title: Repeat endovascular treatment of recurring hepatic artery stenoses in orthotopic liver transplantation.
abstract: Hepatic artery stenosis (HAS) is a complication that impacts the results of orthotopic liver transplantation (OLT). Interventional radiological techniques are important therapeutic options for HAS. The aim of this retrospective study was to evaluate the outcome of repeated radiological treatments in recurring HAS after OLT. Of the 941 patients who underwent OLT at our center from January 1998 to September 2010, 48 (5%) were diagnosed with HAS, 37 (77%) of whom underwent transluminal interventional therapy with the placement of an endovascular stent. Success rate, complications, hepatic artery patency and follow-up were reviewed. After stent placement, artery patency was achieved in all patients. Three patients developed complications, including arterial dissection and hematoma. HAS recurrence was observed in 9 patients (24%), and hepatic artery thrombosis (HAT) occurred in 4 (11%). Radiological interventions were repeated 10 times in 8 patients without complications. At a median follow-up of 66 months (range 10-158), hepatic artery patency was observed in 35 cases (94.6%). The 5-year rates for graft and patient survival were 82.3% and 87.7%, respectively. Restenosis may occur in one-third of patients after endovascular treatment for thrombosis and HAS, but the long-term outcomes of iterative radiological treatment for HAS indicate a high rate of success.
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hospital Beaujon, Clichy, France. danielesommacale@hotmail.com
authors.forename: Daniele
authors.initials: D
authors.lastname: Sommacale
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoyagi
authors.forename: Federica
authors.initials: F
authors.lastname: Dondero
authors.forename: Annie
authors.initials: A
authors.lastname: Sibert
authors.forename: Onorina
authors.initials: O
authors.lastname: Bruno
authors.forename: Samir
authors.initials: S
authors.lastname: Fteriche
authors.forename: Claire
authors.initials: C
authors.lastname: Francoz
authors.forename: Francois
authors.initials: F
authors.lastname: Durand
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000473:pathology* / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015642:Radiology, Interventional; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome; D014654:Vascular Patency