Partial portal arterialization for hepatic arterial thrombosis after living-donor liver transplant.
OBJECTIVE
The most serious, life-threatening complication after living-donor liver transplant is a hepatic arterial thrombosis. Although possible therapies for acute hepatic arterial thrombosis include revascularization to salvage the graft, or retransplant, these may be difficult to perform owing to technical aspects and donor shortages. Previously, we reported the usefulness of partial portal arterialization in such cases.


METHODS
Four cases of partial portal arterialization for hepatic arterial occlusion after living-donor liver transplant were reviewed. The surgical procedure of partial portal arterializations involves making an arteriovenous shunt via a side-to-side anastomosis, using mesenteric vessels approximately 2 mm in diameter.


RESULTS
After partial portal arterialization, hepatic arterial flow was not detected, but graft injury owing to hypoxia gradually improved in all cases. In 1 case, occlusion of the arteriovenous shunt itself and the collateral artery to the graft were identified by angiography 45 days after partial portal arterialization. In another case, massive ascites, pleural effusion, and variceal changes of the mesenteric veins owing to portal hypertension were identified, and surgical closure of the shunt was performed 152 days after partial portal arterialization. In the other 2 cases, there were no definite problems related to partial portal arterialization, but the patients died owing to other complications.


CONCLUSIONS
When hepatic arterial thrombosis occurs after living-donor liver transplant, revascularization should be performed first. However, this sometimes may be difficult, as when the arterial dissection reaches into the graft. Partial portal arterialization is an easy and effective surgical procedure. Therefore, partial portal arterialization appears to be a useful option to gain time until collateral arterial vessels develop or retransplant, even if revascularization cannot be performed.
Department of Gastroenterologic Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan. ekhayashi@hotmail.com
Hironori
H
Hayashi
Hiroyuki
H
Takamura
Takashi
T
Tani
Isamu
I
Makino
Hisatoshi
H
Nakagawara
Hidehiro
H
Tajima
Hirohisa
H
Kitagawa
Ichiro
I
Onishi
Koichi
K
Shimizu
Tetsuo
T
Ohta
D000328:Adult; D000792:Angiography; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D006499:Hepatic Artery / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008643:Mesentery / Q000502:physiology / Q000601:surgery; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome