title: Major vascular complications in living-donor liver transplant recipients: single center team experience.
abstract: OBJECTIVE
  Vascular problems such as thrombosis and stenosis of the hepatic artery, portal vein, and hepatic vein are serious complications after living-donor liver transplant and can cause increased morbidity, graft loss, and patient death. The aim of this study was to assess the incidence, treatment, and outcome of recipient vascular complications after living-donor liver transplant in a single Egyptian center.
  
  
  METHODS
  Between November 2006 and March 2014, we performed 226 living-donor liver transplants for 225 patients at Dar Al Fouad Hospital in 6th of October City in Egypt. Review of all patients with vascular complications was performed.
  
  
  RESULTS
  In 20 of 225 recipients (8.9%), there were vascular complications that occurred from day 0 to 14 (mean, 5.6 ± 3.4 d). Complications included isolated hepatic artery thrombosis in 7 patients (35%), isolated portal vein thrombosis in 6 patients (30%), isolated hepatic vein stenosis in 3 patients (15%), and isolated hepatic artery stenosis in 1 patient (5%). Combined portal vein thrombosis and hepatic artery thrombosis occurred in 2 patients (10%), and combined portal vein thrombosis and hepatic vein stenosis occurred in 1 patient (5%). Complications were identified with duplex ultrasonography and confirmed with computed tomographic angiography and direct angiography when needed. Multidisciplinary treatment included percutaneous transarterial or transvenous thrombolysis with or without balloon dilation and stenting, open surgical exploration with thrombectomy, vascular revision, or retransplant. There were no intraoperative deaths, but mortality occurred in 15 of 20 patients (75%). Survival ranged from 6 days to 70 months. Preoperative portal vein thrombosis was observed in 3 of 7 patients (43%) who had postoperative portal vein thrombosis.
  
  
  CONCLUSIONS
  Major vascular complications in living-donor liver transplant recipients have poor outcome despite early detection and prompt multidisciplinary intervention. Preoperative recipient portal vein thrombosis is a risk factor for postoperative portal vein thrombosis.
authors.affiliation: From the Department of Surgery, Ein Shams University, Cairo.
authors.forename: Refaat
authors.initials: R
authors.lastname: Kamel
authors.forename: Yasser
authors.initials: Y
authors.lastname: Hatata
authors.forename: Mohamed
authors.initials: M
authors.lastname: Taha
authors.forename: Karim
authors.initials: K
authors.lastname: Hosny
authors.forename: Ayman
authors.initials: A
authors.lastname: Amin
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D042241:Early Diagnosis; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy