title: Hepatic allograft rescue following arterial thrombosis. Role of urgent revascularization.
abstract: Hepatic artery thrombosis is a continuing source of morbidity and mortality following orthotopic liver transplantation. The cornerstone of therapy has been urgent retransplantation that is limited by organ availability. For this reason we developed a policy of urgent revascularization for allograft rescue. Hepatic artery thrombosis developed following 15 transplants of which 11 underwent urgent rearterialization. The diagnosis was made a mean of 4.8 days (range 1-10) following transplantation. Duplex ultrasonography was diagnostic in all patients and confirmed by angiography in 4 (36%). Three patients with hepatic artery thrombosis were identified following screening ultrasonography and were clinically unsuspected. Upon reexploration, a specific technical reason for hepatic artery was found in 4 patients (36%). Twelve arterial revascularization procedures were performed in 11 patients including: thrombectomy alone (n = 4); revision of anastomosis with thrombectomy (n = 5); and thrombectomy with placement of vascular conduit (n = 3). Following revascularization, 8 patients maintained hepatic artery patency. Three patients eventually required retransplantation secondary to biliary sepsis. Biliary tract complications developed in 6 patients, at a mean of 23 days following revascularization and included: breakdown of the biliary anastomosis (n = 4); stricture (n = 1); and sludge formation (n = 1). The overall graft and patient survival are 74% and 82% respectively, with a mean follow-up of 6.8 months. Hepatic allograft rescue with the use of urgent revascularization following hepatic artery thrombosis appears to be an effective means of either avoiding retransplantation or providing a bridge until a suitable donor becomes available.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
authors.forename: A N
authors.initials: AN
authors.lastname: Langnas
authors.forename: W
authors.initials: W
authors.lastname: Marujo
authors.forename: R J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: R P
authors.initials: RP
authors.lastname: Wood
authors.forename: S J
authors.initials: SJ
authors.lastname: Li
authors.forename: B W
authors.initials: BW
authors.lastname: Shaw
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000209:etiology; D002648:Child; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D014184:Transplantation, Homologous; D014463:Ultrasonography