Dalgic Aydin, Dalgic Buket, Demirogullari Billur, Ozbay Ferda, Latifoglu Osman, Ersoy Emin, Mahli Ahmet, Ilgit Erhan, Ozdemir Hakan, Arac Mehmet, Akyol Gulen, Tatlicioglu Ertan
Department of Surgery, Gazi University Hospital, Ankara, Turkey.
Pediatr Transplant. 2003 Apr;7(2):149-52. doi: 10.1034/j.1399-3046.2003.00017.x.
Hepatic artery thrombosis (HAT) has an occurrence rate of 1.7-26% following living donor liver transplantation (LDLT) and is one of the most common reasons for graft loss and mortality in this population. There is a higher incidence of HAT in pediatric recipients. The aim of this case report is to discuss clinical approaches for the treatment of HAT occurring in the early post-operative period after LDLT. An 11-month-old, 7.8-kg female with cirrhosis secondary to biliary atresia underwent LDLT at Gazi University Hospital in Ankara. The graft was a left lateral segment from her father with a left hepatic artery (HA) of 2 mm diameter and a graft weight/recipient body weight ratio of 2.0%. After an uneventful early post-operative period, HAT was diagnosed by Doppler ultrasonography (USG) on the fifth post-operative day. Following angiographic evaluation, immediate exploration and reanastomosis was performed using an operation microscope. Post-operatively, the HA was patented by Doppler USG and graft function returned to normal. Now, 42 months later, the patient continues to do well with normal graft function, using a regimen of tacrolimus monotherapy for immunosuppression. In countries which have very limited resources for urgent re-transplantation, given their serious donor shortage, graft salvage may be the only option for patient survival when HAT occurs. In these circumstances, early diagnosis and immediate revascularization may be the only method for graft salvage. A daily routine of Doppler USG examination in the early post-operative period may provide a method for the early diagnosis of HAT, before liver enzymes are elevated and hepatic necrosis has begun.
肝动脉血栓形成（HAT）在活体肝移植（LDLT）后发生率为1.7%-26%，是该人群中移植物丢失和死亡的最常见原因之一。小儿受者中HAT的发生率更高。本病例报告旨在探讨LDLT术后早期发生的HAT的临床治疗方法。一名11个月大、体重7.8千克、因胆道闭锁继发肝硬化的女性在安卡拉的加齐大学医院接受了LDLT。移植物是来自其父亲的左外侧叶，左肝动脉（HA）直径为2毫米，移植物重量与受者体重之比为2.0%。术后早期过程顺利，术后第5天通过多普勒超声（USG）诊断为HAT。经血管造影评估后，立即在手术显微镜下进行探查和重新吻合。术后，HA通过多普勒USG显示通畅，移植物功能恢复正常。现在，42个月后，患者继续情况良好，移植物功能正常，使用他克莫司单一疗法进行免疫抑制。在紧急再次移植资源非常有限的国家，鉴于其严重的供体短缺，当发生HAT时，挽救移植物可能是患者存活的唯一选择。在这些情况下，早期诊断和立即血管重建可能是挽救移植物的唯一方法。术后早期每日进行多普勒USG检查可能提供一种在肝酶升高和肝坏死开始之前早期诊断HAT的方法。
