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Ramalingam V, Shami SMU, Weinstein J, Lee D, Curry M, Eckhoff D, Ahmed M, Sarwar A. Safety and Effectiveness of Early Primary Stent Placement for Hepatic Artery Stenosis in Liver Transplant Recipients. J Vasc Interv Radiol 2025; 36:425-434. [PMID: 39586537 DOI: 10.1016/j.jvir.2024.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 11/01/2024] [Accepted: 11/16/2024] [Indexed: 11/27/2024] Open
Abstract
PURPOSE To evaluate the outcomes of early primary stent placement (within 30 days of liver transplantation) for hepatic artery stenosis (HAS). MATERIALS AND METHODS Patients who underwent liver transplantation between February 2001 and February 2024 were evaluated for HAS. Patients who underwent primary stent placement were selected and stratified based on the time from anastomosis to intervention. Early intervention was defined as primary stent placement within 30 days of surgical anastomosis. Kaplan-Meier analysis was performed for primary patency. RESULTS HAS occurred in 83 of 779 (11%) patients (median age, 55 years; interquartile range, 48-63 years; 27 [48%] women), with 56 patients meeting inclusion criteria. Stent placement was performed within 0-6 days of the anastomosis in 11 (20%), 7-14 days in 11 (20%), 15-30 days in 7 (12%), 31-70 days in 9 (16%), and >70 days in 18 (32%) patients. Technical success was 100%. Primary patency rates were 89%, 87%, and 87% at 1, 3, and 5 years, respectively. Primary assisted patency rates were 100% at 1, 3, and 5 years. Early interventions at 0-6 days, 7-14 days, and 15-30 days showed primary patency rates of 100%, 90%, and 86%, respectively, at 1 year (P = .58). There was no difference in primary patency between the early (<30 days) and late (>30 days) cohorts (P = .88). There was 1 Grade 4 adverse event. There were no cases of anastomotic rupture, hepatic artery dissection, or graft failure. CONCLUSIONS Hepatic artery stent placement within 30 days of liver transplantation is safe and technically successful with excellent long-term primary patency.
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Affiliation(s)
- Vijay Ramalingam
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
| | - Sheikh Muhammad Usman Shami
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Weinstein
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - David Lee
- Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Michael Curry
- Division of Hepatology, Department of Gastroenterology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Devin Eckhoff
- Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Ammar Sarwar
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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2
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Hamed H, Elshobary M, Salah T, Sultan AM, Abou El-Magd ES, Elsabbagh AM, Shehta A, Abdulrazek M, Elsarraf W, Elmorshedi MA, Abdelkhalek M, Shiha U, El Razek HMA, Wahab MA. Navigating complex arterial reconstruction in living donor liver transplantation: the role of the splenic artery as a viable conduit. BMC Surg 2025; 25:9. [PMID: 39757184 PMCID: PMC11702025 DOI: 10.1186/s12893-024-02709-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 12/09/2024] [Indexed: 01/07/2025] Open
Abstract
BACKGROUND In living donor liver transplantation (LDLT), maintaining hepatic arterial flow is critical for graft survival. Alternative methods are required when the recipient's hepatic artery is unsuitable due to extensive dissection or inadequate flow. This study evaluates the efficacy and safety of splenic artery transposition (SAT) for hepatic arterial reconstruction in LDLT. METHODS This retrospective cohort study included 10 LDLT patients with hepatic arterial reconstruction by SAT to assess operative parameters, postoperative complications, mortality, and patency rate. RESULTS The splenic artery was used because of arterial dissection (70%) or inadequate arterial blood flow. Operative time ranged from 640 to 1020 min, and no splenic infarction was observed. Post-operative complications were as follows; biliary leakage (10%), pancreatitis (10%), intraabdominal hemorrhage (10%), and arterial thrombosis (10%). Mortality in this cohort was 30%, one of them was due to thrombosis of the conduit and the other two died from sepsis-related complications. With a median follow-up of 43 months, this technique was associated with a 70% survival rate. CONCLUSION The splenic artery is a viable conduit for hepatic arterial reconstruction in LDLT, demonstrating an acceptable safety profile and complication rates. This approach is recommended in cases where the recipient's hepatic artery is significantly compromised.
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Affiliation(s)
- Hosam Hamed
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Mohamed Elshobary
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Tarek Salah
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Ahmad M Sultan
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - El-Sayed Abou El-Magd
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Ahmed M Elsabbagh
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Ahmed Shehta
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Mohamed Abdulrazek
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt.
| | - Waleed Elsarraf
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Anesthesia Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Mohamed A Elmorshedi
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Anesthesia Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Mostafa Abdelkhalek
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Anesthesia Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Usama Shiha
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Radiology Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Hassan Magdy Abd El Razek
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Radiology Department, Mansoura University, Mansoura, Dakahleyya, Egypt
| | - Mohamed Abdel Wahab
- Liver Transplant Unit, Gastrointestinal Surgical Center (GISC), Surgery Department, Mansoura University, Mansoura, Dakahleyya, Egypt
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3
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Srivastava S, Garg I. Thrombotic complications post liver transplantation: Etiology and management. World J Crit Care Med 2024; 13:96074. [PMID: 39655303 PMCID: PMC11577539 DOI: 10.5492/wjccm.v13.i4.96074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 10/01/2024] [Accepted: 10/24/2024] [Indexed: 10/31/2024] Open
Abstract
Liver transplantation (LT) is the life saving therapeutic option for patients with acute and chronic end stage liver disease. This is a routine procedure with excellent outcomes in terms of patient survival and quality of life post LT. Orthotopic LT (OLT) patients require a critical care as they are prone to variety of post-operative vascular, cardiovascular, biliary, pulmonary and abdominal complications. Thrombotic complications (both arterial and venous) are not uncommon post liver transplant surgery. Such vascular problems lead to increased morbidity and mortality in both donor and graft recipient. Although thromboprophylaxis is recommended in general surgery patients, no such standards exist for liver transplant patients. Drastic advancements of surgical and anesthetic procedures have improvised survival rates of patients post OLT. Despite these, haemostatic imbalance leading to thrombotic events post OLT cause significant graft loss and morbidity and even lead to patient's death. Thus it is extremely important to understand pathophysiology of thrombosis in LT patients and shorten the timing of its diagnosis to avoid morbidity and mortality in both donor and graft recipient. Present review summarizes the current knowledge of vascular complications associated with LT to highlight their impact on short and long-term morbidity and mortality post LT. Also, present report discusses the lacunae existing in the literature regarding the risk factors leading to arterial and venous thrombosis in LT patients.
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Affiliation(s)
- Swati Srivastava
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development organization, Delhi 110054, India
| | - Iti Garg
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development organization, Delhi 110054, India
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4
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Berg T, Aehling NF, Bruns T, Welker MW, Weismüller T, Trebicka J, Tacke F, Strnad P, Sterneck M, Settmacher U, Seehofer D, Schott E, Schnitzbauer AA, Schmidt HH, Schlitt HJ, Pratschke J, Pascher A, Neumann U, Manekeller S, Lammert F, Klein I, Kirchner G, Guba M, Glanemann M, Engelmann C, Canbay AE, Braun F, Berg CP, Bechstein WO, Becker T, Trautwein C. [Not Available]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1397-1573. [PMID: 39250961 DOI: 10.1055/a-2255-7246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Thomas Berg
- Bereich Hepatologie, Medizinischen Klinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Niklas F Aehling
- Bereich Hepatologie, Medizinischen Klinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Tony Bruns
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Martin-Walter Welker
- Medizinische Klinik I Gastroent., Hepat., Pneum., Endokrin. Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Tobias Weismüller
- Klinik für Innere Medizin - Gastroenterologie und Hepatologie, Vivantes Humboldt-Klinikum, Berlin, Deutschland
| | - Jonel Trebicka
- Medizinische Klinik B für Gastroenterologie und Hepatologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Frank Tacke
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Berlin, Deutschland
| | - Pavel Strnad
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Martina Sterneck
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | - Utz Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Daniel Seehofer
- Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Eckart Schott
- Klinik für Innere Medizin II - Gastroenterologie, Hepatologie und Diabetolgie, Helios Klinikum Emil von Behring, Berlin, Deutschland
| | | | - Hartmut H Schmidt
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Hans J Schlitt
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Johann Pratschke
- Chirurgische Klinik, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Andreas Pascher
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Ulf Neumann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Steffen Manekeller
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Frank Lammert
- Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Ingo Klein
- Chirurgische Klinik I, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gabriele Kirchner
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg und Innere Medizin I, Caritaskrankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - Markus Guba
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, München, Deutschland
| | - Matthias Glanemann
- Klinik für Allgemeine, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Cornelius Engelmann
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Berlin, Deutschland
| | - Ali E Canbay
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
| | - Felix Braun
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schlewswig-Holstein, Kiel, Deutschland
| | - Christoph P Berg
- Innere Medizin I Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Wolf O Bechstein
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Thomas Becker
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schlewswig-Holstein, Kiel, Deutschland
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5
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Terasawa M, Imamura H, Allard MA, Pietrasz D, Ciacio O, Pittau G, Salloum C, Sa Cunha A, Cherqui D, Adam R, Azoulay D, Saiura A, Vibert E, Golse N. Intraoperative indocyanine green fluorescence imaging to predict early hepatic arterial complications after liver transplantation. Liver Transpl 2024; 30:805-815. [PMID: 38466885 DOI: 10.1097/lvt.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
The purpose of this study was to propose an innovative intraoperative criterion in a liver transplantation setting that would judge arterial flow abnormality that may lead to early hepatic arterial occlusion, that is, thrombosis or stenosis, when left untreated and to carry out reanastomosis. After liver graft implantation, and after ensuring that there is no abnormality on the Doppler ultrasound (qualitative and quantitative assessment), we intraoperatively injected indocyanine green dye (0.01 mg/Kg), and we quantified the fluorescence signal at the graft pedicle using ImageJ software. From the obtained images of 89 adult patients transplanted in our center between September 2017 and April 2019, we constructed fluorescence intensity curves of the hepatic arterial signal and examined their relationship with the occurrence of early hepatic arterial occlusion (thrombosis or stenosis). Early hepatic arterial occlusion occurred in 7 patients (7.8%), including 3 thrombosis and 4 stenosis. Among various parameters of the flow intensity curve analyzed, the ratio of peak to plateau fluorescence intensity and the jagged wave pattern at the plateau phase were closely associated with this dreaded event. By combining the ratio of peak to plateau at 0.275 and a jagged wave, we best predicted the occurrence of early hepatic arterial occlusion and thrombosis, with sensitivity/specificity of 0.86/0.98 and 1.00/0.94, respectively. Through a simple composite parameter, the indocyanine green fluorescence imaging system is an additional and promising intraoperative modality for identifying recipients of transplant at high risk of developing early hepatic arterial occlusion. This tool could assist the surgeon in the decision to redo the anastomosis despite normal Doppler ultrasonography.
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Affiliation(s)
- Muga Terasawa
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Imamura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Marc Antoine Allard
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Daniel Pietrasz
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Oriana Ciacio
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Gabriella Pittau
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Chady Salloum
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Antonio Sa Cunha
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Daniel Cherqui
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - René Adam
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Daniel Azoulay
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Eric Vibert
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Nicolas Golse
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
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6
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Desai SV, Natarajan B, Khanna V, Brady P. Hepatic artery stenosis following adult liver transplantation: evaluation of different endovascular treatment approaches. CVIR Endovasc 2024; 7:39. [PMID: 38642226 PMCID: PMC11032299 DOI: 10.1186/s42155-024-00439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/19/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE To evaluate the efficacy and safety of hepatic artery interventions (HAI) versus extra-hepatic arterial interventions (EHAI) when managing clinically significant hepatic artery stenosis (HAS) after adult orthotopic liver transplantation. MATERIALS AND METHODS A single-center retrospective cohort analysis was conducted on liver transplant patients who underwent intervention for clinically significant HAS from September 2012 to September 2021. The HAI treatment arm included hepatic artery angioplasty and/or stent placement while the EHAI treatment arm comprised of non-hepatic visceral artery embolization. Primary outcomes included peri-procedural complications and 1-year liver-related deaths. Secondary outcomes included biliary ischemic events, longitudinal trends in liver enzymes and ultrasound parameters pre-and post-intervention. RESULTS The HAI arm included 21 procedures in 18 patients and the EHAI arm included 27 procedures in 22 patients. There were increased 1-year liver-related deaths (10% [2/21] vs 0% [0/27], p = 0.10) and complications (29% [6/21] vs 4% [1/27], p = 0.015) in the HAI group compared to the EHAI group. Both HAI and EHAI groups exhibited similar improvements in transaminitis including changes of ALT (-72 U/L vs -112.5 U/L, p = 0.60) and AST (-58 U/L vs -48 U/L, p = 0.56) at 1-month post-procedure. Both treatment arms demonstrated increases in post-procedural peak systolic velocity of the hepatic artery distal to the stenosis, while the HAI group also showed significant improvement in resistive indices following the intervention. CONCLUSION Direct hepatic artery interventions remain the definitive treatment for clinically significant hepatic artery stenosis; however, non-hepatic visceral artery embolization can be considered a safe alternative intervention in cases of unfavorable hepatic anatomy.
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Affiliation(s)
- Sagar V Desai
- Department of Interventional Radiology, Jefferson Einstein Hospital, Philadelphia, PA, USA.
| | | | - Vinit Khanna
- Department of Interventional Radiology, Jefferson Einstein Hospital, Philadelphia, PA, USA
| | - Paul Brady
- Department of Interventional Radiology, Jefferson Einstein Hospital, Philadelphia, PA, USA
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Abstract
Hepatic artery complications can be divided into 2 different categories, nonocclusive and steno-occlusive disease. Steno-occlusive disease is a collective term that encompasses hepatic artery thrombosis, hepatic artery stenosis, and hepatic arterial kinks, while nonocclusive arterial disease encompasses less than 5% of complications and is a collective term used to describe arteriovenous fistulae, pseudoaneurysms, arterial rupture and nonocclusive hepatic artery hypoperfusion syndrome. This article details the angiographic techniques and definitions needed to accurately diagnose arterial transplant complications and describes the technical aspects and results of endoluminal management of these arterial complications. In addition, this article discusses the presentation, etiology and indications for treatment, including surgical management of these various complications.
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Affiliation(s)
- Ziga Cizman
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT.
| | - Wael Saad
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT
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8
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Agostini C, Buccianti S, Risaliti M, Fortuna L, Tirloni L, Tucci R, Bartolini I, Grazi GL. Complications in Post-Liver Transplant Patients. J Clin Med 2023; 12:6173. [PMID: 37834818 PMCID: PMC10573382 DOI: 10.3390/jcm12196173] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Liver transplantation (LT) is the treatment of choice for liver failure and selected cases of malignancies. Transplantation activity has increased over the years, and indications for LT have been widened, leading to organ shortage. To face this condition, a high selection of recipients with prioritizing systems and an enlargement of the donor pool were necessary. Several authors published their case series reporting the results obtained with the use of marginal donors, which seem to have progressively improved over the years. The introduction of in situ and ex situ machine perfusion, although still strongly debated, and better knowledge and treatment of the complications may have a role in achieving better results. With longer survival rates, a significant number of patients will suffer from long-term complications. An extensive review of the literature concerning short- and long-term outcomes is reported trying to highlight the most recent findings. The heterogeneity of the behaviors within the different centers is evident, leading to a difficult comparison of the results and making explicit the need to obtain more consent from experts.
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Affiliation(s)
| | | | | | | | | | | | - Ilenia Bartolini
- Department of Experimental and Clinical Medicine, AOU Careggi, 50134 Florence, Italy; (C.A.); (S.B.); (M.R.); (L.F.); (L.T.); (R.T.); (G.L.G.)
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9
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Endovascular treatment for early hepatic artery occlusion after liver transplantation: Angioplasty or stent. Hepatobiliary Pancreat Dis Int 2022; 21:614-615. [PMID: 35248481 DOI: 10.1016/j.hbpd.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/14/2022] [Indexed: 02/05/2023]
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10
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Zhu HK, Cao GH, Zheng SS. Reply to: Endovascular treatment for early hepatic artery occlusion after liver transplantation: Angioplasty or stent. Hepatobiliary Pancreat Dis Int 2022; 21:616. [PMID: 35248480 DOI: 10.1016/j.hbpd.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/14/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Heng-Kai Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Guo-Hong Cao
- Department of Radiology, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Shu-Sen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China.
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11
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Naidu SG, Alzubaidi SJ, Patel IJ, Iwuchukwu C, Zurcher KS, Malik DG, Knuttinen MG, Kriegshauser JS, Wallace AL, Katariya NN, Mathur AK, Oklu R. Interventional Radiology Management of Adult Liver Transplant Complications. Radiographics 2022; 42:1705-1723. [DOI: 10.1148/rg.220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sailendra G. Naidu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Sadeer J. Alzubaidi
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Indravadan J. Patel
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Chris Iwuchukwu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Kenneth S. Zurcher
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Dania G. Malik
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Martha-Gracia Knuttinen
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - J. Scott Kriegshauser
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Alex L. Wallace
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Nitin N. Katariya
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Amit K. Mathur
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Rahmi Oklu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
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12
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Risk factors and management of hepatic artery stenosis post liver transplantation. Dig Liver Dis 2022; 54:1052-1059. [PMID: 35331635 DOI: 10.1016/j.dld.2022.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic Artery Stenosis (HAS) after liver transplantation (LT), if untreated, can lead to hepatic artery thrombosis (HAT) that carries significant morbidity. AIMS To identify risk factors associated with HAS and determine if endovascular therapy (EVT) reduces the occurrence of HAT. METHODS This is a retrospective cohort study of adult LT patients between 2013 and 2018. The primary outcome was development of HAT, and secondary outcomes included graft failure and mortality. Logistic regression was used to ascertain the odds ratio of developing HAS. Outcomes between intervention types were compared with Fisher's-exact test. RESULTS The odds of HAS doubled in DCD-donor recipients (OR=2.27; P = 0.04) and transplants requiring vascular reconstruction for donor arterial variation (OR=2.19, P = 0.046). Of the 63 identified HAS patients, 44 underwent EVT, 7 with angioplasty alone, 37 combined with stenting. HAT was not significantly different in those who underwent angioplasty with or without stenting than conservative treatment (P = 0.71). However, compared to patients without HAS, patients with HAS had higher odds of biliary stricture and decreased graft and overall patient survival (log-rank P < 0.001 & P = 0.019, respectively). CONCLUSION HAS is significantly higher in DCD-graft recipients. EVT was not associated with reduction in HAT progression. HAS has poor graft and overall survival.
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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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14
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How to Handle Arterial Conduits in Liver Transplantation? Evidence From the First Multicenter Risk Analysis. Ann Surg 2021; 274:1032-1042. [PMID: 31972653 DOI: 10.1097/sla.0000000000003753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aims of the present study were to identify independent risk factors for conduit occlusion, compare outcomes of different AC placement sites, and investigate whether postoperative platelet antiaggregation is protective. BACKGROUND Arterial conduits (AC) in liver transplantation (LT) offer an effective rescue option when regular arterial graft revascularization is not feasible. However, the role of the conduit placement site and postoperative antiaggregation is insufficiently answered in the literature. STUDY DESIGN This is an international, multicenter cohort study of adult deceased donor LT requiring AC. The study included 14 LT centers and covered the period from January 2007 to December 2016. Primary endpoint was arterial occlusion/patency. Secondary endpoints included intra- and perioperative outcomes and graft and patient survival. RESULTS The cohort was composed of 565 LT. Infrarenal aortic placement was performed in 77% of ACs whereas supraceliac placement in 20%. Early occlusion (≤30 days) occurred in 8% of cases. Primary patency was equivalent for supraceliac, infrarenal, and iliac conduits. Multivariate analysis identified donor age >40 years, coronary artery bypass, and no aspirin after LT as independent risk factors for early occlusion. Postoperative antiaggregation regimen differed among centers and was given in 49% of cases. Graft survival was significantly superior for patients receiving aggregation inhibitors after LT. CONCLUSION When AC is required for rescue graft revascularization, the conduit placement site seems to be negligible and should follow the surgeon's preference. In this high-risk group, the study supports the concept of postoperative antiaggregation in LT requiring AC.
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15
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Aktas S, Alkara U, Sevmis M, Kilercik H, Yıldız H, Sevmis S. Analysis of Hepatic Arterial Reconstruction Technique Using Surgical Loupes for Living-Donor Liver Transplantation: Results From a Single Center. Transplant Proc 2021; 53:2929-2933. [PMID: 34756714 DOI: 10.1016/j.transproceed.2021.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/28/2021] [Accepted: 09/22/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The reconstruction of the hepatic artery (HA) is the most complex step in living-donor liver transplantation (LDLT) owing to the artery's smaller diameter and the increased risk for HA-related complications. In this study, we presented our HA anastomosis technique for LDLT, which employed interrupted sutures using magnifying loupes. MATERIALS AND METHODS Since January 2019, we retrospectively analyzed 179 LDLTs that were performed at our center. HA anastomosis was performed under a loupes magnifier (2.5 or 4.5 × ) by the same surgeon. RESULTS There were 65 female and 114 male recipients with a mean age of 41.6 ± 21.6 years. Of the recipients, 34 were children. HA thrombosis (HAT) was seen in 3 recipients (1.67%; 1 child and 2 adults) in this series. HAT occurred on the third, sixth, and seventh days after LDLT. HAT was successfully treated with interventional radiologic technique. All recipients are still alive with a patent HA. CONCLUSION The use of magnifying surgical loupes and interrupted sutures to perform HA reconstruction is safe, feasible, and yields a low rate of HAT. Also, endovascular treatment can be used safely for treatment of HAT within the first week after LDLT with a high success rate and is not associated with major complications.
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Affiliation(s)
- Sema Aktas
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Utku Alkara
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Interventional Radiology, Istanbul, Turkey
| | - Murat Sevmis
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Hakan Kilercik
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Hakan Yıldız
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Gastroenterology and Organ Transplantation, Istanbul, Turkey
| | - Sinasi Sevmis
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey.
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16
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Naidu S, Alzubaidi S, Knuttinen G, Patel I, Fleck A, Sweeney J, Aqel B, Larsen B, Buras M, Golafshar M, Oklu R. Treatment of Hepatic Artery Stenosis in Liver Transplant Patients Using Drug-Eluting versus Bare-Metal Stents. J Clin Med 2021; 10:jcm10030380. [PMID: 33498286 PMCID: PMC7863956 DOI: 10.3390/jcm10030380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 01/10/2023] Open
Abstract
Hepatic artery stenosis after liver transplant is often treated with endovascular stent placement. Our institution has adopted use of drug-eluting stents, particularly in small-caliber arteries. We aimed to compare patency rates of drug-eluting stents vs. traditional bare-metal stents. This was a single-institution, retrospective study of liver transplant hepatic artery stenosis treated with stents. Primary patency was defined as time from stent placement to resistive index on Doppler ultrasonography (<0.5), hepatic artery thrombosis, or any intervention including surgery. Fifty-two patients were treated with stents (31 men; mean age, 57 years): 15, drug-eluting stents; 37, bare-metal stents. Mean arterial diameters were 4.1 mm and 5.1 mm, respectively. Technical success was 100% (52/52). At 6 months, 1, 2, and 3 years, primary patency for drug-eluting stents was 80%, 71%, 71%, and 71%; bare-metal stents: 76%, 65%, 53%, and 46% (p = 0.41). Primary patency for small-caliber arteries (3.5–4.5 mm) with drug-eluting stents was 93%, 75%, 75%, and 75%; bare-metal stents: 60%, 60%, 50%, and 38% (p = 0.19). Overall survival was 100%, 100%, 94%, and 91%. Graft survival was 100%, 98%, 96%, and 90%. Stenting for hepatic artery stenosis was safe and effective. While not statistically significant, patency improved with drug-eluting stents compared with bare-metal stents, especially in arteries < 4.5 mm in diameter. Drug-eluting stents can be considered for liver transplant hepatic artery stenosis, particularly in small-caliber arteries.
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Affiliation(s)
- Sailendra Naidu
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (S.A.); (G.K.); (I.P.); (A.F.); (R.O.)
- Correspondence:
| | - Sadeer Alzubaidi
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (S.A.); (G.K.); (I.P.); (A.F.); (R.O.)
| | - Grace Knuttinen
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (S.A.); (G.K.); (I.P.); (A.F.); (R.O.)
| | - Indravadan Patel
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (S.A.); (G.K.); (I.P.); (A.F.); (R.O.)
| | - Andrew Fleck
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (S.A.); (G.K.); (I.P.); (A.F.); (R.O.)
| | - John Sweeney
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA;
| | - Bashar Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA;
| | - Brandon Larsen
- Division of Anatomic Pathology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA;
| | - Matthew Buras
- Division of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (M.B.); (M.G.)
| | - Michael Golafshar
- Division of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (M.B.); (M.G.)
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (S.A.); (G.K.); (I.P.); (A.F.); (R.O.)
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Kitano Y, Allard MA, Nakada S, Beghdadi N, Karam V, Vibert E, Sa Cunha A, Castaing D, Cherqui D, Baba H, Adam R. Early- and long-term outcomes of liver transplantation with rescue allocation grafts. Clin Transplant 2020; 35:e14046. [PMID: 32686220 DOI: 10.1111/ctr.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/20/2020] [Accepted: 07/11/2020] [Indexed: 11/30/2022]
Abstract
In France, liver grafts which have been refused by at least five centers are proposed as rescue allocation (RA). The aim of this study is to clarify the feasibility and safety of RA grafts in liver transplantation (LT). Short- and long-term outcomes of patients who received RA grafts (RA group) were compared with those of patients who received standard allocation (SA) grafts (SA group). From a total of 1635 patients, 102 patients received RA grafts. Before matching, the RA group was characterized primarily by less severe liver disease, but the quality of graft was worse. After matching recipients' characteristics of 102 patients who used RA grafts with 306 patients who used SA grafts, recipients' characteristics were well balanced (1:3 matching). Although the rate of primary dysfunction was significantly higher in the RA group, there is no significant difference in the occurrence of major complications, length of hospitalization, and mortality between two groups. Graft survival (GS) and overall survival (OS) in the RA group were not significantly different from the SA group (GS; HR = 1.03 P = .89, OS; HR = 1.03 P = .90). In the French allocation system, the feasibility and safety of RA grafts might be comparable to SA grafts for carefully selected patients.
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Affiliation(s)
- Yuki Kitano
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Marc-Antoine Allard
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France
| | - Shinichiro Nakada
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France.,Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nassiba Beghdadi
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France
| | - Vincent Karam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France
| | - Antonio Sa Cunha
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France
| | - Denis Castaing
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France
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18
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Zhu HK, Zhuang L, Chen CZ, Ye ZD, Wang ZY, Zhang W, Cao GH, Zheng SS. Safety and efficacy of an integrated endovascular treatment strategy for early hepatic artery occlusion after liver transplantation. Hepatobiliary Pancreat Dis Int 2020; 19:524-531. [PMID: 33071179 DOI: 10.1016/j.hbpd.2020.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/30/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatic artery occlusion (HAO) after liver transplantation (LT) is typically comprised of hepatic artery thrombosis (HAT) and stenosis (HAS), both of which are severe complications that coexist and interdependent. This study aimed to evaluate an integrated endovascular treatment (EVT) strategy for the resolution of early HAO and identify the risk factors associated with early HAO as well as the procedural challenge encountered in the treatment strategy. METHODS Consecutive orthotopic LT recipients (n = 366) who underwent transplantation between June 2017 and December 2018 were retrospectively investigated. EVT was performed using an integrated strategy that involved thrombolytic therapy, shunt artery embolization plus vasodilator therapy, percutaneous transluminal angioplasty, and/or stent placement. Simple EVT was defined as the clinical resolution of HAO by one round of EVT with thrombolytic therapy and/or shunt artery embolization plus vasodilator therapy. Otherwise, it was defined as complex EVT. RESULTS Twenty-six patients (median age 52 years) underwent EVT for early HAO that occurred within 30 days post-LT. The median interval from LT to EVT was 7 (6-16) days. Revascularization time (OR = 1.027; 95% CI: 1.005-1.050; P = 0.018) and the need for conduit (OR = 3.558; 95% CI: 1.241-10.203, P = 0.018) were independent predictors for early HAO. HAT was diagnosed in eight patients, and four out of those presented with concomitant HAS. We achieved 100% technical success and recanalization by performing simple EVT in 19 patients (3 HAT+/HAS- and 16 HAT-/HAS+) and by performing complex EVT in seven patients (1 HAT+/HAS-, 4 HAT+/HAS+, and 2 HAT-/HAS+), without major complications. The primary assisted patency rates at 1, 6, and 12 months were all 100%. The cumulative overall survival rates at 1, 6, and 12 months were 88.5%, 88.5%, and 80.8%, respectively. Autologous transfusion < 600 mL (94.74% vs. 42.86%, P = 0.010) and interrupted suture for hepatic artery anastomosis (78.95% vs. 14.29%, P = 0.005) were more prevalent in simple EVT. CONCLUSIONS The integrated EVT strategy was a feasible approach providing effective resolution with excellent safety for early HAO after LT. Appropriate autologous transfusion and interrupted suture technique helped simplify EVT.
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Affiliation(s)
- Heng-Kai Zhu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, China; NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment for Hepatobiliary and Pancreatic Cancer, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Provincial Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou 310003, China
| | - Li Zhuang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Cheng-Ze Chen
- Department of Intensive Care Unit, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Zhao-Dan Ye
- Department of Radiology, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Zhuo-Yi Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Wu Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Guo-Hong Cao
- Department of Radiology, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, China; NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment for Hepatobiliary and Pancreatic Cancer, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Provincial Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou 310003, China; Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China.
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19
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Fang J, Chen Z, Jiang N, He Q, Wang S, Zhang W, Ma J, Li G, Zhang L, Xu L, Yin W, Lai X, Chen R, Li L, Liu L, Xiong Y, Zhang T, Xu H, Wan J, Wu J, Pan G, Shi B, Li K. Reconstruction of the hepatic artery using the superior mesenteric artery for liver transplantation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1520. [PMID: 33313265 PMCID: PMC7729337 DOI: 10.21037/atm-20-7200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the application of the superior mesenteric artery (SMA) for the in vitro reconstruction of the hepatic artery for liver transplantation, and to improve the success rate and safety of donor liver transplantation. Methods The donor liver and the pancreas were obtained, and the SMA and its branches were used to reconstruct the hepatic artery. Liver transplantation was performed after reconstruction to understand the intraoperative situation after donor liver opening, as well as postoperative liver function. Color Doppler ultrasound of the transplanted liver was also performed. Results During the period from September 2016 to March 2020, a total of 98 pancreases were obtained. The common hepatic artery and gastroduodenal artery loop (CHA-GDA) were preserved to the donor pancreas, and only the proper hepatic artery (PHA) or left/right hepatic artery (LHA/RHA) were preserved to the donor liver. If the PHA of the donor liver was short or absent, the SMA was used for lengthening the PHA or in vitro reconstruction of the LHA/RHA, followed by implantation of the donor liver after reconstruction. A total of 17 cases of this type of donor liver required mesenteric artery lengthening or reconstruction. After opening, the donor liver was well-filled, bile secretion was normal, and liver function recovered as scheduled after surgery. Color Doppler ultrasound and CT angiography (CTA) of the transplanted liver revealed that hepatic arteries were normal without complications such as hepatic artery embolism. Conclusions In vitro reconstruction of the hepatic artery with the SMA is an effective new method of vascular reconstruction, which ensures the blood flow of the hepatic artery, reduces the anastomosis difficulty of the arteries of the donor liver, and reduces the occurrence of vascular complications.
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Affiliation(s)
- Jiali Fang
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zheng Chen
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nan Jiang
- Liver Transplant Center, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Qiang He
- Liver Transplant Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shaoping Wang
- Department of Hepatobiliary Surgery, General Hospital of Southern Theater Command, Guangzhou, China
| | - Weiting Zhang
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junjie Ma
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guanghui Li
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lei Zhang
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lu Xu
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Yin
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingqiang Lai
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongxin Chen
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Li
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luhao Liu
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunyi Xiong
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tao Zhang
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hailin Xu
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiao Wan
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jialin Wu
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guanghui Pan
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bingyi Shi
- Organ Transplantation Research Institute, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Kun Li
- Department of Hepatobiliary Surgery, The Second People's Hospital of Guiyang, Guiyang, China
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20
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Ly M, Crawford M, Verran D. Biliary complications in donation after circulatory death liver transplantation: the Australian National Liver Transplantation Unit's experience. ANZ J Surg 2020; 91:445-450. [PMID: 32985774 DOI: 10.1111/ans.16304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Biliary complications are the most common complications of donation after circulatory death (DCD) liver transplantation and the international experience with DCD transplants suggests increased rates of biliary complications compared to donation after brain death transplants. Therefore, it is important to understand factors that are associated with the development of biliary complications within the Australian DCD context in order to inform future practice. The aim of this study is to determine the incidence of biliary complications after DCD liver transplantation at the Australian National Liver Transplantation Unit and identify factors associated with this outcome. METHODS A retrospective analysis of all adult DCD liver transplants at the Australian National Liver Transplantation Unit from 2007 to 2015 was undertaken. The primary outcome measure was the incidence of biliary complications and was censored on 31 December 2016. Recipients were then stratified into groups based on the development of biliary complications and risk factor analysis was performed. RESULTS Biliary complications occurred in 35% of DCD transplants, including seven anastomotic strictures and 10 non-anastomotic strictures. Higher donor risk index scores (P = 0.03), post-transplant portal vein complications (P = 0.042) and peak gamma-glutamyl transferase levels within 7 days post-transplant (P = 0.047) were associated with biliary complications. CONCLUSION Findings from this study demonstrate that biliary complications remain common in DCD liver recipients. Recipients who developed a biliary complication tended to have higher donor risk index, elevated peak gamma-glutamyl transferase levels within 7 days post-transplant or a portal vein complication. The presence of any of these factors should prompt close monitoring for post-transplant biliary complications.
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Affiliation(s)
- Mark Ly
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Crawford
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Deborah Verran
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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21
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Goria O, Archambeaud I, Lemaitre C, Dutheil D, Plessier A, Rautou PE, Hernandez-Gea V, Valla D. Ischemic cholangiopathy: An update. Clin Res Hepatol Gastroenterol 2020; 44:486-490. [PMID: 32461060 DOI: 10.1016/j.clinre.2020.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Odile Goria
- Gastroenterology and hepatology unit, Charles Nicolle hospital, university hospital of Rouen, 1, rue de Germont, 76038 Rouen, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
| | - Isabelle Archambeaud
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Gastroenterology and hepatology unit, Nantes university hospital, Nantes, France
| | - Caroline Lemaitre
- Gastroenterology and hepatology unit, Charles Nicolle hospital, university hospital of Rouen, 1, rue de Germont, 76038 Rouen, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Danielle Dutheil
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Association of patients with vascular liver diseases (AMVF), department of hepatology, Beaujon hospital, 100, boulevard du Général-Leclerc, 92118 Clichy, France
| | - Aurélie Plessier
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Department of hepatology, Beaujon hospital AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; Reference center of vascular liver diseases, European Reference Network (ERN) "Rare-Liver", Hamburg, Germany
| | - Pierre-Emmanuel Rautou
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Department of hepatology, Beaujon hospital AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; Reference center of vascular liver diseases, European Reference Network (ERN) "Rare-Liver", Hamburg, Germany
| | - Virginia Hernandez-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd). Health Care Provider of the European Reference Network onRare Liver Disorders (ERN-Liver), Spain
| | - Dominique Valla
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Department of hepatology, Beaujon hospital AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; Reference center of vascular liver diseases, European Reference Network (ERN) "Rare-Liver", Hamburg, Germany
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22
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Gastaca M, Gomez J, Terreros I, Izquierdo J, Ruiz P, Prieto M, Ventoso A, Palomares I, Aguinaga A, Valdivieso A. Endovascular Therapy of Arterial Complications Within the First Week After Liver Transplant. Transplant Proc 2020; 52:1464-1467. [PMID: 32220478 DOI: 10.1016/j.transproceed.2020.02.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/07/2020] [Accepted: 02/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent radiologic advances have made endovascular treatment a very successful option for arterial complications after liver transplant. This article presents our experience of using endovascular treatments during the first week after liver transplant. METHODS This study is a retrospective, single-center analysis. Liver transplants performed between 2010 and 2018 were analyzed. All patients underwent Doppler ultrasonography on days 1 and 7. Endovascular therapy was indicated in hepatic artery thrombosis diagnosed early after transplant and in stenosis when hepatic narrowing was > 70%. Patients were treated with subcutaneous anticoagulant therapy and with antiplatelet agents after endovascular therapy. RESULTS Seven patients (1.1%) were included in the study. Stenosis was the reason in 5 patients while 2 patients had symptoms of thrombosis. The first 2 patients were initially treated with angioplasty; both had restenosis and were treated with angioplasty and stent placement, respectively. The 5 most recent patients received stenting as a primary treatment. Two of these patients developed a new stenosis. No patient developed any hepatic artery complication related to the procedure, and only 1 patient experienced a postprocedure complication (femoral artery pseudoaneurysm), which was managed conservatively. No patient required retransplant. After a median follow-up of 48 months (range, 35-85 months) 1 patient had died, and the rest were alive and asymptomatic. CONCLUSIONS Although there is scant experience of the use of endovascular therapy very shortly after liver transplant, recent advances in interventional radiology have made the technique feasible and safe, and it achieves a high success rate.
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Affiliation(s)
- Mikel Gastaca
- Biocruces Bizkaia Health Research Institute. Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain; University of the Basque Country, Bilbao, Spain.
| | - Javier Gomez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario San Cecilio, Granada, Spain
| | - Ignacio Terreros
- Interventional Radiology Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Javier Izquierdo
- Interventional Radiology Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Patricia Ruiz
- Biocruces Bizkaia Health Research Institute. Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Mikel Prieto
- Biocruces Bizkaia Health Research Institute. Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain; University of the Basque Country, Bilbao, Spain
| | - Alberto Ventoso
- Biocruces Bizkaia Health Research Institute. Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Ibone Palomares
- Biocruces Bizkaia Health Research Institute. Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Alexander Aguinaga
- University of the Basque Country, Bilbao, Spain; Interventional Radiology Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Andrés Valdivieso
- Biocruces Bizkaia Health Research Institute. Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain; University of the Basque Country, Bilbao, Spain
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23
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Barahman M, Alanis L, DiNorcia J, Moriarty JM, McWilliams JP. Hepatic artery stenosis angioplasty and implantation of Wingspan neurovascular stent: A case report and discussion of stenting in tortuous vessels. World J Gastroenterol 2020; 26:448-455. [PMID: 32063693 PMCID: PMC7002905 DOI: 10.3748/wjg.v26.i4.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/05/2019] [Accepted: 01/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic artery stenosis is a complication of orthotopic liver transplant occurring in 3.1%-7.4% of patients that can result in graft failure and need for re-transplantation. Endovascular therapy with angioplasty and stenting has been used with a high degree of technical success and good clinical outcomes, but tortuous hepatic arteries present a unique challenge for intervention. Suitable stents for this application should be maneuverable and conformable while also exerting adequate radial force to maintain a patent lumen.
CASE SUMMARY Herein we report our experience with a neurovascular Wingspan stent system in a challenging case of recurrent hepatic artery stenosis and discuss the literature of stenting in tortuous transplant hepatic arteries.
CONCLUSION Wingspan neurovascular stent is self-expanding, has good conformability, and adequate radial resistance and as such it could be added to the armamentarium of interventionalists in the setting of a tortuous and stenotic transplant hepatic artery.
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Affiliation(s)
- Mark Barahman
- Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, United States
| | - Lourdes Alanis
- Department of Radiology, Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
- Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Joseph DiNorcia
- Department of Surgery, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - John M Moriarty
- Department of Radiology, Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
- Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Justin P McWilliams
- Department of Radiology, Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
- Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
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24
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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: 1.2] [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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25
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Vairavamurthy JP, Li C, Urban S, Katz M. Percutaneous Transarterial Stent Placement in a Transplant Liver Hepatic Artery Complicated by Angioplasty Balloon Rupture and Fragmentation. Semin Intervent Radiol 2019; 36:133-136. [PMID: 31123386 DOI: 10.1055/s-0039-1688428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The incidence of posttransplant hepatic arterial stenosis (HAS) has been reported in 5 to 10% of orthotopic liver transplants and, left untreated, can lead to hepatic arterial thrombosis. Most vascular complications develop less than 3 months after initial transplant, with thrombosis representing over half of all complications. There has been a trend toward minimally invasive, endovascular techniques for treating HAS with angioplasty and stenting. In one review of endovascular therapies for HAS, primary technical success was achieved in 95% of the interventions. Complication rates following endovascular repair of HAS have been reported to be between 0 and 23% in the literature. The main risk factors for complications include tortuosity of the hepatic artery and history of a second liver transplant. Other associated risk factors include female gender, age greater than 60 years, prior history of transarterial chemoembolization, and multiple arterial graft anastomoses. The case presented here is representative of a complication of balloon rupture and fragmentation in a patient undergoing hepatic arterial stent placement post-liver transplant.
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Affiliation(s)
- Jenanan P Vairavamurthy
- Division of Interventional Radiology, Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Charles Li
- Division of Interventional Radiology, Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Seth Urban
- Division of Interventional Radiology, Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michael Katz
- Division of Interventional Radiology, Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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26
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Molvar C, Ogilvie R, Aggarwal D, Borge M. Transplant Hepatic Artery Stenosis: Endovascular Treatment and Complications. Semin Intervent Radiol 2019; 36:84-90. [PMID: 31123377 DOI: 10.1055/s-0039-1688420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hepatic artery stenosis (HAS) is an infrequent complication of liver transplant; if left untreated, it can lead to hepatic artery thrombosis with high risk of biliary necrosis and graft loss. HAS is diagnosed with screening Doppler ultrasound, together with computed tomography angiography and magnetic resonance angiography. Endovascular treatment with angioplasty ± stent placement is safe and effective with infrequent major complications; however, when complications occur, they can devastate long-term graft survival. Herein, we present two cases of HAS treated with balloon angioplasty with resultant major complications requiring operative intervention.
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Affiliation(s)
- Christopher Molvar
- Section of Vascular and Interventional Radiology, Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Ross Ogilvie
- Section of Vascular and Interventional Radiology, Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Deep Aggarwal
- Section of Vascular and Interventional Radiology, Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Marc Borge
- Section of Vascular and Interventional Radiology, Department of Radiology, Loyola University Medical Center, Maywood, Illinois
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27
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Capelli R, Allard M, Ciacio O, Pittau G, Golse N, Vibert E, Sa Cunha A, Castaing D, Cherqui D, Adam R. Late hepaticartery thrombosis after liver transplantation: which strategy? A single‐center retrospective study. Transpl Int 2019; 32:473-480. [DOI: 10.1111/tri.13394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/22/2018] [Accepted: 12/12/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Rafaela Capelli
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
| | - Marc‐Antoine Allard
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Unités Mixtes de Recherche en Santé 1193 Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - Oriana Ciacio
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
| | - Gabriella Pittau
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
| | - Nicolas Golse
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Unités Mixtes de Recherche en Santé 1193 Villejuif France
| | - Eric Vibert
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Unités Mixtes de Recherche en Santé 1193 Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - Antonio Sa Cunha
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - Denis Castaing
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Unités Mixtes de Recherche en Santé 1193 Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - Daniel Cherqui
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
| | - René Adam
- Centre Hépato‐Biliaire AP‐HP Hôpital Paul Brousse Villejuif France
- Faculté de Médecine Université Paris‐Sud Le Kremlin‐Bicêtre France
- Unités Mixtes de Recherche en Santé 985 INSERM Villejuif France
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28
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Jang HY, Kim KW, Kim SY, Kim JS, Choi SH, Kim SY, Lee SG. Visibility of the graft hepatic artery using superb microvascular imaging in liver transplantation recipients: initial experience. Acta Radiol 2018; 59:1326-1335. [PMID: 29430938 DOI: 10.1177/0284185118757275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Hepatic artery (HA) obstruction is one of the most threatening complications following liver transplantation (LT); however, conventional color Doppler imaging (CDI) suffers from technical limitations regarding the visualization of fine vessels and low-velocity blood flow. Purpose To test the visibility of HA in postoperative evaluation of LT using a superb microvascular imaging (SMI). Material and Methods This retrospective study was approved by our institutional review board. Fifty-five consecutive patients (58 grafts; mean age = 56 years) who underwent LT with Doppler ultrasonography (US) on postoperative day 1 were included. We compared the subjective visibility of HA and objective measurements of HA caliber, visible HA length on CDI, monochrome SMI (mSMI), contrast-enhanced mSMI (CE-mSMI), and contrast harmonic imaging (CHI). Reproducibility of HA caliber measurements on SMI techniques were also evaluated by using intraclass correlation coefficients (ICCs). Results The subjective image quality for visibility of HA tended to be graded higher with mSMI than CDI, and with CE-mSMI than mSMI ( P < 0.001). The overall reproducibility of HA caliber measurements was good to excellent for both mSMI and CE-mSMI (ICC = 0.674-0.855). HA caliber measurements on mSMI and CE-mSMI strongly correlated with CHI ( R = 0.785, 0.798, P < 0.001), while mean HA length on mSMI was significantly longer than on CDI (1.88 ± 0.83 vs. 1.42 ± 1.01cm, P = 0.004), and even longer on CE-mSMI (vs. 3.28 ± 1.11 cm, P < 0.001). Conclusion The mSMI technique shows good reproducibility and correlates well with currently used methods for postoperative evaluation of HA in LT recipients. It is further improved by administration of an US contrast agent.
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Affiliation(s)
- Hye Young Jang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Kyoung Won Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Sil Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Mokdong Hospital, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Se-Young Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sung-Gyu Lee
- Division of Liver Transplantation and Hepatobiliary Surgery, Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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29
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Sarwar A, Chen C, Khwaja K, Malik R, Raven KE, Weinstein JL, Evenson A, Faintuch S, Fisher R, Curry MP, Ahmed M. Primary Stent Placement for Hepatic Artery Stenosis After Liver Transplantation: Improving Primary Patency and Reintervention Rates. Liver Transpl 2018; 24:1377-1383. [PMID: 30359488 DOI: 10.1002/lt.25292] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/22/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023]
Abstract
Recent studies have reported high rates of reintervention after primary stenting for hepatic artery stenosis (HAS) due to the loss of primary patency. The aims of this study were to evaluate the outcomes of primary stenting after HAS in a large cohort with longterm follow-up. After institutional review board approval, all patients undergoing liver transplantation between 2003 and 2017 at a single institution were evaluated for occurrence of hepatic artery complications. HAS occurred in 37/454 (8%) of patients. HAS was defined as >50% stenosis on computed tomography or digital subtraction angiography. Hepatic arterial patency and graft survival were evaluated at annual intervals. Primary patency was defined as the time from revascularization to imaging evidence of new HAS or reaching a censored event (retransplantation, death, loss to follow-up, or end of study period). Primary stenting was attempted in 30 patients (17 female, 57%; median age, 51 years; range, 24-68 years). Surgical repair of HAS prior to stenting was attempted in 5/30 (17%) patients. Endovascular treatment was performed within 1 week of the primary anastomosis in 5/30 (17%) of patients. Technical success was accomplished in 97% (29/30) of patients. Primary patency was 90% at 1 year and remained unchanged throughout the remaining follow-up period (median, 41 months; interquartile range [IQR], 25-86 months). Reintervention was required in 3 patients to maintain stent patency. The median time period between primary stenting and retreatment was 5.9 months (IQR, 4.4-11.1 months). There were no major complications, and no patient developed hepatic arterial thrombosis or required listing for retransplantation or retransplantation during the follow-up period. In conclusion, primary stenting for HAS has excellent longterm primary patency and low reintervention rates.
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Affiliation(s)
- Ammar Sarwar
- Divisions of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christine Chen
- Divisions of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Khalid Khwaja
- Divisions of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Raza Malik
- Divisions of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kristin E Raven
- Divisions of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jeffrey L Weinstein
- Divisions of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Amy Evenson
- Divisions of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Salomao Faintuch
- Divisions of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robert Fisher
- Divisions of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael P Curry
- Divisions of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Muneeb Ahmed
- Divisions of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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30
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Marked Decrease in Urgent Listing for Liver Transplantation Over Time: Evolution of Characteristics and Outcomes of Status-1 Liver Transplantation. Transplantation 2018; 102:e18-e25. [PMID: 28968354 DOI: 10.1097/tp.0000000000001967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Approximately 5% of liver transplants annually are performed urgently with "status-1" designation. This study aims to determine if the demand, characteristics, and outcome for status-1 liver transplantation has changed over time. METHODS We used the Scientific Registry of Transplant Patients (2003-2015) to characterize 2352 adult patients who underwent 2408 status-1 liver transplants and compared them between Era1 (2003-6/2009) and Era2 (7/2009-2015). RESULTS Overall, there were fewer liver transplants performed with the status-1 designation in Era2 than Era1 (1099 vs 1309). Although the number of urgent liver transplants was relatively constant with successive years, the proportion transplanted with status-1 designation decreased markedly over time. Era2 patients were older (43.2 years vs 41.7 years, P = 0.01) and less likely be ABO-incompatible (1.1% vs 2.4%, P = 0.01) or retransplant (77 vs 124, P = 0.03). In terms of disease etiology, the largest group was "acute liver failure (ALF), nonspecified" (43.4%). There was no difference in proportion with drug-induced liver injury (DILI), but the subset of herbal/dietary supplements increased in Era2 (1.3% vs 0.46%, P = 0.04). Survival was increased in Era2 in the overall cohort and for patients with autoimmune disease (P < 0.05), despite longer waiting times for this etiology (186 days vs 149 days). DILI or nonspecified ALF had shorter waiting times, and 90% were transplanted within 7 days. CONCLUSIONS Liver transplantation for the most urgent indications (status-1) is decreasing while survival remains excellent. Fewer incidences of ALF are classified as indeterminate, mostly as a result of increasing awareness of autoimmune hepatitis and DILI as causes of the syndrome.
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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: 0.6] [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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Is Routine Intraoperative Contrast-Enhanced Ultrasonography Useful During Whole Liver Transplantation? World J Surg 2017; 42:1523-1535. [DOI: 10.1007/s00268-017-4295-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Allard MA, Lopes F, Frosio F, Golse N, Sa Cunha A, Cherqui D, Castaing D, Adam R, Vibert E. Extreme large-for-size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication. Liver Transpl 2017; 23:1294-1304. [PMID: 28779555 DOI: 10.1002/lt.24835] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/14/2017] [Accepted: 07/09/2017] [Indexed: 02/07/2023]
Abstract
There is currently no tool available to predict extreme large-for-size (LFS) syndrome, a potentially disastrous complication after adult liver transplantation (LT). We aimed to identify the risk factors for extreme LFS and to build a simple predictive model. A cohort of consecutive patients who underwent LT with full grafts in a single institution was studied. The extreme LFS was defined by the impossibility to achieve direct fascial closure, even after delayed management, associated with early allograft dysfunction or nonfunction. Computed tomography scan-based measurements of the recipient were done at the lower extremity of the xiphoid. After 424 LTs for 394 patients, extreme LFS occurred in 10 (2.4%) cases. The 90-day mortality after extreme LFS was 40.0% versus 6.5% in other patients (P = 0.003). In the extreme LFS group, the male donor-female recipient combination was more often observed (80.0% versus 17.4%; P < 0.001). The graft weight (GW)/right anteroposterior (RAP) distance ratio was predictive of extreme LFS with the highest area under the curve (area under the curve, 0.95). The optimal cutoff was 100 (sensitivity, 100%; specificity, 88%). The other ratios based on height, weight, body mass index, body surface area, and standard liver volume exhibited lower predictive performance. The final multivariate model included the male donor-female recipient combination and the GW/RAP. When the GW to RAP ratio increases from 80, 100, to 120, the probability of extreme LFS was 2.6%, 9.6%, and 29.1% in the male donor-female recipient combination, and <1%, 1.2%, and 4.5% in other combinations. In conclusion, the GW/RAP ratio predicts extreme LFS and may be helpful to avoid futile refusal for morphological reasons or to anticipate situation at risk, especially in female recipients. Liver Transplantation 23 1294-1304 2017 AASLD.
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Affiliation(s)
- Marc-Antoine Allard
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 935, Villejuif, France
| | - Felipe Lopes
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Fabio Frosio
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Nicolas Golse
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France
| | - Antonio Sa Cunha
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France
| | - Daniel Cherqui
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 785, Paris, France
| | - Denis Castaing
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 785, Paris, France
| | - René Adam
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 935, Villejuif, France
| | - Eric Vibert
- Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.,Université Paris-Sud, Orsay, France.,INSERM 785, Paris, France
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Thornburg B, Katariya N, Riaz A, Desai K, Hickey R, Lewandowski R, Salem R. Interventional radiology in the management of the liver transplant patient. Liver Transpl 2017; 23:1328-1341. [PMID: 28741309 DOI: 10.1002/lt.24828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023]
Abstract
Liver transplantation (LT) is commonly used to treat patients with end-stage liver disease. The evolution of surgical techniques, endovascular methods, and medical care has led to a progressive decrease in posttransplant morbidity and mortality. Despite these improvements, a multidisciplinary approach to each patient remains essential as the early diagnosis and treatment of the complications of transplantation influence graft and patient survival. The critical role of interventional radiology in the collaborative approach to the care of the LT patient will be reviewed. Liver Transplantation 23 1328-1341 2017 AASLD.
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Affiliation(s)
- Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Nitin Katariya
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Robert Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.,Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
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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: 22] [Impact Index Per Article: 2.8] [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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Taner T, Heimbach J. To stent or not to stent: Endovascular treatment of hepatic artery stenosis. Liver Transpl 2016; 22:884-5. [PMID: 27149241 DOI: 10.1002/lt.24476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Timucin Taner
- Division of Transplantation Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Julie Heimbach
- Division of Transplantation Surgery, Mayo Clinic College of Medicine, Rochester, MN
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