Intraarterial thrombolytic treatment for hepatic artery thrombosis immediately after living donor liver transplantation.
Hepatic artery thrombosis (HAT) following living donor liver transplantation (LDLT) remains one of the major causes of graft failure and mortality in liver transplant recipients. This complication requires early diagnosis and revascularization to avoid graft loss. We have reported herein two cases of successful urokinase intraarterial thrombolytic treatment for HAT in the immediate postoperative period after LDLT. Significant elevation of liver transaminases was noted 6 and 4 hours after LDLT and HAT confirmed by three-dimensional computed tomogram and angiogram. Both patients were treated successfully with intraarterial thrombolysis using an urokinase infusion (a total dose of 200,000 to 250,000 IU over 20 to 25 minutes) immediately after HAT was confirmed. One patient underwent laparotomy and bleeder ligation owing to hepatic arterial anastomotic site bleeding after thrombolysis. These two patients remain in good condition without any ischemic graft sequelae at 7 and 8 months follow-up. In conclusion, intraarterial thrombolysis using an urokinase infusion could be considered as one of the treatment modalities of acute HAT following LDLT even in the immediate postoperative period.
Kim
B-W
BW
Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Won
J-H
JH
Lee
B-M
BM
Ko
B-H
BH
Wang
H-J
HJ
Kim
M-W
MW
D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator