Early Detection of a Hepatic Artery Pseudoaneurysm After Liver Transplantation Is the Determinant of Survival.
BACKGROUND
Hepatic artery pseudoaneurysm (PA) after liver transplantation (LT) is a rare but potentially fatal complication. Among a series of 50 patients of LT, we experienced 3 such cases. Some authors also have reported cases of PA, either intrahepatic or extrahepatic. The aim of this study was to investigate the important factors that affect the treatment outcome.


METHODS
Three patients were presented. To analyze the factors, not only our patients but also the patients with PA reported in the literature (including 10 case series and 23 case reports) were enrolled for analysis. The possible factors probably affecting the survival were compared statistically, including age, sex, clinical manifestation as bleeding (including gastrointestinal bleeding, hemobilia, or intra-abdominal bleeding), treatment (with embolization or surgical exploration or stent), diagnosis establishment before or after bleeding, and so forth.


RESULTS
From univariate analysis, the significant factors that affect survival are sex (female) (P = .036), stent treatment (P = .006), and early detection (P = .036), whereas age (P = .493) and presentation with hemorrhage (P = .877) are not significant factors. However, according to multivariate analysis, stent treatment has a borderline significance (P = .056).


CONCLUSIONS
Early detection of such a life-threatening complication is a key determinant of survival. "Early" does not refer to early postoperative days but means the detection prior to the rupture of the pseudoaneurysm. Postoperative imaging studies such as computed tomographic scan or magnetic resonance cholangiopancreatography early and periodically to follow up the graft status is recommended, especially for those who had received other interventions before or after the liver transplantation.
Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan. Electronic address: kevin.ksjeng@gmail.com.
K-S
KS
Jeng
Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan.
C-C
CC
Huang
Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan.
C-K
CK
Lin
Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan.
C-C
CC
Lin
Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan.
C-C
CC
Liang
Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan.
C-S
CS
Chung
Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan.
M-T
MT
Weng
Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
K-H
KH
Chen
D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D000072226:Computed Tomography Angiography; D042241:Early Diagnosis; D004621:Embolization, Therapeutic; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006431:Hemobilia / Q000209:etiology; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures