Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
Eur Radiol. 2013 May;23(5):1323-34. doi: 10.1007/s00330-012-2730-9. Epub 2012 Dec 13.
Hepatic artery stenosis (HAS) is a serious complication of liver transplantation but data on the most effective endovascular management are lacking. We aimed to compare percutaneous balloon angioplasty (PBA) with stent placement.
We searched MEDLINE, Cochrane, Web of Science, EMBASE, SCOPUS, and Biosis Previews between 1970 and December 2011 and performed meta-analysis of short-term (procedural success, complications) and long-term outcomes (liver function, arterial patency, survival, re-intervention, re-transplantation). Random effects models were used for the analysis and meta-regression performed for the year of study.
A total of 263 liver transplants in 257 patients [age 43 (±8) years] underwent 147 PBAs and 116 stents. Transplanted livers were from deceased donors in 240 (91 %). Follow-up was 1 month to 4.5 years (median 17 months). PBA and stent had similar procedural success (89 % vs. 98 %), complications (16 % vs. 19 %), normal liver function tests (80 % vs. 68 %), arterial patency (76 % vs. 68 %), survival (80 % vs. 82 %), and requirement for re-intervention (22 % vs. 25 %) or re-transplantation (20 % vs. 24 %) (P non-significant). In the most recent studies re-transplantation was reported less compared to older series (P = 0.04).
Both PBA and stent offer comparable results for HAS. These techniques have contributed to a recent decline in re-transplantation.
• Interventional radiological procedures are often used to treat post-transplant hepatic artery stenosis. • Meta-analysis shows that percutaneous balloon angioplasty and stent placement are both efficacious. • Percutaneous balloon angioplasty and stent placement appear to have similar complication rates. • Re-transplantation rates have declined, partly due to interventional management for arterial stenosis.
肝动脉狭窄（HAS）是肝移植的严重并发症，但缺乏最有效的血管内治疗数据。我们旨在比较经皮球囊血管成形术（PBA）与支架置入。
我们在 1970 年至 2011 年 12 月间检索了 MEDLINE、Cochrane、Web of Science、EMBASE、SCOPUS 和 Biosis Previews，并对短期（手术成功率、并发症）和长期结果（肝功能、动脉通畅性、存活率、再介入、再移植）进行了荟萃分析。采用随机效应模型进行分析，并对研究年份进行了荟萃回归分析。
257 例患者的 263 例肝移植术接受了 147 例 PBA 和 116 例支架置入。移植肝脏来自 240 例（91%）死亡供体。随访时间为 1 个月至 4.5 年（中位数为 17 个月）。PBA 和支架的手术成功率（89%比 98%）、并发症（16%比 19%）、肝功能正常（80%比 68%）、动脉通畅率（76%比 68%）、存活率（80%比 82%）以及需要再介入（22%比 25%）或再移植（20%比 24%）的情况相似（P 非显著）。在最近的研究中，与较旧的系列相比，报告的再移植较少（P=0.04）。
PBA 和支架对 HAS 均具有相似的疗效。这些技术促成了最近再移植率的下降。
介入放射学程序常用于治疗移植后肝动脉狭窄。
荟萃分析显示，经皮球囊血管成形术和支架置入均有效。
经皮球囊血管成形术和支架置入的并发症发生率似乎相似。
再移植率下降，部分原因是动脉狭窄的介入治疗。
