title: Hepatic artery complications after orthotopic liver transplantation: interventional treatment or retransplantation?
abstract: BACKGROUND
  The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation (OLT) include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT.
  
  
  METHODS
  The clinical data of 25 patients diagnosed with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement.
  
  
  RESULTS
  Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients' liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion.
  
  
  CONCLUSIONS
  Individualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.
authors.affiliation: Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.forename: Bin-sheng
authors.initials: BS
authors.lastname: Fu
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Ying-cai
authors.initials: YC
authors.lastname: Zhang
authors.forename: Ming-qiang
authors.initials: MQ
authors.lastname: Lu
authors.forename: Chang-jie
authors.initials: CJ
authors.lastname: Cai
authors.forename: Chi
authors.initials: C
authors.lastname: Xu
authors.forename: Gen-shu
authors.initials: GS
authors.lastname: Wang
authors.forename: Shu-hong
authors.initials: SH
authors.lastname: Yi
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.forename: Jun-feng
authors.initials: JF
authors.lastname: Zhang
authors.forename: Hui-min
authors.initials: HM
authors.lastname: Yi
authors.forename: Nan
authors.initials: N
authors.lastname: Jiang
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.forename: Kang-shun
authors.initials: KS
authors.lastname: Zhu
authors.forename: Zai-bo
authors.initials: ZB
authors.lastname: Jiang
authors.forename: Hong
authors.initials: H
authors.lastname: Shan
authors.forename: Gui-hua
authors.initials: GH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic; D005260:Female; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013927:Thrombosis / Q000628:therapy*