title: Systematic computer tomographic scans 7 days after liver transplantation surgery can lower rates of repeat-transplantation due to arterial complications.
abstract: Arterial complications are a major cause of graft lost after liver transplantation (LT). The aim of our study was to assess the clinical impact of systematic early postoperative injected computed tomographic (CT) scans after LT rather than its performance on demand in the event of abnormalities. Two series of consecutive transplantation patients in different periods (1997-1999, 231 patients versus 2008-2010, 250 patients) were analyzed. During the first period, an injected CT scan was only performed in the event of clinical, biological, or ultrasound abnormalities revealed by tests performed daily during the first week after surgery. During the second period, in addition to standard follow-up examination, an injected CT scan was performed systematically at approximately postoperative day 7. During the first (versus the more recent) period, both recipients (whose ages were 46 ± 13 years versus 50 ± 12 years; P = .004) and donors (whose ages were 42 ± 17 versus 52 ± 17 years; P = .0001) were younger and end-stage liver disease was more common (34% versus 12%; P = .0001), but hepatocellular carcinoma (7% vs 26%; P = .0001) and retransplantation (2% versus 7%; P = .01) were less frequent. Postoperative mortality was higher during the first period (14% versus 4%; P = .0003). The incidence of early arterial thrombosis (<1 month) was similar (1.3% versus 1.6%; P = .78), but that of arterial stenosis was higher with a systematic CT scan (1.7 versus 4.4; P = .07). As a consequence of the early detection and treatment of arterial abnormalities, the repeat LT rate due to late arterial thrombosis was nil in the second period and 2.1% (5/231) in the first period. In conclusion, a systematic CT angiogram at the end of the first postoperative week reduced retransplantation rates due to late hepatic artery thrombosis by detecting patients at risk who required specific treatment.
authors.affiliation: Centre Hépato-biliaire, Paul Brousse Hospital, Université Paris Sud, Villejuif, France. Electronic address: drmeme@yahoo.it.
authors.forename: R
authors.initials: R
authors.lastname: Memeo
authors.affiliation: Centre Hépato-biliaire, Paul Brousse Hospital, Université Paris Sud, Villejuif, France.
authors.forename: O
authors.initials: O
authors.lastname: Ciacio
authors.affiliation: Centre Hépato-biliaire, Paul Brousse Hospital, Université Paris Sud, Villejuif, France.
authors.forename: G
authors.initials: G
authors.lastname: Pittau
authors.affiliation: Centre Hépato-biliaire, Paul Brousse Hospital, Université Paris Sud, Villejuif, France.
authors.forename: D
authors.initials: D
authors.lastname: Cherqui
authors.affiliation: Centre Hépato-biliaire, Paul Brousse Hospital, Université Paris Sud, Villejuif, France.
authors.forename: D
authors.initials: D
authors.lastname: Castaing
authors.affiliation: Centre Hépato-biliaire, Paul Brousse Hospital, Université Paris Sud, Villejuif, France.
authors.forename: R
authors.initials: R
authors.lastname: Adam
authors.affiliation: Centre Hépato-biliaire, Paul Brousse Hospital, Université Paris Sud, Villejuif, France.
authors.forename: E
authors.initials: E
authors.lastname: Vibert
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology; D013997:Time Factors; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed / Q000379:methods*