Prevalence, treatment, and outcomes of the hepatic artery stenosis after liver transplantation.
BACKGROUND
Hepatic artery stenosis (HAS) after liver transplantation can lead to altered hepatic function and/or thrombosis, there by increasing morbidity and mortality. The prevalence of HAS in the literatures varies from 4% to 11%.


OBJECTIVE
We sought to describe the prevalence and treatment of hepatic artery stenosis.


METHODS
We performed a descriptive retrospective analysis of 253 liver transplantations from March 1998 to May 2007, including patients with suspected HAS owing to increased hepatic enzymes, altered Doppler ultrasound (us) and hepatic biopsy. The confirmation of HAS was achieved through areriography.


RESULTS
Nine patients were identified to have HAS, a 3.5% prevalence. Among the HAS patients, seven were male and two female. Their average age was 35.5 years (range, 65 to 53). The average time between the diagnosis and transplantation was 14.2 months (range, 9 to 68). The increase in hepatic enzymes among this group averaged: aspartate aminotransferase 131 U/L (range, 26 to 412) and alanine aminotransferase 192 U/L (range, 35 to 511). Doppler US showed alteration in the resistance level index. All patients underwent areriography; only one could not be treated owing to severe hepatic artery spasm, which also occurred during another attempt weeks after the first one. Among the eight patients, six were treated with stents and two with angioplastis. All treated patients displayed improvements in parameters. Four patients treated with stents required retreatment: two underwent angioplasty and two, a thrombolytic. One graft rethrombosed but evolved in compensated fashion with recanalization by collaterals. There has been no graft loss or mortality in this population. The average time of posttreatment follow-up was 31.28 (range, 9 to 68) months.


CONCLUSIONS
The prevalence of HAS in our unit was within that reported in the literature. Treatment with a stent or angioplasty proved to be efficient to control this complication, considering that hepatic function recovered and that there was neither graft nor patient loss.
da Silva
R F
RF
FAMERP Medical School / FUNFARME, Sao Paulo, Brazil. renatosilva@farmerp.br
Raphe
R
R
Felício
H C
HC
Rocha
M F
MF
Duca
W J
WJ
Arroyo
P C J
PC
Palini
G L
GL
Vasquez
A M
AM
Miquelin
D G
DG
Reis
L F
LF
Silva
A A M
AA
da Silva
R C M A
RC
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001157:Arterial Occlusive Diseases / Q000453:epidemiology* / Q000628:therapy; D001219:Aspartate Aminotransferases / Q000097:blood; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase