title: A case of portal vein arterialization after a liver transplant.
abstract: Hepatic artery thrombosis represents a potentially deadly complication after a liver transplant. Portal vein arterialization recently has been proposed as a bridge approach in patients with hepatic artery thrombosis needing a retransplant. We report the case of a 53-year-old man treated with a liver transplant for a cryptogenetic cirrhosis. One month after a liver transplant, a hepatic artery thrombosis was documented, and a portal vein arterialization as bridge therapy for another liver transplant was performed. After surgery, improvement in the patient's liver functioning was seen. No signs of portal hypertension or hepatic abscesses were documented. Unfortunately, 8 months after the liver transplant, the patient experienced a severe urinary infection caused by a multidrug-resistant Klebsiella and died. An increase in the oxygen supply to the liver parenchyma after portal vein arterializations represents rationale use for managing hepatic artery thromboses. Several cases of treating post liver transplant hepatic artery thromboses have been reported in the literature. Portal vein arterializations can be used as bridge therapy in well-selected situations of post-liver transplant hepatic artery thromboses. Strict surveillance should be used to prevent the onset of complications that can exclude a patient from a transplant. The correct timing for retransplant is not fully known, but we think the shorter the time to retransplant, the better is the patient survival.
authors.affiliation: Department of General Surgery and Organ Transplantation, Sapienza University, Umberto I Hospital, Rome, Italy. fabmelan@yahoo.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Melandro
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Levi Sandri
authors.forename: Nicola
authors.initials: N
authors.lastname: Guglielmo
authors.forename: Marco
authors.initials: M
authors.lastname: Di Laudo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Morabito
authors.forename: Renzo
authors.initials: R
authors.lastname: Pretagostini
authors.forename: Pasquale B
authors.initials: PB
authors.lastname: Berloco
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
mesh_terms: D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017809:Fatal Outcome; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery; D008642:Mesenteric Veins / Q000601:surgery; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000382:microbiology; D014656:Vascular Surgical Procedures