Technical Feasibility and Clinical Outcomes of Interventional Endovascular Treatment for Hepatic Artery Thrombosis After Living-donor Liver Transplantation.
OBJECTIVE
Hepatic artery thrombosis (HAT) is a serious complication after living-donor liver transplantation (LDLT) leading to patient death in the absence of revascularization. With the recent advances in interventional radiology, interventional endovascular techniques have been used as alternative therapeutic options for HAT. This study evaluates the feasibility and clinical outcomes of endovascular treatment for HAT after LDLT.


METHODS
The medical records of 120 patients who underwent adult-to-adult LDLT between February 2002 and February 2015 in our hospital were retrospectively reviewed to evaluate the frequency of HAT and outcomes of endovascular treatment.


RESULTS
A total of nine patients (7.5%) developed HAT after LDLT, and the all patients underwent endovascular treatment. Overall technical success with endovascular treatment was achieved in 77.8% (7 of 9) of the patients. Intra-arterial thrombolysis was successful in one patient. Further intervention after intra-arterial thrombolysis was performed in the form of percutaneous transluminal angioplasty in six patients, and percutaneous transluminal angioplasty with stenting in two patients. Two patients with failure of revascularization by endovascular treatment were treated conservatively and developed hepatic arterial collaterals, and the both patients could avoid the graft failure. The overall survival rates did not differ significantly between the patients without HAT (n = 111) and those with HAT (n = 9) (1-, 3-, and 5-year overall survival rates of the patients without HAT vs. with HAT: 78.1%, 67.8%, and 65.3% vs. 66.7%, 66.7%, and 66.7%, respectively; P = .77).


CONCLUSIONS
Interventional endovascular treatment of HAT in LDLT is a feasible and reliable procedure in avoiding early graft failure with acceptable long-term patient outcome.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Y
Y
Murata
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan. Electronic address: mizunos@clin.medic.mie-u.ac.jp.
S
S
Mizuno
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
H
H
Kato
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
A
A
Tanemura
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
N
N
Kuriyama
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Y
Y
Azumi
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
M
M
Kishiwada
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
M
M
Usui
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
H
H
Sakurai
Department of Interventional radiology (IVR), Mie University Graduate School of Medicine, Japan.
M
M
Fujimori
Department of Interventional radiology (IVR), Mie University Graduate School of Medicine, Japan.
T
T
Yamanaka
Department of Interventional radiology (IVR), Mie University Graduate School of Medicine, Japan.
A
A
Nakatsuka
Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
K
K
Yamakado
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
S
S
Isaji
D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult