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Feier FH, Melere MU, Trein CS, da Silva CS, Lucchese A, Horbe A, Tonet F, Ricachinevsky C, Ferreira CT, Chedid MF, Kalil AN. Early hepatic arterial thrombosis in liver transplantation: Systemic intravenous alteplase as a potential rescue treatment after failed surgical revascularization. Pediatr Transplant 2021; 25:e13902. [PMID: 33111470 DOI: 10.1111/petr.13902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/29/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
eHAT is one of the most dreaded post-LT complication. Treatment approaches include retransplantation, revascularization, or observation. Systemic thrombolytic therapy is used in pediatric patients with thromboembolic events. However, there is no previous study reporting on the use of systemic r-tPA to treat eHAT. The treatment strategies used in patients with eHAT are described, focusing on two children who failed SR and were treated with systemic heparinization plus systemic r-tPA infusion. r-tPA-RP consists of intravenous systemic infusion at a dose of 0.3 mg/kg/h during 6 hours, for 5 days. First case (3-year) was transplanted with a whole liver, and second case (6-year) received a LLS from a living donor. HAT was diagnosed by doppler US and confirmed by angioCT scan in both patients in the first day after LT. They underwent SR and were clinically stable. Re-thrombosis occurred in both patients the day after, and r-TPA-RP was started-one patient required two r-TPA-RP for HAT recurrence. They presented minor bleeding, without repercussion. Hepatic artery recanalized after 10 and 3 days in the first and second patient, respectively. Retransplant was avoided, and one developed biliary strictures, successfully managed in the follow-up. r-TPA-RP avoided retransplantation after eHAT in these cases. To our knowledge, this is the first report of the use of systemic r-TPA to treat eHAT in children. This strategy may compose an algorithm to treat eHAT that failed SR in stable patients.
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Affiliation(s)
- Flávia H Feier
- Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Melina U Melere
- Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Cristine S Trein
- Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Carolina Soares da Silva
- Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Angelica Lucchese
- Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Alex Horbe
- Interventional Radiology Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Fabio Tonet
- Division of Radiology, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Claudia Ricachinevsky
- Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Cristina T Ferreira
- Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Marcio F Chedid
- Postgraduation Program in Surgery, Medical School of UFRGS, Porto Alegre, Brazil
| | - Antonio N Kalil
- Pediatric Liver Transplantation Unit, Hospital Santa Casa, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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