Wu Linwei, Zhang Jianwei, Guo Zhiyong, Tai Qiang, He Xiaoshun, Ju Weiqiang, Wang Dongping, Zhu Xiaofeng, Ma Yi, Wang Guodong, Hu Anbin
Department of Organ Transplantation of First Affiliated Hospital, Guangzhou, China.
Exp Clin Transplant. 2011 Jun;9(3):191-6.
Summarize the experience of managing patients with hepatic artery thrombosis after orthotopic liver transplant in a single center.
A total of 726 adult patients who received a liver transplant at the Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-Sen University, between January 2004 and December 2009, were selected. Fourteen patients had hepatic artery thrombosis after the operation, and the clinical data of these patients were analyzed retrospectively.
The incidence rate of hepatic artery thrombosis was 1.9% (14/726), and the mean time of onset was 10 days (range, 1-41 d) after surgery. Six patients had acute deterioration of liver function, 4 had bile leakage, 1 had hepatic abscess, and 3 had no symptoms. Three patients received urgent rearterialization, 2 received intra-arterial thrombolysis, 3 received combined urgent rearterialization and intra-arterial thrombolysis, and 6 patients received a retransplant. The mortality rate associated with hepatic artery thrombosis was 42.9% (6/14); 2 from biliary necrosis and secondary hepatic failure after urgent rearterialization; 1 from recurrent hepatic artery thrombosis and multiple organ failure after intra-arterial thrombolysis; 1 from renal failure and severe infection after combined urgent rearterialization and intra-arterial thrombolysis, and 2 from severe infection after retransplant. The other patients recovered and were followed for 18 to 66 months. Their liver grafts all functioned well with a patent artery. Two died from tumor recurrence at 18 and 29 months after transplant.
Hepatic artery thrombosis is a severe complication after liver transplant, which leads to graft loss and recipient death. Rearterialization as early as possible before irreversible biliary and liver parenchyma damage can avoid retransplant.
总结单中心原位肝移植术后肝动脉血栓形成患者的管理经验。
选取2004年1月至2009年12月在中山大学附属第一医院器官移植科接受肝移植的726例成年患者。14例患者术后发生肝动脉血栓形成，对这些患者的临床资料进行回顾性分析。
肝动脉血栓形成的发生率为1.9%（14/726），平均发病时间为术后10天（范围1 - 41天）。6例患者肝功能急性恶化，4例有胆漏，1例有肝脓肿，3例无症状。3例患者接受了紧急再通动脉手术，2例接受了动脉内溶栓，3例接受了紧急再通动脉手术与动脉内溶栓联合治疗，6例患者接受了再次移植。与肝动脉血栓形成相关的死亡率为42.9%（6/14）；2例因紧急再通动脉手术后胆道坏死和继发性肝衰竭死亡；1例因动脉内溶栓后复发性肝动脉血栓形成和多器官功能衰竭死亡；1例因紧急再通动脉手术与动脉内溶栓联合治疗后肾衰竭和严重感染死亡，2例因再次移植后严重感染死亡。其他患者康复并随访18至66个月。他们的肝移植均功能良好，动脉通畅。2例在移植后18个月和29个月因肿瘤复发死亡。
肝动脉血栓形成是肝移植术后的严重并发症，可导致移植物丢失和受者死亡。在不可逆的胆道和肝实质损伤之前尽早进行再通动脉手术可避免再次移植。
