title: Treatment of early hepatic artery thrombosis after liver transplantation.
abstract: BACKGROUND
  Early hepatic artery thrombosis remains one of the major causes of graft failure and mortality in liver transplant recipients. It is the most frequent severe vascular complication after orthotopic liver transplantation (OLT) accounting for >50% of all arterial complications. Most patients need to be considered for urgent liver retransplantation.
  
  
  METHODS
  Among 911 OLTs in 862 from 1989 to 2011, we observed 23 cases (2.6%) of acute early hepatic artery thrombosis. Seventeen patients were qualified immediately for liver retransplantation, and 6 underwent endovascular therapies, including intra-arterial heparin infusion or percutaneous transluminal angioplasty with stent placement.
  
  
  RESULTS
  Among patients who were assigned to early liver retransplantation, 11/17 survived with 3 succumbling due to postoperative complications, including 1 portal vein thrombosis, and 3 succumbling on the waiting list. All patients who underwent endovascular therapy survived with an excellent result obtained in 1 who underwent treatment<24 hours after arterial thrombosis. In 2 patients we achieved a satisfactory result not requiring retransplantation, but 3 patients assigned to endovascular treatment>24 hours after arterial thrombosis needed to be reassigned to liver retransplantation because of poor results of endovascular treatment.
  
  
  CONCLUSIONS
  Endovascular treatment efforts should be made to rescue liver grafts through urgent revascularization depending on the patient's condition and the interventional expertise at the transplant center, reserving the option of retransplantation for graft failure or severe dysfunction.
authors: Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland. murgen1973@tlen.pl
authors: M
authors: M
authors: Grodzicki
authors: A
authors: A
authors: Anysz-Grodzicka
authors: P
authors: P
authors: Remiszewski
authors: B
authors: B
authors: Cieślak
authors: M
authors: M
authors: Kotulski
authors: P
authors: P
authors: Kalinowski
authors: R
authors: R
authors: Paluszkiewicz
authors: O
authors: O
authors: Rowiński
authors: M
authors: M
authors: Krawczyk
mesh_terms: D000208:Acute Disease; D017130:Angioplasty; D057510:Endovascular Procedures; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D013997:Time Factors