Melandro Fabio, Lai Quirino, Levi Sandri Giovanni B, Guglielmo Nicola, Di Laudo Marco, Morabito Vincenzo, Pretagostini Renzo, Berloco Pasquale B, Rossi Massimo
Department of General Surgery and Organ Transplantation, Sapienza University, Umberto I Hospital, Rome, Italy.
Exp Clin Transplant. 2013 Jun;11(3):287-9. doi: 10.6002/ect.2012.0172.
Hepatic artery thrombosis represents a potentially deadly complication after a liver transplant. Portal vein arterialization recently has been proposed as a bridge approach in patients with hepatic artery thrombosis needing a retransplant. We report the case of a 53-year-old man treated with a liver transplant for a cryptogenetic cirrhosis. One month after a liver transplant, a hepatic artery thrombosis was documented, and a portal vein arterialization as bridge therapy for another liver transplant was performed. After surgery, improvement in the patient's liver functioning was seen. No signs of portal hypertension or hepatic abscesses were documented. Unfortunately, 8 months after the liver transplant, the patient experienced a severe urinary infection caused by a multidrug-resistant Klebsiella and died. An increase in the oxygen supply to the liver parenchyma after portal vein arterializations represents rationale use for managing hepatic artery thromboses. Several cases of treating post liver transplant hepatic artery thromboses have been reported in the literature. Portal vein arterializations can be used as bridge therapy in well-selected situations of post-liver transplant hepatic artery thromboses. Strict surveillance should be used to prevent the onset of complications that can exclude a patient from a transplant. The correct timing for retransplant is not fully known, but we think the shorter the time to retransplant, the better is the patient survival.
肝动脉血栓形成是肝移植术后一种潜在的致命并发症。门静脉动脉化最近被提议作为肝动脉血栓形成且需要再次移植的患者的一种过渡方法。我们报告了一例53岁男性患者，因不明原因肝硬化接受肝移植治疗。肝移植术后1个月，记录到肝动脉血栓形成，遂进行门静脉动脉化作为再次肝移植的过渡治疗。术后，患者肝功能有所改善。未记录到门静脉高压或肝脓肿的迹象。不幸的是，肝移植术后8个月，患者发生了由多重耐药克雷伯菌引起的严重泌尿系统感染并死亡。门静脉动脉化后肝脏实质氧供增加是处理肝动脉血栓形成的合理依据。文献中已报道了几例治疗肝移植术后肝动脉血栓形成的病例。门静脉动脉化可在精心挑选的肝移植术后肝动脉血栓形成情况下用作过渡治疗。应进行严格监测以预防可能导致患者无法进行移植的并发症的发生。再次移植的正确时机尚不完全清楚，但我们认为再次移植的时间越短，患者生存率越高。
