Yang Yang, Li Hua, Fu Bin-sheng, Zhang Qi, Zhang Ying-cai, Lu Ming-qiang, Cai Chang-jie, Xu Chi, Wang Gen-shu, Yi Shu-hong, Zhang Jian, Zhang Jun-feng, Yi Hui-min, Jiang Nan, Jiang Hua, Zhu Kang-shun, Jiang Zai-bo, Shan Hong, Chen Gui-hua
Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
Chin Med J (Engl). 2008 Oct 20;121(20):1997-2000.
The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation (OLT) include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT.
The clinical data of 25 patients diagnosed with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement.
Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients' liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion.
Individualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.
原位肝移植（OLT）后肝动脉并发症的主要治疗方法包括溶栓、经皮腔内血管成形术、支架置入和再次肝移植。OLT后肝动脉并发症的预后不仅与类型、程度和时间有关，还与治疗方法的选择和时机密切相关。然而，对于这些并发症的治疗尚无共识。本研究的目的是确定OLT后肝动脉并发症的最佳治疗方法。
回顾性分析2003年10月至2007年3月期间诊断为肝动脉血栓形成（HAT）和肝动脉狭窄（HAS）的25例患者的临床资料。治疗方法包括再次肝移植和介入治疗，介入治疗包括溶栓、经皮腔内血管成形术和支架置入。
在5例HAT患者中，3例接受了溶栓治疗。1例恢复，1例溶栓后死亡，另1例因复发性HAT在再次肝移植后死于多器官功能衰竭。其余2例患者成功进行了再次肝移植并存活。在术后1个月内出现HAS的12例患者中，2例因不可逆性肝功能衰竭接受了再次肝移植，另外10例患者接受了介入治疗。3例患者肝功能未改善，4例患者在支架置入后因缺血性胆管炎进行了再次肝移植。在6例接受再次肝移植的患者中，2例分别死于颅内出血和感染。8例患者在术后1个月后出现HAS，5例患者接受了介入治疗，支架置入后恢复。在另外3例出现HAS的患者中，2例患者肝功能稳定，1例患者因缺血性胆管病变接受了晚期再次肝移植。
OLT后肝动脉并发症的治疗应根据术后时期、类型以及是否存在缺血性胆管病变采用个体化治疗方案。肝移植是肝动脉血栓形成患者的最佳治疗方法。对于晚期HAS且无不可逆性肝功能衰竭或胆管缺血的患者，介入治疗是合适的，而对于早期HAS则建议进行再次肝移植。
