title: Prevalence, presentation, and endovascular management of hemodynamically or clinically significant arterio-portal fistulae in living and cadaveric donor liver transplant recipients.
abstract: OBJECTIVE
  To compare the prevalence (cadaveric vs. living donor transplants), clinical features, and the effectiveness of endovascular management of significant arterio-portal fistulae (APF) in liver transplant recipients.
  
  
  METHODS
  A retrospective audit of liver transplant recipients in two institutions was performed (1996-2009). Significant APF were included and were defined as symptomatic and/or hemodynamically significant (causing graft dysfunction and/or having abnormal Doppler findings in the portal vein). Patients with significant APF were evaluated for presenting symptoms, imaging features, size/branch order portal vein involvement, and effectiveness of the endovascular management (coil embolization).
  
  
  RESULTS
  Four significant APF were found in 1992 (0.2%) liver transplants. Two were symptomatic and two were asymptomatic but were hemodynamically significant with liver function test abnormalities. All four APF were found in cadaveric donor graft recipients (0.23%, N = 4/1753) and none in 239 living donor graft recipients. However, there was no statistical difference between cadaveric and living donor graft recipients (p = 1.0, odds ratio = 1.23). Coil embolization was technically and clinically successful in all 4 without complications and causing normalization of the abnormal Doppler findings.
  
  
  CONCLUSIONS
  Significant APF are a rare diagnosis (0.2% of transplants). Coil embolization is a safe and effective treatment option for APF in transplants.
authors.affiliation: Division of Vascular Interventional Radiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Wael
authors.initials: W
authors.lastname: Saad
authors.forename: Allison
authors.initials: A
authors.lastname: Lippert
authors.forename: Mark
authors.initials: M
authors.lastname: Davies
authors.forename: Bulent
authors.initials: B
authors.lastname: Arslan
authors.forename: Sean
authors.initials: S
authors.lastname: Kumer
authors.forename: David
authors.initials: D
authors.lastname: Waldman
authors.forename: Ulku
authors.initials: U
authors.lastname: Turba
authors.forename: Timothy
authors.initials: T
authors.lastname: Schmitt
authors.forename: Alan
authors.initials: A
authors.lastname: Matsumoto
authors.forename: John
authors.initials: J
authors.lastname: Angle
mesh_terms: D000328:Adult; D000792:Angiography; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D007223:Infant; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011379:Prognosis; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D018608:Ultrasonography, Doppler; D055815:Young Adult