title: Intra-Arterial Thrombolysis for Hepatic Artery Thrombosis following Liver Transplantation.
abstract: OBJECTIVE
  Hepatic artery thrombosis (HAT) is a major cause of morbidity and death following liver transplantation. The purpose of this study was to evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) in liver transplant recipients with HAT.
  
  
  METHODS
  Adult liver transplant recipients who underwent attempted IAT for HAT were identified. This included patients with early and late HAT (occurring less than or greater than 30 d after transplantation). Records were reviewed to determine the rates of technical success, complications, surgical revascularization, repeat liver transplantation, and ischemic cholangiopathy.
  
  
  RESULTS
  Twenty-six patients underwent attempted thrombolysis, 13 of whom had early HAT. IAT was successfully initiated in 23 patients (88%), with a median IAT duration of 28 hours (range, 12-90 h). Recanalization was achieved in 12 patients (46%). Major complications were observed in 11 patients (42%). The early HAT group showed a trend toward increased major bleeding compared with the late HAT group (50% vs 9%; P = .07). Among 12 patients who had technically successful thrombolysis, five (42%) required surgical revascularization or repeat transplantation within 2 months. At 6 months after thrombolysis, 45% with unsuccessful recanalization avoided surgery or development of ischemic cholangiopathy, similar to the proportion in those who had successful recanalization (42%; P = .88).
  
  
  CONCLUSIONS
  Posttransplantation hepatic artery thrombolysis yields suboptimal results with a high complication rate, especially in early HAT. Even with successful restoration of flow, clinical outcomes are poor. Although thrombolysis may still be considered in view of the limited treatment options for HAT, awareness of potential complications and suboptimal success rate is essential.
authors.affiliation: Interventional Radiology Section, University of Washington, 1959 NE Pacific St., Seattle, WA 98195; Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195. Electronic address: kogutm@uw.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kogut
authors.affiliation: Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195.
authors.forename: David S
authors.initials: DS
authors.lastname: Shin
authors.affiliation: Interventional Radiology Section, University of Washington, 1959 NE Pacific St., Seattle, WA 98195; Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195.
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Padia
authors.affiliation: Interventional Radiology Section, University of Washington, 1959 NE Pacific St., Seattle, WA 98195; Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Johnson
authors.affiliation: Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.affiliation: Interventional Radiology Section, University of Washington, 1959 NE Pacific St., Seattle, WA 98195; Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195.
authors.forename: Karim
authors.initials: K
authors.lastname: Valji
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006499:Hepatic Artery / Q000187:drug effects*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator