dis 2024:S1590-8658(24)01020-X. [PMID: 39379231 DOI: 10.1016/j.dld.2024.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 10/10/2024]
Abstract
AIM This study aimed to investigate the outcomes and effectiveness of various treatment strategies in patients with hepatic artery stenosis (HAS) after pediatric liver transplantation (pLT). METHODS This is a single center observational cohort study between January 1st, 2004 and August 1st, 2023, including pLT recipients aged <18 years. The primary outcome was graft and patient survival. The secondary outcomes included incidence of biliary complications, technical success of surgery or endovascular therapy (EVT), and changes in liver function. The cut-off for early and late HAS was 14 days after pLT. RESULTS Among a total of 327 pLT patients, 4 % (n = 13) developed HAS (n = 3 early; n = 10 late). Treatments included surgical revascularization for one early HAS, conservative management with anticoagulation for one early and four late HAS, and EVT for one early and six late HAS. Over a median follow-up of 28.2 months after the diagnosis of HAS, graft survival was 100 % and 83 % in early and late HAS groups, and patient survival reached 100 % in both groups. One graft loss occurred in the conservative group. Conversely, graft survival in the EVT group was 100 %. CONCLUSION The long-term outcomes of HAS after pLT are excellent. Both EVT and conservative management exhibited high graft survival rates for late HAS, with EVT achieving high technical success.
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Affiliation(s)
- Weihao Li
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomai Kotsou
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Hermien Hartog
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rene Scheenstra
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Vincent E de Meijer
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin W Stenekes
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martijn V Verhagen
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hubert P J van der Doef
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Li W, van der Doef HPJ, Wildhaber BE, Marra P, Bravi M, Pinelli D, Minetto J, Dip M, Sierre S, de Santibañes M, Ardiles V, Uno JW, Hardikar W, Bates S, Goh L, Aldrian D, Seisenbacher J, Vogel GF, Neto JS, Antunes da Fonseca E, Magalhães Costa C, Ferreira CT, Nader LS, Farina MA, Dajani KZ, Parente A, Bigam DL, Liang TB, Bai X, Zhang W, Gonsorčíková L, Froněk J, Bohuš Š, Franchi-Abella S, Gonzales E, Guérin F, Junge N, Baumann U, Richter N, Hartleif S, Sturm E, Rajakannu M, Palaniappan K, Rela M, Pawaria A, Rajakrishnan H, Surendran S, Kumar M, Agarwal S, Gupta S, Asthana S, Bandewar V, Raichurkar K, Spada M, Monti L, Alterio T, Yanagi Y, Uchida H, Komine R, Evans H, Carr-Boyd P, Duncan D, Stefanowicz M, Latka-Grot J, Kolesnik A, Broering DC, Raptis DA, Ann H Marquez K, Mali V, Aw M, Beretta M, Van der Schyff F, Quintero-Bernabeu J, Mercadal-Hally M, Larrarte K M, Andres AM, Hernandez-Oliveros F, Frauca E, Casswall T, Jorns C, Delle M, Gupte G, Sharif K, McGuirk S, Superina R, Caicedo JC, Jaramillo C, Bitterfeld L, Kastenberg Z, Shah AA, Domenick B, Acord MR, Mazariegos GV, Soltys K, DiNorcia J, Antala S, Florman SS, Buchholz BM, Herden U, Fischer L, Dierckx RAJO, Hartog H, Bokkers RPH. Incidence, management and outcomes in hepatic artery complications after paediatric liver transplantation: protocol of the retrospective, international, multicentre HEPATIC Registry. BMJ Open 2024; 14:e081933. [PMID: 38866577 PMCID: PMC11177692 DOI: 10.1136/bmjopen-2023-081933] [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: 11/13/2023] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Hepatic artery complications (HACs), such as a thrombosis or stenosis, are serious causes of morbidity and mortality after paediatric liver transplantation (LT). This study will investigate the incidence, current management practices and outcomes in paediatric patients with HAC after LT, including early and late complications. METHODS AND ANALYSIS The HEPatic Artery stenosis and Thrombosis after liver transplantation In Children (HEPATIC) Registry is an international, retrospective, multicentre, observational study. Any paediatric patient diagnosed with HAC and treated for HAC (at age <18 years) after paediatric LT within a 20-year time period will be included. The primary outcomes are graft and patient survivals. The secondary outcomes are technical success of the intervention, primary and secondary patency after HAC intervention, intraprocedural and postprocedural complications, description of current management practices, and incidence of HAC. ETHICS AND DISSEMINATION All participating sites will obtain local ethical approval and (waiver of) informed consent following the regulations on the conduct of observational clinical studies. The results will be disseminated through scientific presentations at conferences and through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER The HEPATIC registry is registered at the ClinicalTrials.gov website; Registry Identifier: NCT05818644.
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Affiliation(s)
- Weihao Li
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hubert P J van der Doef
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Barbara E Wildhaber
- Swiss Pediatric Liver Centre, Division of Child and Adolescent Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michela Bravi
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Julia Minetto
- Division of Liver Transplant, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Marcelo Dip
- Division of Liver Transplant, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Sergio Sierre
- Division of Interventional Radiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Martin de Santibañes
- HPB and Liver transplant unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- HPB and Liver transplant unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimmy Walker Uno
- HPB and Liver transplant unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Winita Hardikar
- Department of Gastroenterology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sue Bates
- Department of Gastroenterology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Lynette Goh
- Department of Gastroenterology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Denise Aldrian
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Georg F Vogel
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joao Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | | | | | - Luiza S Nader
- Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil
| | - Marco A Farina
- Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil
| | - Khaled Z Dajani
- Department of Surgery, Division of Transplantation Surgery, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Alessandro Parente
- Department of Surgery, Division of Transplantation Surgery, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - David L Bigam
- Department of Surgery, Division of Transplantation Surgery, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplant Center, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Xueli Bai
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplant Center, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplant Center, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lucie Gonsorčíková
- Department of Pediatrics, First Faculty of Medicine, Thomayer University Hospital, Praha, Czech Republic
| | - Jiří Froněk
- Department of Transplant Surgery, Institute of Clinical and Experimental medicine, Praha, Czech Republic
| | - Šimon Bohuš
- Department of Pediatrics, First Faculty of Medicine, Thomayer University Hospital, Praha, Czech Republic
| | - Stéphanie Franchi-Abella
- Department of Paediatric Radiology, Paris-Saclay University, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Paediatric Hepatology and Paediatric Liver Transplantation Unit, Paris-Saclay University, AP-HP, Hopital Bicetre, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Paediatric Surgery and Paediatric Liver Transplantation Unit, Paris-Saclay University, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Norman Junge
- Division for Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ulrich Baumann
- Division for Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Nicolas Richter
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Steffen Hartleif
- Paediatric Gastroenterology and Hepatology, University Hospitals Tubingen, Tubingen, Germany
| | - Ekkehard Sturm
- Paediatric Gastroenterology and Hepatology, University Hospitals Tubingen, Tubingen, Germany
| | - Muthukumarassamy Rajakannu
- Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Kumar Palaniappan
- Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Mohamed Rela
- Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Arti Pawaria
- Department of Pediatric Hepatology & Gastroenterology, Amrita Institute of Medical Sciences & Research Centre, New Delhi, Delhi, India
| | - Haritha Rajakrishnan
- Department of Solid organ transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Sudhindran Surendran
- Department of Solid organ transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Mukesh Kumar
- Centre for Liver and Biliary Sciences, Max Super Speciality Hospital Saket, New Delhi, Delhi, India
| | - Shaleen Agarwal
- Centre for Liver and Biliary Sciences, Max Super Speciality Hospital Saket, New Delhi, Delhi, India
| | - Subhash Gupta
- Centre for Liver and Biliary Sciences, Max Super Speciality Hospital Saket, New Delhi, Delhi, India
| | - Sonal Asthana
- Integrated Liver Care Department, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Vaishnavi Bandewar
- Integrated Liver Care Department, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Karthik Raichurkar
- Integrated Liver Care Department, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantion, Ospedale Pediatrico Bambino Gesu, Roma, Italy
| | - Lidia Monti
- Gastrointestinal and Transplanted Liver Imaging Unit, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Tommaso Alterio
- Hepatology and Liver Transplant Unit, Ospedale Pediatrico Bambino Gesu, Roma, Italy
| | - Yusuke Yanagi
- Organ Transplantation Center, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Hajime Uchida
- Organ Transplantation Centre, National Center for Child Health and Development Hospital, Tokyo, Japan
| | - Ryuji Komine
- Organ Transplantation Center, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Helen Evans
- Department of Paediatric Gastroenterology, Starship Children's Health, Auckland, New Zealand
| | - Peter Carr-Boyd
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, Auckland, New Zealand
| | - David Duncan
- Department of Interventional Radiology, Auckland City Hospital, Auckland, Auckland, New Zealand
| | - Marek Stefanowicz
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warszawa, Poland
| | - Julita Latka-Grot
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warszawa, Poland
| | - Adam Kolesnik
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warszawa, Poland
| | - Dieter C Broering
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dimitri A Raptis
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Kris Ann H Marquez
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Marion Aw
- Department of Paediatrics, National University Hospital, Singapore
| | - Marisa Beretta
- Department of Peadiatrics, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | | | - Jesús Quintero-Bernabeu
- Pediatric Hepatology and Liver Trasplant Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria Mercadal-Hally
- Pediatric Hepatology and Liver Trasplant Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mauricio Larrarte K
- Pediatric Hepatology and Liver Trasplant Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ane M Andres
- Pediatric Surgery Department, La Paz University Hospital, Madrid, Madrid, Spain
| | | | - Esteban Frauca
- Pediatric Hepatology Department, La Paz University Hospital, Madrid, Madrid, Spain
| | - Thomas Casswall
- Department Clinical Interventions and Technology CLINTEC, Division for Paediatrics, Karolinska Institute, Stockholm, Sweden
| | - Carl Jorns
- Division for Transplantation Surgery, Department Clinical Interventions and Technology CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Martin Delle
- Department Clinical Science, Intervention and Technology CLINTEC, Division for Interventional Radiology, Karolinska Institute, Stockholm, Sweden
| | - Girish Gupte
- Liver Unit (including small bowel transplantation), Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Khalid Sharif
- Liver Unit (including small bowel transplantation), Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Simon McGuirk
- Department of Radiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Riccardo Superina
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | - Catalina Jaramillo
- Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA
| | | | - Zachary Kastenberg
- Department of Surgery, Division of Paediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Amit A Shah
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bryanna Domenick
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael R Acord
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - George V Mazariegos
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kyle Soltys
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph DiNorcia
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, Los Angeles, California, USA
| | - Swanti Antala
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, Los Angeles, California, USA
| | - Sander S Florman
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, Los Angeles, California, USA
| | - Bettina M Buchholz
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hermien Hartog
- Department of Surgery, Section of Hepatobiliary Surgery & Liver Transplantation, University Medical Centre Groningen, Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
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Li W, Bokkers RPH, Dierckx RAJO, Verkade HJ, Sanders DH, de Kleine R, van der Doef HPJ. Treatment strategies for hepatic artery complications after pediatric liver transplantation: A systematic review. Liver Transpl 2024; 30:160-169. [PMID: 37698924 DOI: 10.1097/lvt.0000000000000257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
This study aimed to evaluate the effectiveness of different treatments for hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) after pediatric liver transplantation. We systematically reviewed studies published since 2000 that investigated the management of HAT and/or HAS after pediatric liver transplantation. Studies with a minimum of 5 patients in one of the treatment methods were included. The primary outcomes were technical success rate and graft and patient survival. The secondary outcomes were hepatic artery patency, complications, and incidence of HAT and HAS. Of 3570 studies, we included 19 studies with 328 patients. The incidence was 6.2% for HAT and 4.1% for HAS. Patients with an early HAT treated with surgical revascularization had a median graft survival of 45.7% (interquartile range, 30.7%-60%) and a patient survival of 61.3% (interquartile range, 58.7%-66.9%) compared with the other treatments (conservative, endovascular revascularization, or retransplantation). As for HAS, endovascular and surgical revascularization groups had a patient survival of 85.7% and 100% (interquartile range, 85%-100%), respectively. Despite various treatment methods, HAT after pediatric liver transplantation remains a significant issue that has profound effects on the patient and graft survival. Current evidence is insufficient to determine the most effective treatment for preventing graft failure.
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Affiliation(s)
- Weihao Li
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henkjan J Verkade
- Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dewey H Sanders
- The Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Ruben de Kleine
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hubert P J van der Doef
- Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Astarcıoglu I, Egeli T, Gulcu A, Ozbilgin M, Agalar C, Cesmeli EB, Kaya E, Karademir S, Unek T. Vascular Complications After Liver Transplantation. EXP CLIN TRANSPLANT 2023; 21:504-511. [PMID: 30880648 DOI: 10.6002/ect.2018.0240] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Vascular complications after liver transplant can be lethal. High levels of suspicion and aggressive use of diagnostic tools may help with early diagnosis and treatment. Here, we share our experiences regarding this topic. MATERIALS AND METHODS Adult and pediatric patients who had liver transplant between February 1997 and June 2018 in our clinic were included in the study. Patients were grouped according to age (pediatric patients were those under 18 years old), male versus female, indication for transplant, type of liver transplant, type of vascular complication, treatment, and survival aftertreatment.We analyzed the statistical incidence of vascular complications according to age, male versus female, and type of liver transplant. RESULTS Our analyses included 607 liver transplant procedures, including 7 retransplants, with 349 (57.4%) from living donors and 258 (42.6%) from deceased donors. Of total patients, 539 were adults (89.8%) and 61 were children (10.2%). Vascular complications occurred in 25 patients (4.1%), with hepatic artery complications seen in 13 patients (2.1%) (10 adults [1.8%] and 3 children [4.9%]), portal vein complications seen in 9 patients (1.5%) (6 adults [1.1%] and 3 children [4.9%]), and hepatic vein complications seen in 3 patients (0.5%) (2 adults [0.36%] and 1 child [1.6%]). Rate of vascular complications was statistically higher in pediatric patients (11.4% vs 3.3%; P = .007) and higher but not statistically in recipients of livers from living donors (5.2% vs 2.7%; P = .19). Twelve patients (48.8%) were treated with endovascular approach, and 11 (0.44%)required surgicaltreatment. Two patients underwent immediate retransplant due to hepatic artery thrombosis. CONCLUSIONS Because vascular complications are the most severe complications afterlivertransplant,there must be close follow-up of vascular anastomoses, particularly early postoperatively, with radiologic methods. In cases of vascular complications, emergent treatment, including endovascular interventions, surgery, and retransplant, must be performed.
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Affiliation(s)
- Ibrahim Astarcıoglu
- From the Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University Faculty of Medicine, Narlıdere, Izmir, Turkey
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Neuroform EZ Stents for Hepatic Artery Stenosis After Liver Transplantation: A Single-Center Preliminary Report. Cardiovasc Intervent Radiol 2022; 45:852-857. [PMID: 35237859 DOI: 10.1007/s00270-022-03100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/10/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This preliminary study evaluated the safety and effectiveness for off-label use of Neuroform EZ (NEZ) stents in the revascularization of hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT). MATERIALS AND METHODS Nine of 489 (5%) OLTs with HAS were managed with NEZ stents between September 2016 and July 2021. Stenting outcomes were evaluated based on the technical success rate, procedure-related complications, and primary patency. RESULTS A total of 10 NEZ stents (4.5 mm × 3 cm, n = 6; 4 mm × 3 cm, n = 4) were successfully deployed in 9 torturous hepatic arteries and in 1 relatively straight artery without any procedure-related complications. Combined thrombolysis (n = 3) and balloon angioplasty (n = 6) was performed. The median duration of follow-up was 438 days (range, 120-1126 days). Asymptomatic re-stenoses were detected in 2 stents on days 60 and 433 after stenting. A Kaplan-Meier curve predicted cumulative primary stent patencies at 1, 2, and 3 years of 90%, 75%, and 75%, respectively. CONCLUSION NEZ stents can be safely used to treat HAS after OLT with high technical success and favorable primary patency.
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Channaoui A, Tambucci R, Pire A, de Magnée C, Sokal E, Smets F, Stephenne X, Scheers I, Reding R. Management and outcome of hepatic artery thrombosis after pediatric liver transplantation. Pediatr Transplant 2021; 25:e13938. [PMID: 33314551 DOI: 10.1111/petr.13938] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pediatric LT are at particular risk of HAT, and its management still constitutes a matter of debate. Our purpose was to study predisposing factors and outcome of HAT post-LT, including the impact of surgical revisions on survival and biliary complications. METHODS Among 882 primary pediatric LT performed between 1993 and 2015, 36 HAT were encountered (4.1%, 35 fully documented). Each HAT case was retrospectively paired with a LT recipient without HAT, according to diagnosis, age at LT, type of graft, and era. RESULTS Five-year patient survivals were 77.0% versus 83.9% in HAT and non-HAT paired groups, respectively (P = .321). Corresponding graft survivals were 20.0% versus 80.5% (P < .001), and retransplantation rates 77.7% versus 10.7%, respectively (P < .001). One-year biliary complication-free survivals were 16.6% versus 83.8% in the HAT and non-HAT groups, respectively (P < .001). Regarding chronology of surgical re-exploration, only HAT cases that occurred within 14 days post-LT were re-operated, fourteen of them being explored within 7 days post-LT (revascularization rate: 6/14), versus two beyond 7 days (no revascularization). When revascularization was achieved, graft and biliary complication-free survival rates at 1 year were 33.3% and 22.2%, respectively, both rates being 0.0% in case of failure. CONCLUSIONS The pejorative prognosis associated with HAT in terms of graft survival is confirmed, whereas patient survival could be preserved through retransplantation. Results suggest that HAT should be re-operated if occurring within 7 days post-LT, but not beyond.
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Affiliation(s)
- Aniss Channaoui
- Pediatric Surgery and Transplant Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Roberto Tambucci
- Pediatric Surgery and Transplant Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Aurore Pire
- Pediatric Surgery and Transplant Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Catherine de Magnée
- Pediatric Surgery and Transplant Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Etienne Sokal
- Pediatric Gastroenterology and Hepatology Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Smets
- Pediatric Gastroenterology and Hepatology Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Xavier Stephenne
- Pediatric Gastroenterology and Hepatology Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Isabelle Scheers
- Pediatric Gastroenterology and Hepatology Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Raymond Reding
- Pediatric Surgery and Transplant Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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7
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Gruttadauria S, Barbera F, Conaldi PG, Pagano D, Liotta R, Gringeri E, Miraglia R, Burgio G, Barbara M, Pietrosi G, Cammà C, Di Francesco F. Clinical and Molecular-Based Approach in the Evaluation of Hepatocellular Carcinoma Recurrence after Radical Liver Resection. Cancers (Basel) 2021; 13:518. [PMID: 33572904 PMCID: PMC7866287 DOI: 10.3390/cancers13030518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hepatic resection remains the treatment of choice for patients with early-stage HCC with preserved liver function. Unfortunately, however, the majority of patients develop tumor recurrence. While several clinical factors were found to be associated with tumor recurrence, HCC pathogenesis is a complex process of accumulation of somatic genomic alterations, which leads to a huge molecular heterogeneity that has not been completely understood. The aim of this study is to complement potentially predictive clinical and pathological factors with next-generation sequencing genomic profiling and loss of heterozygosity analysis. METHODS 124 HCC patients, who underwent a primary hepatic resection from January 2016 to December 2019, were recruited for this study. Next-generation sequencing (NGS) analysis and allelic imbalance assessment in a case-control subgroup analysis were performed. A time-to-recurrence analysis was performed as well by means of Kaplan-Meier estimators. RESULTS Cumulative number of HCC recurrences were 26 (21%) and 32 (26%), respectively, one and two years after surgery. Kaplan-Meier estimates for the probability of recurrence amounted to 37% (95% C.I.: 24-47) and to 51% (95% C.I.: 35-62), after one and two years, respectively. Multivariable analysis identified as independent predictors of HCC recurrence: hepatitis C virus (HCV) infection (HR: 1.96, 95%C.I.: 0.91-4.24, p = 0.085), serum bilirubin levels (HR: 5.32, 95%C.I.: 2.07-13.69, p = 0.001), number of nodules (HR: 1.63, 95%C.I.: 1.12-2.38, p = 0.011) and size of the larger nodule (HR: 1.11, 95%C.I.: 1.03-1.18, p = 0.004). Time-to-recurrence analysis showed that loss of heterozygosity in the PTEN loci (involved in the PI3K/AKT/mTOR signaling pathway) was significantly associated with a lower risk of HCC recurrence (HR: 0.35, 95%C.I.: 0.13-0.93, p = 0.036). CONCLUSIONS multiple alterations of cancer genes are associated with HCC progression. In particular, the evidence of a specific AI mutation presented in 20 patients seemed to have a protective effect on the risk of HCC recurrence.
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Affiliation(s)
- Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), 90127 Palermo, Italy; (D.P.); (G.P.); (F.D.F.)
- Department of Surgery and Medical and Surgical Specialties, University of Catania, 95124 Catania, Italy
| | - Floriana Barbera
- Research Department, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), 90127 Palermo, Italy; (F.B.); (P.G.C.); (M.B.)
| | - Pier Giulio Conaldi
- Research Department, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), 90127 Palermo, Italy; (F.B.); (P.G.C.); (M.B.)
| | - Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), 90127 Palermo, Italy; (D.P.); (G.P.); (F.D.F.)
| | - Rosa Liotta
- Pathology Unit, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), 90127 Palermo, Italy;
| | - Enrico Gringeri
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy;
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), 90127 Palermo, Italy;
| | - Gaetano Burgio
- Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), 90127 Palermo, Italy;
| | - Marco Barbara
- Research Department, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), 90127 Palermo, Italy; (F.B.); (P.G.C.); (M.B.)
| | - Giada Pietrosi
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), 90127 Palermo, Italy; (D.P.); (G.P.); (F.D.F.)
| | - Calogero Cammà
- Section of Gastroenterology & Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Fabrizio Di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico—Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), 90127 Palermo, Italy; (D.P.); (G.P.); (F.D.F.)
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8
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Gruttadauria S, Tropea A, Pagano D, Calamia S, Ricotta C, Bonsignore P, Li Petri S, Cintorino D, di Francesco F. Case report: Trans-papillary free stenting of the cystic duct and of the common bile duct in a double biliary ducts anastomoses of a right lobe living donor transplantation. BMC Surg 2021; 21:44. [PMID: 33468113 PMCID: PMC7816360 DOI: 10.1186/s12893-020-01045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background One of the major issues related to the living donor liver transplantation recipient outcome is still the high rate of biliary complication, especially when multiple biliary ducts are present and multiple anastomoses have to be performed. Case presentation and conclusion We report a case of adult-to-adult right lobe living donor liver transplantation performed for a recipient affected by alcohol-related cirrhosis with MELD score of 17. End-stage liver disease was complicated by refractory ascites, portal hypertension, small esophageal varices and portal gastropathy, hypersplenism, and abundant right pleural effusion. Here in the attached video we described the adult-to-adult LDLT procedures, where a right lobe with two biliary ducts draining respectively the right anterior and the right posterior segments has been transplanted. LDLT required a biliary reconstruction using the native cystic and common bile ducts stented trans-papillary with two 5- French 6 cm long soft silastic catheter. None major complications were detected during post-operative clinical courses. Actually, the donor and the recipient are alive and well. The technique we describe in the video, allow to keep the biliary anastomoses protected and patent without having the risk of creating cholestasis and the need of invasive additional procedure. No living donor right lobe transplantation should be refused because of the presence of multiple biliary ducts.
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Affiliation(s)
- Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy. .,Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy.
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Sergio Calamia
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Calogero Ricotta
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Pasquale Bonsignore
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Sergio Li Petri
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Davide Cintorino
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
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9
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Kim BR, Oh J, Yu KS, Ryu HG. Pharmacokinetics of human antithrombin III concentrate in the immediate postoperative period after liver transplantation. Br J Clin Pharmacol 2020; 86:923-932. [PMID: 31840271 DOI: 10.1111/bcp.14200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 01/31/2023] Open
Abstract
AIMS Antithrombin III (AT-III) concentrates have been used to prevent critical thrombosis in the immediate post-liver transplantation period without clear evidence regarding the optimal dose or administration scheme. The relationship between the AT-III dosage and the plasma activity levels during the period was evaluated in this study. METHODS The plasma AT-III activity levels and clinical data obtained from patients who received liver transplantation from January 2017 to September 2018 were retrospectively analysed. A population pharmacokinetic (PK) model was developed using nonlinear mixed-effects method and externally validated thereafter. Several dosing scenarios were simulated to maintain the plasma AT-III activity level within the normal range using the developed PK model to search for an optimal AT-III dosing regimen. RESULTS The plasma AT-III activity levels were best described by a single compartment model with first order elimination kinetics. The recovery of endogenous AT-III level during the postoperative days was modelled using an Emax model. The typical values (95% confidence interval) of volume of distribution and clearance were 3.86 (3.40-4.32) L, and 0.129 (0.111-0.147) L h-1 , respectively. Serum albumin and body weight had significant effect on clearance and were included in the model. External validation of the proposed model demonstrated adequate prediction performance. Furthermore, simulation of previously suggested or modified dosing scenarios showed successful maintenance of AT-III activity level within the normal range. CONCLUSION A population PK model of AT-III concentrate was developed using data from liver recipients. Dosing scenarios simulated in our study may help establish a practical guide for AT-III concentrate titration after liver transplantation.
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Affiliation(s)
- Bo Rim Kim
- Departments of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jaeseong Oh
- Clinical Pharmacology & Therapeutics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Sang Yu
- Clinical Pharmacology & Therapeutics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ho Geol Ryu
- Departments of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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10
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Magand N, Coronado JL, Drevon H, Manichon A, Mabrut J, Mohkam K, Ducerf C, Boussel L, Rode A. Primary angioplasty or stenting for hepatic artery stenosis treatment after liver transplantation. Clin Transplant 2019; 33:e13729. [DOI: 10.1111/ctr.13729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Nicolas Magand
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - José Luis Coronado
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Harir Drevon
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Anne‐Frédérique Manichon
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Jean‐Yves Mabrut
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Kayvan Mohkam
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Christian Ducerf
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Loïc Boussel
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Agnès Rode
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
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11
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Carrillo-Martínez MÁ, Rodríguez-Montalvo C, Flores-Villaba E, Tijerina-Gómez L, Puente-Gallegos FE, Kettenhofen SE, Garza-García GA. Catheter directed hepatic artery thrombolysis following liver transplantation. Case report and review of the literature. BJR Case Rep 2019; 5:20190005. [PMID: 31555475 PMCID: PMC6750628 DOI: 10.1259/bjrcr.20190005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/27/2019] [Accepted: 03/20/2019] [Indexed: 11/05/2022] Open
Abstract
Hepatic artery thrombosis is the most frequent vascular complication following orthotopic liver transplantation, and often results in biliary complications, early graft loss and death. Surgical revascularization and retransplantation are considered the mainstay of treatment. However, intraarterial endovascular therapy is an alternative that has shown low morbidity and mortality, thereby avoiding the need for retransplantation. We describe a case of orthotopic liver transplantation complicated with hepatic artery thrombosis that was successfully treated with endovascular therapy.
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Affiliation(s)
| | | | - Eduardo Flores-Villaba
- Deparment of Surgery, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
| | - Lucas Tijerina-Gómez
- Deparment of Surgery, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
| | | | - Samuel Eugene Kettenhofen
- Department of Diagnostic Radiology, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
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12
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Endovascular Treatment of Arterial Complications After Liver Transplantation: Long-Term Follow-Up Evaluated on Doppler Ultrasound and Magnetic Resonance Cholangiopancreatography. Cardiovasc Intervent Radiol 2018; 42:381-388. [DOI: 10.1007/s00270-018-2108-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/30/2018] [Indexed: 02/06/2023]
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13
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Sanada Y, Katano T, Hirata Y, Yamada N, Okada N, Ihara Y, Ogaki K, Otomo S, Imai T, Ushijima K, Mizuta K. Interventional radiology treatment for vascular and biliary complications following pediatric living donor liver transplantation - a retrospective study. Transpl Int 2018; 31:1216-1222. [DOI: 10.1111/tri.13285] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Yukihiro Sanada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Takumi Katano
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Yuta Hirata
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Naoya Yamada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Noriki Okada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Yoshiyuki Ihara
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Keiko Ogaki
- Department of Pharmacy; Jichi Medical University Hospital; Shimotsuke Japan
| | - Shinya Otomo
- Department of Pharmacy; Jichi Medical University Hospital; Shimotsuke Japan
| | - Toshimi Imai
- Division of Clinical Pharmacology; Department of Pharmacology; Jichi Medical University; Shimotsuke Japan
| | - Kentraro Ushijima
- Division of Clinical Pharmacology; Department of Pharmacology; Jichi Medical University; Shimotsuke Japan
| | - Koichi Mizuta
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
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14
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Endovascular Treatment for Very Early Hepatic Artery Stenosis Following Living-Donor Liver Transplantation: Report of Two Cases. Transplant Proc 2018; 50:1457-1460. [DOI: 10.1016/j.transproceed.2018.02.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 12/11/2022]
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15
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Complications after endovascular treatment of hepatic artery stenosis after liver transplantation. J Vasc Surg 2017; 66:1488-1496. [PMID: 28697937 DOI: 10.1016/j.jvs.2017.04.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/30/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatic artery stenosis (HAS) after liver transplantation can progress to hepatic artery thrombosis (HAT) and a subsequent 30% to 50% risk of graft loss. Although endovascular treatment of severe HAS after liver transplantation has emerged as the dominant method of treatment, the potential risks of these interventions are poorly described. METHODS A retrospective review of all endovascular interventions for HAS after liver transplantation between August 2009 and March 2016 was performed at a single institution, which has the largest volume of liver transplants in the United States. Severe HAS was identified by routine surveillance duplex ultrasound imaging (peak systolic velocity >400 cm/s, resistive index <0.5, and presence of tardus parvus waveforms). RESULTS In 1129 liver transplant recipients during the study period, 106 angiograms were performed in 79 patients (6.9%) for severe de novo or recurrent HAS. Interventions were performed in 99 of 106 cases (93.4%) with percutaneous transluminal angioplasty alone (34 of 99) or with stent placement (65 of 99). Immediate technical success was 91%. Major complications occurred in eight of 106 cases (7.5%), consisting of target vessel dissection (5 of 8) and rupture (3 of 8). Successful endovascular treatment was possible in six of the eight patients (75%). Ruptures were treated with the use of a covered coronary balloon-expandable stent graft or balloon tamponade. Dissections were treated with placement of bare-metal or drug-eluting stents. No open surgical intervention was required to manage any of these complications. With a median of follow-up of 22 months, four of eight patients (50%) with a major complication progressed to HAT compared with one of 71 patients (1.4%) undergoing a hepatic intervention without a major complication (P < .001). One patient required retransplantation. Severe vessel tortuosity was present in 75% (6 of 8) of interventions with a major complication compared with 34.6% (34 of 98) in those without (P = .05). In the complication cohort, 37.5% (3 of 8) of the patients had received a second liver transplant before intervention compared with 12.6% (9 of 71) of the patients in the noncomplication cohort (P = .097). CONCLUSIONS Although endovascular treatment of HAS is safe and effective in most patients, target vessel injury is possible. Severe tortuosity of the hepatic artery and prior retransplantation were associated with a twofold to threefold increased risk of a major complication. Acute vessel injury can be managed successfully using endovascular techniques, but these patients have a significant risk of subsequent HAT and need close surveillance.
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16
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Paz-Fumagalli R, Jia Z, Sella DM, McKinney JM, Frey GT, Wang W. Percutaneous Retrograde Transhepatic Arterial Puncture to Regain Access in the True Lumen of the Dissected and Acutely Occluded Transplant Hepatic Artery. Am J Transplant 2017; 17:830-833. [PMID: 27778486 DOI: 10.1111/ajt.14092] [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] [Received: 07/03/2016] [Revised: 09/25/2016] [Accepted: 10/14/2016] [Indexed: 01/25/2023]
Abstract
Iatrogenic hepatic artery dissection is a serious complication that can progress to complete hepatic artery occlusion and graft loss. Restoration of arterial flow to the graft is urgent, but the severity and extent of the dissection may interfere with endovascular techniques. The authors describe a technique of percutaneous retrograde transhepatic arterial puncture to regain access into the true lumen of the dissected hepatic artery to restore in-line flow to the liver graft.
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Affiliation(s)
| | - Z Jia
- Department of Radiology, Mayo Clinic, Jacksonville, FL.,Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China
| | - D M Sella
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - J M McKinney
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - G T Frey
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - W Wang
- Department of Radiology, Mayo Clinic, Jacksonville, FL
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17
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Feasibility and Midterm Results of Endovascular Treatment of Hepatic Artery Occlusion within 24 Hours after Living-Donor Liver Transplantation. J Vasc Interv Radiol 2017; 28:269-275. [DOI: 10.1016/j.jvir.2016.06.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 02/06/2023] Open
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18
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Rajakannu M, Awad S, Ciacio O, Pittau G, Adam R, Cunha AS, Castaing D, Samuel D, Lewin M, Cherqui D, Vibert E. Intention-to-treat analysis of percutaneous endovascular treatment of hepatic artery stenosis after orthotopic liver transplantation. Liver Transpl 2016; 22:923-33. [PMID: 27097277 DOI: 10.1002/lt.24468] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/16/2016] [Indexed: 02/06/2023]
Abstract
Hepatic artery stenosis (HAS) is a rare complication of orthotopic liver transplantation (LT). HAS could evolve into complete thrombosis and lead to graft loss, incurring significant morbidity and mortality. Even though endovascular management by percutaneous transluminal angioplasty ± stenting (PTA) is the primary treatment of HAS, its longterm impact on hepatic artery (HA) patency and graft survival remains unclear. This study aimed to evaluate longterm outcomes of PTA and to define the risk factors of treatment failure. From 2006 to 2012, 30 patients with critical HAS (>50% stenosis of HA) and treated by PTA were identified from 870 adult patients undergoing LT. Seventeen patients were diagnosed by post-LT screening, and 13 patients were symptomatic due to HAS. PTA was completed successfully in 27 (90%) patients with angioplasty plus stenting in 23 and angioplasty alone in 4. The immediate technical success rate was 90%. A major complication that was observed was arterial dissection (1 patient) which eventually necessitated retransplantation. Restenosis was observed in 10 (33%) patients. One-year, 3-year, and 5-year HA patency rates were 68%, 62.8%, and 62.8%, respectively. Overall patient survival was 93.3% at 3 years and 85.3% at 5 years. The 3-year and 5-year liver graft survival rates were 84.7% and 64.5%, respectively. No significant difference was observed in patient and graft survivals between asymptomatic and symptomatic patients after PTA. Similarly, no difference was observed between angioplasty alone and angioplasty plus stenting. In conclusion, endovascular therapy ensures a good 5-year graft survival (64.5%) and patient survival (85.3%) in patients with critical HAS by maintaining HA patency with a low risk of serious morbidity (3.3%). Liver Transplantation 22 923-933 2016 AASLD.
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Affiliation(s)
- Muthukumarassamy Rajakannu
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Sameh Awad
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Oriana Ciacio
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Gabriella Pittau
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.,Unités Mixtes de Recherche en Santé 776, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Antonio Sa Cunha
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Denis Castaing
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Didier Samuel
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Maïté Lewin
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
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Gad EH, Abdelsamee MA, Kamel Y. Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (A retrospective cohort study). ANNALS OF MEDICINE AND SURGERY (2012) 2016. [PMID: 27257483 DOI: 10.1016/j.amsu.2016.04.021.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES Hepatic arterial (HA) and portal venous (PV) complications of recipients after living donor liver transplantation(LDLT) result in patient loss. The aim of this study was to analyze these complications. METHODS We retrospectively analyzed HA and/or PV complications in 213 of 222 recipients underwent LDLT in our centre. The overall male/female and adult/pediatric ratios were 183/30 and 186/27 respectively. RESULTS The overall incidence of HA and/or PV complications was 19.7% (n = 42), while adult and pediatric complications were 18.3% (n = 39) and 1.4% (n = 3) respectively. However early (<1month) and late (>1month) complications were 9.4% (n = 20) and 10.3% (n = 22) respectively. Individually HA problems (HA stenosis, HA thrombosis, injury and arterial steal syndrome) 15% (n = 32), PV problems (PV thrombosis and PV stenosis) 2.8% (n = 6) and simultaneous HA and PV problems 1.9% (n = 4). 40/42 of complications were managed by angiography (n = 18), surgery (n = 10) or medically (Anticoagulant and/or thrombolytic) (n = 12) where successful treatment occurred in 18 patients. 13/42 (31%) of patients died as a direct result of these complications. Preoperative PVT was significant predictor of these complications in univariate analysis. The 6-month, 1-, 3-, 5- 7- and 10-year survival rates in patients were 65.3%, 61.5%, 55.9%, 55.4%, 54.5% and 54.5% respectively. CONCLUSION HA and/or PV complications specially early ones lead to significant poor outcome after LDLT, so proper dealing with the risk factors like pre LT PVT (I.e. More intensive anticoagulation therapy) and the effective management of these complications are mandatory for improving outcome.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery and Liver Transplantation, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt
| | | | - Yasmin Kamel
- Anaesthesia, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt
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20
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Gad EH, Abdelsamee MA, Kamel Y. Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (A retrospective cohort study). Ann Med Surg (Lond) 2016; 8:28-39. [PMID: 27257483 PMCID: PMC4878848 DOI: 10.1016/j.amsu.2016.04.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/24/2016] [Indexed: 02/05/2023] Open
Abstract
Objectives Hepatic arterial (HA) and portal venous (PV) complications of recipients after living donor liver transplantation(LDLT) result in patient loss. The aim of this study was to analyze these complications. Methods We retrospectively analyzed HA and/or PV complications in 213 of 222 recipients underwent LDLT in our centre. The overall male/female and adult/pediatric ratios were 183/30 and 186/27 respectively. Results The overall incidence of HA and/or PV complications was 19.7% (n = 42), while adult and pediatric complications were 18.3% (n = 39) and 1.4% (n = 3) respectively. However early (<1month) and late (>1month) complications were 9.4% (n = 20) and 10.3% (n = 22) respectively. Individually HA problems (HA stenosis, HA thrombosis, injury and arterial steal syndrome) 15% (n = 32), PV problems (PV thrombosis and PV stenosis) 2.8% (n = 6) and simultaneous HA and PV problems 1.9% (n = 4). 40/42 of complications were managed by angiography (n = 18), surgery (n = 10) or medically (Anticoagulant and/or thrombolytic) (n = 12) where successful treatment occurred in 18 patients. 13/42 (31%) of patients died as a direct result of these complications. Preoperative PVT was significant predictor of these complications in univariate analysis. The 6-month, 1-, 3-, 5- 7- and 10-year survival rates in patients were 65.3%, 61.5%, 55.9%, 55.4%, 54.5% and 54.5% respectively. Conclusion HA and/or PV complications specially early ones lead to significant poor outcome after LDLT, so proper dealing with the risk factors like pre LT PVT (I.e. More intensive anticoagulation therapy) and the effective management of these complications are mandatory for improving outcome. Preoperative PVT was significant predictor of HA and/or PV complications. HA and/or PV complications especially early ones lead to significant poor outcome. Proper dealing with the risk factors like pre LT PVT improves outcome. The effective management of these complications is mandatory for improving outcome.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery and Liver Transplantation, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt
- Corresponding author.
| | | | - Yasmin Kamel
- Anaesthesia, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt
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21
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The role of interventional radiology in complications associated with liver transplantation. Clin Radiol 2015; 70:1323-35. [DOI: 10.1016/j.crad.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/21/2015] [Accepted: 07/08/2015] [Indexed: 02/07/2023]
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22
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Le L, Terral W, Zea N, Bazan HA, Smith TA, Loss GE, Bluth E, Sternbergh WC. Primary stent placement for hepatic artery stenosis after liver transplantation. J Vasc Surg 2015; 62:704-9. [PMID: 26054583 DOI: 10.1016/j.jvs.2015.04.400] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/19/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Significant hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT) can lead to thrombosis, with subsequent liver failure in 30% of patients. Although operative intervention or retransplantation has been the traditional solution, endovascular therapy has emerged as a less invasive treatment strategy. Prior smaller studies have been conflicting in the relative efficacy of percutaneous transluminal angioplasty (PTA) vs primary stent placement for HAS. METHODS This was a single-center retrospective review of all endovascular interventions for HAS after OLT during a 54-month period (August 2009-December 2013). Patients with ultrasound imaging with evidence of severe HAS (peak systolic velocity >400-450 cm/s, resistive index <0.5) underwent endovascular treatment with primary stent placement or PTA. Outcomes calculated were technical success, primary and primary assisted patency rates, reinterventions, and complications. RESULTS Sixty-two interventions for HAS were performed in 42 patients with a mean follow-up of 19.1 ± 15.2 months. During the study period, 654 OLTs were performed. Of 61 patients diagnosed with HAS, 42 underwent an endovascular intervention. The rate of endovascularly treated HAS was 6.4% (42 of 654). Primary technical success was achieved in 95% (59 of 62) of the interventions. Initial treatment was with PTA alone in 17 or primary stent in 25. Primary patency rates after initial stent placement were 87%, 76.5%, 78%, and 78% at 1, 6, 12, and 24 months, respectively, compared with initial PTA rates of 64.7%, 53.3%, 40%, and 0% (P = .19). There were 20 reinterventions in 14 patients (eight stents, six PTAs). The time to the initial reintervention was 51 days in patients with PTA alone vs 105.8 days for those with an initial stent (P = .16). Overall primary assisted patency was 93% at 24 months. Major complications were one arterial rupture and two hepatic artery dissections. The long-term risk of hepatic artery thrombosis in the entire patient cohort was 3.2%. CONCLUSIONS HAS after OLT can be treated endovascularly with high technical success and excellent primary assisted patency. This series represents the largest reported cohort of endovascular interventions for HAS to date. Initial use of a stent showed a strong trend toward decreasing the need for reintervention. Avoidance of hepatic artery thrombosis is possible in >95% of patients with endovascular treatment and close follow-up.
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Affiliation(s)
- Linda Le
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - William Terral
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - Nicolas Zea
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - Hernan A Bazan
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - Taylor A Smith
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - George E Loss
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - Edward Bluth
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - W Charles Sternbergh
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
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23
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Kamran Hejazi Kenari S, Mirzakhani H, Eslami M, Saidi RF. Current state of the art in management of vascular complications after pediatric liver transplantation. Pediatr Transplant 2015; 19:18-26. [PMID: 25425338 DOI: 10.1111/petr.12407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 12/12/2022]
Abstract
Vascular complications by compromising the blood flow to the allograft can have significant and sometimes life-threatening consequences after pediatric liver transplantation. High level of suspicion and aggressive utilization of diagnostic modalities can lead to early diagnosis and salvage of the allograft. This review will summarize the current trends in management of vascular complications after pediatric liver transplantation.
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Affiliation(s)
- Seyed Kamran Hejazi Kenari
- Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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24
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Vidjak V, Novačić K, Matijević F, Kavur L, Slavica M, Mrzljak A, Filipec-Kanižaj T, Leder NI, Škegro D. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment. Pol J Radiol 2015; 80:309-16. [PMID: 26150902 PMCID: PMC4476501 DOI: 10.12659/pjr.893831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/17/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. MATERIAL/METHODS Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. RESULTS During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. CONCLUSIONS Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery.
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Affiliation(s)
- Vinko Vidjak
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
| | - Karlo Novačić
- Queens and King George, Barking, Havering and Redbridge University Hospitals NHS Trust, London, U.K
| | - Filip Matijević
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
- Author’s address: Filip Matijević, Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zajčeva 19 Str., 10000 Zagreb, Croatia, e-mail:
| | - Lovro Kavur
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
| | - Marko Slavica
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
| | - Anna Mrzljak
- Clinical Department of Internal Medicine, Division of Gastroenterology, Merkur University Hospital, Zagreb, Croatia
| | - Tajana Filipec-Kanižaj
- Queens and King George, Barking, Havering and Redbridge University Hospitals NHS Trust, London, U.K
| | - Nikola Ivan Leder
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
| | - Dinko Škegro
- Clinical Department of Internal Medicine, Department of Nephrology, Merkur University Hospital, Zagreb, Croatia
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25
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Chen J, Weinstein J, Black S, Spain J, Brady PS, Dowell JD. Surgical and endovascular treatment of hepatic arterial complications following liver transplant. Clin Transplant 2014; 28:1305-12. [PMID: 25091402 DOI: 10.1111/ctr.12431] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2014] [Indexed: 12/17/2022]
Abstract
Vascular complications after liver transplantation increase post-operative morbidity and contribute to the incidence of retransplantation. Vascular complications comprise arterial, caval, and portal venous pathology, with the majority of complications being arterial in etiology, including anastomotic stricture, pseudoaneurysm, and thrombosis. There are two major therapeutic options for the treatment of these arterial complications: endovascular intervention and surgery. The former includes intra-arterial thrombolysis, embolization, percutaneous transluminal angioplasty, and stent placement. The latter includes thrombectomy, reanastomosis, and retransplantation. Although surgical treatment has been considered the first choice for management in the past, advances in endovascular intervention have increased and make it a viable therapeutic option following orthotopic liver transplantation. This review focuses on the role of surgical and endovascular therapy in the management of hepatic arterial complications after liver transplantation.
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Affiliation(s)
- Jun Chen
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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26
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Quintero J, Ortega J, Miserachs M, Bueno J, Bilbao I, Charco R. Low plasma levels of antithrombin III in the early post-operative period following pediatric liver transplantation: should they be replaced? A single-center pilot study. Pediatr Transplant 2014; 18:185-9. [PMID: 24438318 DOI: 10.1111/petr.12217] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2013] [Indexed: 12/26/2022]
Abstract
eHAT after LT remains a life-threatening complication. In the majority of anticoagulation protocols, heparin is used to prevent thromboses. Our study aimed to monitor AT-III levels in the early post-LT period to assess the need for the administration of AT-III concentrate to ensure the effectiveness of heparin. We monitored coagulation daily by measuring INR, APTT, fibrinogen, platelets, and AT-III. Anticoagulation therapy consisted of LMWH, AT-III, and dipyridamole. AT-III concentrate was administered when AT-III activity was ≤60%. DUS was performed daily for the first five post-operative days or whenever vascular thrombosis was suspected. Between October 2007 and October 2011, 39 LT were performed in our center. The median age was 26 months (6-196) with a median weight of 9 kg (5.5-49). AT-III activity was ≤60% in 27 patients. Lower levels were particularly observed in partial grafts and recipients weighing less than 10 kg. Patent arterial flow was present in all 39 LT during the first five post-operative days. AT-III levels were low in 70% of pediatric patients following LT, thereby risking heparin ineffectiveness. These results may implicate low AT-III levels in the etiology of eHAT post-LT. However, this is a small single-center pilot study and further larger prospective trials are required to confirm these results.
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Affiliation(s)
- Jesús Quintero
- Pediatric Liver Transplant Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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27
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Sanada Y, Wakiya T, Hishikawa S, Hirata Y, Yamada N, Okada N, Ihara Y, Urahashi T, Mizuta K, Kobayashi E. Risk factors and treatments for hepatic arterial complications in pediatric living donor liver transplantation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:463-72. [PMID: 24142418 DOI: 10.1002/jhbp.49] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hepatic artery complications (HAC) are a serious complication in pediatric liver transplant recipients because its incidence is high and it can occasionally lead to graft liver failure. We herein present a retrospective analysis of our 10-year experience with pediatric living donor liver transplantation (LDLT) focusing on the risk factors and treatments for HAC. METHODS Between May 2001 and November 2011, 209 LDLTs were performed for 203 pediatric recipients. We performed the multivariate analyses to identify the factors associated with HAC and showed the therapeutic strategy and outcome for HAC. RESULTS The overall incidence of HAC was 7.2%, and the graft survival of recipients with HAC was 73.3%. The multivariate analysis showed that the pediatric end-stage liver disease score (≥20), post-transplant laparotomy except for HAC treatment and extra-anatomical hepatic artery reconstruction were independent risk factors for HAC (P = 0.020, P = 0.015 and P = 0.002, respectively). Eleven surgical interventions and 13 endovascular interventions were performed for 15 recipients with HAC. The serum aspartate aminotransferase levels pre- and post-treatment for HAC were significantly higher in the surgical group than in the endovascular group (P = 0.016 and P = 0.022, respectively). CONCLUSIONS It is important for recipients with risk factors to maintain strict post-transplant management to help prevent HAC and detect it in earlier stages. Endovascular intervention can be a less invasive method for treating HAC than surgical intervention, and can be performed as an early treatment.
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Affiliation(s)
- Yukihiro Sanada
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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28
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Wakiya T, Sanada Y, Mizuta K, Urahashi T, Ihara Y, Yamada N, Okada N, Egami S, Nakata M, Hakamada K, Yasuda Y. A comparison of open surgery and endovascular intervention for hepatic artery complications after pediatric liver transplantation. Transplant Proc 2013; 45:323-9. [PMID: 23375320 DOI: 10.1016/j.transproceed.2012.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/25/2012] [Accepted: 08/08/2012] [Indexed: 12/13/2022]
Abstract
There are currently 2 major therapeutic options for the treatment of hepatic artery complications: endovascular intervention and open surgery. We herein report a retrospective analysis of 14 pediatric patients with hepatic artery complications after pediatric living donor liver transplantation (LDLT) at our institution. We divided them into an open surgery group and an endovascular intervention group based on their primary treatment, and compared the results and outcomes. We then evaluated which procedure is more effective and less invasive. In the open surgery group, recurrent stenosis or spasm of the hepatic artery occurred in 3 of the 8 patients (37.5%). In the endovascular intervention group, 5 of the 6 patients were technically successfully treated by only endovascular treatment. Of the 5 successfully treated patients, 3 developed recurrent stenosis (60%). There were significant differences in the mean length of the operation for the first treatment of hepatic artery complications (open surgery, 428 minutes vs endovascular intervention, 160 minutes; P = .01) and in the mean value of the posttreatment aspartate aminotransferase (AST)/alanine aminotransferase (ALT) (open surgery > endovascular intervention; P = .04/.05). Although endovascular intervention needs to be examined in further studies to reduce the rate of relapse, it is a less invasive method for the patient and graft than open surgery.
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Affiliation(s)
- T Wakiya
- Department of Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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29
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Cheng YS, Lin PY, Lin KH, Ko CJ, Lin CC, Chen YL. Innovative technique for preventing hepatic artery kinking in living donor liver transplantation. Liver Transpl 2013; 19:664-5. [PMID: 23526647 DOI: 10.1002/lt.23641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/07/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Yu-Shu Cheng
- Department of Surgery; Changhua Christian Hospital; Changhua City Taiwan
| | - Ping-Yi Lin
- Transplant Medicine and Surgery Research Centre, Changhua Christian Hospital; Changhua City Taiwan
| | - Kuo-Hua Lin
- Department of Surgery; Changhua Christian Hospital; Changhua City Taiwan
| | - Chih-Jan Ko
- Department of Surgery; Changhua Christian Hospital; Changhua City Taiwan
| | - Chia-Cheng Lin
- Department of Surgery; Changhua Christian Hospital; Changhua City Taiwan
| | - Yao-Li Chen
- Department of Surgery; Changhua Christian Hospital; Changhua City Taiwan
- School of Medicine, Chung Shan Medical University; Taichung Taiwan
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30
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Rostambeigi N, Hunter D, Duval S, Chinnakotla S, Golzarian J. Stent placement versus angioplasty for hepatic artery stenosis after liver transplant: a meta-analysis of case series. Eur Radiol 2013; 23:1323-34. [PMID: 23239061 DOI: 10.1007/s00330-012-2730-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 10/23/2012] [Accepted: 11/07/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic artery stenosis (HAS) is a serious complication of liver transplantation but data on the most effective endovascular management are lacking. We aimed to compare percutaneous balloon angioplasty (PBA) with stent placement. METHODS We searched MEDLINE, Cochrane, Web of Science, EMBASE, SCOPUS, and Biosis Previews between 1970 and December 2011 and performed meta-analysis of short-term (procedural success, complications) and long-term outcomes (liver function, arterial patency, survival, re-intervention, re-transplantation). Random effects models were used for the analysis and meta-regression performed for the year of study. RESULTS A total of 263 liver transplants in 257 patients [age 43 (±8) years] underwent 147 PBAs and 116 stents. Transplanted livers were from deceased donors in 240 (91 %). Follow-up was 1 month to 4.5 years (median 17 months). PBA and stent had similar procedural success (89 % vs. 98 %), complications (16 % vs. 19 %), normal liver function tests (80 % vs. 68 %), arterial patency (76 % vs. 68 %), survival (80 % vs. 82 %), and requirement for re-intervention (22 % vs. 25 %) or re-transplantation (20 % vs. 24 %) (P non-significant). In the most recent studies re-transplantation was reported less compared to older series (P = 0.04). CONCLUSION Both PBA and stent offer comparable results for HAS. These techniques have contributed to a recent decline in re-transplantation. KEY POINTS • Interventional radiological procedures are often used to treat post-transplant hepatic artery stenosis. • Meta-analysis shows that percutaneous balloon angioplasty and stent placement are both efficacious. • Percutaneous balloon angioplasty and stent placement appear to have similar complication rates. • Re-transplantation rates have declined, partly due to interventional management for arterial stenosis.
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31
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Sommacale D, Aoyagi T, Dondero F, Sibert A, Bruno O, Fteriche S, Francoz C, Durand F, Belghiti J. Repeat endovascular treatment of recurring hepatic artery stenoses in orthotopic liver transplantation. Transpl Int 2013; 26:608-15. [PMID: 23551134 DOI: 10.1111/tri.12089] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/08/2012] [Accepted: 02/13/2013] [Indexed: 02/06/2023]
Abstract
Hepatic artery stenosis (HAS) is a complication that impacts the results of orthotopic liver transplantation (OLT). Interventional radiological techniques are important therapeutic options for HAS. The aim of this retrospective study was to evaluate the outcome of repeated radiological treatments in recurring HAS after OLT. Of the 941 patients who underwent OLT at our center from January 1998 to September 2010, 48 (5%) were diagnosed with HAS, 37 (77%) of whom underwent transluminal interventional therapy with the placement of an endovascular stent. Success rate, complications, hepatic artery patency and follow-up were reviewed. After stent placement, artery patency was achieved in all patients. Three patients developed complications, including arterial dissection and hematoma. HAS recurrence was observed in 9 patients (24%), and hepatic artery thrombosis (HAT) occurred in 4 (11%). Radiological interventions were repeated 10 times in 8 patients without complications. At a median follow-up of 66 months (range 10-158), hepatic artery patency was observed in 35 cases (94.6%). The 5-year rates for graft and patient survival were 82.3% and 87.7%, respectively. Restenosis may occur in one-third of patients after endovascular treatment for thrombosis and HAS, but the long-term outcomes of iterative radiological treatment for HAS indicate a high rate of success.
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Affiliation(s)
- Daniele Sommacale
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hospital Beaujon, Clichy, France.
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32
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Hamby BA, Ramirez DE, Loss GE, Bazan HA, Smith TA, Bluth E, Sternbergh WC. Endovascular treatment of hepatic artery stenosis after liver transplantation. J Vasc Surg 2013; 57:1067-72. [PMID: 23332988 DOI: 10.1016/j.jvs.2012.10.086] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 10/12/2012] [Accepted: 10/12/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic artery stenosis (HAS) after orthotopic liver transplantation is a significant risk factor for subsequent hepatic artery thrombosis (HAT). HAT is associated with a 30%-50% risk of liver failure culminating in retransplantation or death. Traditional treatment of hepatic artery complications has been surgical, with hepatic artery revision or retransplantation. Endovascular therapy of HAS, described primarily in the interventional radiology literature, may provide a less-invasive treatment option. METHODS This was a retrospective review of all endovascular interventions performed for HAS after orthotopic liver transplantation over a 31-month period (August 2009 to January 2012). Patients with duplex ultrasound imaging evidence of severe main HAS (peak systolic velocity of >400 cm/s, resistive index of <.5) underwent endovascular treatment with either primary stent placement or percutaneous transluminal angioplasty (PTA) alone. Patients were followed with serial ultrasound imaging to assess for treatment success and late restenosis. Reintervention was performed if significant restenosis occurred. RESULTS Thirty-five hepatic artery interventions were performed in 23 patients. Over the 31-month study period, 318 orthotopic liver transplantations were performed, yielding a 7.4% (23/318) rate of hepatic artery intervention. Primary technical success was achieved in 97% (34/35) of cases. Initial treatment was with PTA alone (n = 10) or primary stent placement (n = 13). The initial postintervention ultrasound images revealed improvements in hepatic artery peak systolic velocity (267 ± 118 [posttreatment] vs 489.9 ± 155 cm/s [pretreatment]; P < .0001) and main hepatic artery resistive index (0.61 ± 0.08 [posttreatment] vs 0.41 ± 0.07 [pretreatment]; P < .0001). At a mean follow-up of 8.2 ± 1.8 months (range, 0-29), there were 12 reinterventions in 10 patients for recurrent HAS. Thirty-one percent (n = 4/13) of patients undergoing initial stent placement required reintervention (at 236 ± 124 days of follow-up) compared with 60% (n = 6/10) of patients undergoing initial PTA (at 62.5 ± 44 days of follow-up). Primary patency rates (Kaplan-Meier) after primary stent placement were 92%, 85%, and 69% at 1, 3, and 6 months, respectively, compared with 70%, 60%, and 50% after PTA (P = .17). Primary-assisted patency for the entire cohort was 97% at 6 and 12 months. Major complications were one arterial rupture managed endovascularly and one artery dissection that precipitated HAT and required retransplantation. The overall rate of HAT in the entire cohort was 4.3% (1/23). CONCLUSIONS Endovascular treatment of HAS can be performed with high technical success, excellent primary-assisted patency, and acceptable morbidity. Initial use of a stent may improve primary patency when compared with PTA. The need for reintervention is common, placing particular importance on aggressive surveillance. Longer follow-up and a larger cohort are needed to confirm these encouraging early results.
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Affiliation(s)
- Blake A Hamby
- Section of Vascular and Endovascular Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Panaro F, Bouyabrine H, Carabalona JP, Marchand JP, Jaber S, Navarro F. Hepatic artery kinking during liver transplantation: survey and prospective intraoperative flow measurement. J Gastrointest Surg 2012; 16:1524-30. [PMID: 22562392 DOI: 10.1007/s11605-012-1897-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/17/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic artery thrombosis (HAT) represents the most common vascular complication occurring after liver transplantation (LT). Herein, we report the results of a prospective study of hepatic artery flow (HAF) measurement during abdominal wall closure after LT along with the results of an international survey of procedures adopted, in order to avoid the arterial kinking (AK) in case of long artery. METHODS Sixty-four surgeons were asked regarding the different procedures used to avoid AK in the presence of long artery. We prospectively assessed the HAF during three phases of LT in 26 consecutive LT performed in patients with a long HA: after completion of the biliary anastomosis (M0), and partial abdominal wall closure with (M1w) or without (M1w/o) hepatic artery anti-kinking method (HAAK). RESULTS Sixty (93.7 %) surgeons replied to the survey: 44 (73.3 %) surgeons cut the artery as short as possible, of whom 38 (86.3 %) interposed an oxidized polymer or the omentum, and six (13.7 %) used other systems. Fourteen (23.3 %) surgeons did not use any interposition methods. The remaining two (3.3 %) surgeons left a long artery without HAAK. In our cohort we obtained the following HAF measures: M0 152 mL/min (89-205), M1 without HAAK 114 (66-168) and M1 with HAAK procedure 158 (91-219) (p = 0.002). CONCLUSIONS Our survey confirms that no consensus is currently available regarding the most effective method for avoiding AK. Kinking occurs most probably when the liver is released in its final position. The utilization of an interposition method could ensure the maintenance of a correct HAF.
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Affiliation(s)
- Fabrizio Panaro
- Department of General and Liver Transplant Surgery, University of Montpellier Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295 Montpellier, Cedex 5, France.
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Phillips GS, Bhargava P, Stanescu L, Dick AA, Parnell SE. Pediatric intestinal transplantation: normal radiographic appearance and complications. Pediatr Radiol 2011; 41:1028-39. [PMID: 21607597 DOI: 10.1007/s00247-011-2094-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 03/28/2011] [Accepted: 04/01/2011] [Indexed: 12/23/2022]
Abstract
We present a pictorial essay on pediatric intestinal transplantation that describes the indications for pediatric intestinal transplantation, surgical technique, and the role of imaging in the pre-transplant work-up and detection of post-transplant complications. We illustrate the normal post-transplant imaging appearance and common complications, including rejection, infection, post-transplant lymphoproliferative disease (PTLD), mechanical dysfunction and vascular complications. We conclude with an imaging algorithm for suspected post-transplant complications based on clinical scenarios.
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Affiliation(s)
- Grace S Phillips
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, 98105, USA.
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Panaro F, Gallix B, Bouyabrine H, Ramos J, Addeo P, Testa G, Carabalona JP, Pageaux G, Domergue J, Navarro F. Liver transplantation and spontaneous neovascularization after arterial thrombosis: "the neovascularized liver". Transpl Int 2011; 24:949-57. [PMID: 21740470 DOI: 10.1111/j.1432-2277.2011.01293.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The only arterial pathway available after liver transplantation is the hepatic artery. Therefore, hepatic artery thrombosis can result in graft loss necessitating re-transplantation. Herein, we present evidence of neovascularization at long-term follow-up in a series of transplant patients with hepatic artery thrombosis. We termed this phenomenon "neovascularized liver". Hepatic artery thrombosis was noted in 30/407 cases (7.37%), and occurred early in 13 patients (43.3%) and late (>30 days) in 17 (56.7%) patients. At the time of this study, 11 (36.7%) patients had a neovascularized liver. Those patients with neovascularized liver and normal liver function were closely followed. Of these patients, 10 (91%) showed evidence of neovascularized liver by imaging, and an echo-Doppler arterial signal was recorded in all patients. The mean interval between the diagnosis of hepatic artery thrombosis and neovascularized liver was 4.1 months (range of 3-5.5 months). Liver histology showed an arterial structure in 4 (36.4%) patients. Four factors were associated with development of neovascularized liver: late hepatic artery thrombosis, early hepatic artery stenosis, site of thrombosis, and Roux-en-Y anastomosis. The overall survival rate at 54 months was 90.9%. In conclusion, a late hepatic artery thrombosis may be quite uneventful and should not automatically lead to re-transplantation.
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Affiliation(s)
- Fabrizio Panaro
- Department of General and Liver Transplant Surgery, University of Montpellier, Hôpital Saint Eloi, Montpellier-Cedex 5, France.
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