[The role of early hepatic artery ischemia on biliary complications after liver transplantation and hepatic arterial interventional therapy].
OBJECTIVE
To explore the influence of early hepatic artery ischemia on the occurrence and prognosis of biliary complications after orthotopic liver transplantation (OLT), and the value of early hepatic arterial interventional therapy.


METHODS
In the 720 recipients who received OLT in our hospital from October 2003 to June 2007, 32 cases were detected hepatic artery stenosis (HAS, 30 cases) or hepatic artery thrombosis (HAT, 2 cases) by color Doppler Ultrasound from 4 to 65 days (mean, 25 +/- 15) after OLT. All of them were confirmed by DSA and/or CT angiography. Of the 32 patients, 20 were treated by hepatic arterial interventional therapy. The end-point of follow-up was the time of patient's death and retransplantation.


RESULTS
In this study, 20 cases developed biliary complications, including the common bile duct stenosis in 2 cases, intra- and extra hepatic bile duct stenosis in 13 cases and multiple intrahepatic bile duct stenosis in 5 cases. Among them, 2 patients complicated with bile leakage, 4 with biloma and 3 with liver abscess. Of the 20 patients, 8 with HAS received successful hepatic arterial interventional therapy which was performed two weeks after HAS detected; 10 with HAS didn't receive hepatic arterial interventional therapy; 1 with HAT received successful thrombolysis; 1 with HAS received failed hepatic artery stent implantation. During a median follow-up of 262 days (range, 22 -517 days), 10 patients died, 6 underwent retransplantation, and the other 4 survived; cumulated survival rates at 6, 12 and 24 months were 60.0%, 34.9% and 0, respectively. 12 cases didn't develop biliary complications. Nine of them received successful hepatic arterial interventional therapy within 2 weeks HAS detected, 2 with acute rejection received flushing anti-rejection therapy, 1 with HAT received retransplantation because of unsuccessful thrombolysis. During a median follow-up of 952 days (range, 14 - 1398 days), 3 patients died, 1 underwent retransplantation, and the other 8 survived; cumulated survival rates at 6, 12 and 24 months were 75%, 66.7% and 66.7%, respectively.


CONCLUSIONS
Early hepatic artery ischemia after OLT is an important agent for biliary complications. Early and successful hepatic arterial interventional therapy helped to reduce the incidence of biliary complications and improve the patients' prognosis.
Zhu
Kang-Shun
KS
Department of Radiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
Meng
Xiao-Chun
XC
Huang
Ming-Sheng
MS
Qian
Jie-Sheng
JS
Guan
Shou-Hai
SH
Li
Zheng-Ran
ZR
Jiang
Zai-Bo
ZB
Shan
Hong
H
Yang
Yang
Y
Chen
Gui-Hua
GH
D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000209:etiology / Q000628:therapy*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000628:therapy*; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis