Department of Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Transpl Int. 2011 Oct;24(10):984-90. doi: 10.1111/j.1432-2277.2011.01298.x. Epub 2011 Jul 14.
Hepatic artery complications after living donor liver transplantation (LDLT) can directly affect both graft and recipient outcomes. For this reason, early diagnosis and treatment are essential. In the past, relaparotomy was generally employed to treat them. Following recent advances in interventional radiology, favorable outcomes have been reported with endovascular treatment. However, there is ongoing discussion regarding the best and safe time for definitive endovascular interventions. We herein report a retrospective analysis for six children with early hepatic artery complication after pediatric LDLT who underwent endovascular treatment as primary therapy at our institution. We evaluate the usefulness of endovascular treatment for hepatic artery complication and its optimal timing. The mean patient age was 11.9 months and mean body weight at LDLT was 6.7 kg. The mean duration between the transplantation and first endovascular treatment was 5.3 days. Five of the six patients were technically successful treated by only endovascular treatment. Of these five patients, two developed biliary complications. Endovascular procedures were performed 10 times in six patients without any complications and nine of the 10 procedures were successful. By selecting optimal devices, our findings suggest that endovascular treatment can be feasible and safe in the earliest time period after pediatric LDLT.
肝动脉并发症是活体肝移植（LDLT）后直接影响移植物和受者预后的重要因素。因此，早期诊断和治疗至关重要。过去，一般采用再次剖腹手术治疗。近年来，随着介入放射学的进步，血管内治疗已取得良好的效果。然而，对于确定最佳和安全的血管内干预时间仍存在争议。本研究回顾性分析了我院 6 例小儿 LDLT 后早期肝动脉并发症患儿的临床资料，这些患儿接受了血管内治疗作为一线治疗。我们评估了血管内治疗肝动脉并发症的有效性及其最佳时机。患儿的平均年龄为 11.9 个月，LDLT 时的平均体重为 6.7kg。肝移植和首次血管内治疗之间的平均时间为 5.3 天。6 例患儿中，5 例仅通过血管内治疗获得技术上的成功。其中 2 例发生胆道并发症。6 例患儿共进行了 10 次血管内手术，无任何并发症，9 次手术成功。通过选择最佳的设备，我们的研究结果表明，在小儿 LDLT 后的最早时间内，血管内治疗是可行和安全的。
