Late acute celiac and hepatic artery thrombosis with portal vein thrombosis resulting in hepatic infarction 12 years post orthotopic liver transplantation.
Hepatic artery thrombosis (HAT) is relatively infrequent, but possibly a devastating complication of orthotopic liver transplantation (OLT). It often requires urgent retransplantation. Two main forms of HAT are recognized as early and late HAT (diagnosis within or after 30 days following LT). Early HAT typically results in graft failure. Late HAT features biliary obstruction, cholangitis, and hepatic abscess formation. We report here the case of a patient of Wilson's disease who presented twelve years post-liver transplant symptoms typical of acute HAT and hepatic infarction. On diagnostic imaging, celiac axis and hepatic artery were thrombosed, resulting in ischemic necrosis of the left hepatic lobe. The resulting sepsis and transient hepatic insufficiency were managed conservatively, and repeat OLT was avoided. The patient remains stable more than one year later. To the best of our knowledge this case report is unique in the literature for the unusually long interval between OLT and late acute HAT, as well as celiac and portal vein occlusion. The acute presentation of sub massive hepatic necrosis is also uncharacteristic of late HAT and more typical of acute HAT. This report describes our experience in managing this and a literature review of the topic.
Haque
Mazhar
M
Division of Gastroenterology, University of British Columbia, British Columbia Transplant Society, BC, Canda.
Schumacher
P Andrew
PA
Harris
Alison
A
Scudamore
Charles H
CH
Steinbrecher
Urs P
UP
Chung
Stephen W
SW
Buczkowski
Andrezj K
AK
Erb
Siegfried R
SR
Yoshida
Eric M
EM
D000328:Adult; D002445:Celiac Artery; D006499:Hepatic Artery; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology*; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging; D016031:Liver Transplantation; D008297:Male; D011169:Portal Vein; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed