Treatment of vascular complications following liver transplantation: multidisciplinary approach.
OBJECTIVE
Complications affecting the vascularization of the graft following orthotopic liver transplantation still represent a significant cause of graft loss and patient mortality. Strategies have recently been developed for the early detection and treatment of these complications before irreversible graft failure takes place.


METHODS
A series of 429 consecutive liver transplants performed on 384 patients between April 1986 and December 1998 was retrospectively reviewed to assess the incidence of all the vascular complications and the results of their treatment with either surgery or interventional radiology.


RESULTS
The incidence of vascular complications was 6.06% for the hepatic artery, 2.56% for the inferior vena cava and 1.16% for the portal vein. As regards anastomotic stenosis and thrombosis, the requirement of retransplantation decreased progressively with the advent of systematic postoperative screening with duplex Doppler ultrasonography and the introduction of graft-salvage procedures, falling from 50% for those cases diagnosed before 1996 to 19% for those diagnosed from 1996 on. Mortality following 18 graft-salvage procedures was 11.1% versus 41.6% following retransplantation. Graft-salvage procedures were successful in 14 out of 18 cases.


CONCLUSIONS
Close surveillance of the vascular anastomoses and multidisciplinary approach to the treatment of vascular complication after liver transplantation considerably reduces graft loss and patient mortality.
Clinica Chirurgica II, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy.
A
A
Cavallari
M
M
Vivarelli
R
R
Bellusci
E
E
Jovine
A
A
Mazziotti
C
C
Rossi
D000714:Anastomosis, Surgical; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D000800:Angioplasty, Balloon; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000628:therapy; D006085:Graft Survival; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D011169:Portal Vein / Q000601:surgery; D019233:Retreatment; D012189:Retrospective Studies; D013157:Splenic Artery / Q000601:surgery; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D014684:Venae Cavae / Q000601:surgery