Living donor liver graft salvage after rupture of hepatic artery pseudoaneurysm.
Hepatic artery pseudoaneurysm (HAP) is an uncommon but life-threatening complication of liver transplantation (LTx). It is often associated with a local infection. Prompt diagnosis and intervention are necessary. We report the first occurrence of such complication in the setting of adult living donor liver transplant. A 48-year-old female with primary sclerosing cholangitis underwent living donor right lobe LTx. Her postoperative course was uneventful. A month later, she developed massive gastrointestinal bleeding, with negative endoscopy and angiography. She rebled 2 weeks later, and an HAP was shown on angiography. On exploration, she was found to have an HAP caused by bile leakage from an accessory bile duct and a dissection of the native artery, likely a result of the angiography. The liver was revascularized using a cadaveric iliac artery conduit between the donor hepatic artery and the aorta, and the hepaticojejunostomy was reconstructed. Biliary complications are the most frequent complications in living donor LTx. A clinically silent bile leak can cause an HAP, resulting in massive gastrointestinal bleeding. Surgical repair and biliary reconstruction can yield an excellent clinical result.
Jarzembowski
Tomasz M
TM
Department of Surgery, Division of Transplantation, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Sankary
Howard N
HN
Bogetti
Diego
D
Manzelli
Antonio
A
Ong
Evan
E
Oberholzer
Jose
J
Benedetti
Enrico
E
Testa
Giuliano
G
D000714:Anastomosis, Surgical; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery*; D015209:Cholangitis, Sclerosing / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012008:Recurrence