Asymptomatic process of hepatic artery thrombosis in a patient after orthotopic liver transplantation.

BACKGROUND

Hepatic artery thrombosis is one of the serious complications after liver transplantation. It will mostly cause a failure of the transplantation. This case of hepatic artery thrombosis showed a stable clinical course and minimal histological change, and now has been surviving for 4 years with normal liver function. We investigated the possible causes for asymptomatic hepatic artery thrombosis in one patient after orthotopic liver transplantation (OLT) and discussed the diagnosis of ischemia of OLT pathologically and clinically.

METHODS

Liver function test, color Doppler ultrasonography, and hepatic arteriography were performed during the development of hepatic arteriothrombosis. Possible factors for the asymptomatic process of the thrombosis were analyzed.

RESULTS

On the 4th postoperative day, thrombosis formed at the anastomotic stoma of the hepatic artery, and on the 11th postoperative day, the artery was completely occluded. Serial liver biopsies revealed intrahepatic cholestasis, hydropic degeneration of hepatocytes, atrophy of the biliary epithelium, and fibrosis in the portal area. Monitoring of liver function showed nothing abnormal except elevation of gamma-GT and ALP levels. On the 71st day after OLT, arteriography demonstrated that the hepatic artery remained completely occluded in addition to the establishment of collateral circulation and compensation of the portal vein. The patient didn't show any symptoms of arterial thrombosis.

CONCLUSION

Collateral circulation and compensation of the portal vein are beneficial to allograft survival and avoidance of retransplantation after thrombosis of the hepatic artery. Color Doppler ultrasonography within 2 weeks after OLT is helpful to the early diagnosis of hepatic arteriothrombosis.