Kamel Refaat, Hatata Yasser, Taha Mohamed, Hosny Karim, Amin Ayman
From the Department of Surgery, Ein Shams University, Cairo.
Exp Clin Transplant. 2015 Apr;13 Suppl 1:64-70.
Vascular problems such as thrombosis and stenosis of the hepatic artery, portal vein, and hepatic vein are serious complications after living-donor liver transplant and can cause increased morbidity, graft loss, and patient death. The aim of this study was to assess the incidence, treatment, and outcome of recipient vascular complications after living-donor liver transplant in a single Egyptian center.
Between November 2006 and March 2014, we performed 226 living-donor liver transplants for 225 patients at Dar Al Fouad Hospital in 6th of October City in Egypt. Review of all patients with vascular complications was performed.
In 20 of 225 recipients (8.9%), there were vascular complications that occurred from day 0 to 14 (mean, 5.6 ± 3.4 d). Complications included isolated hepatic artery thrombosis in 7 patients (35%), isolated portal vein thrombosis in 6 patients (30%), isolated hepatic vein stenosis in 3 patients (15%), and isolated hepatic artery stenosis in 1 patient (5%). Combined portal vein thrombosis and hepatic artery thrombosis occurred in 2 patients (10%), and combined portal vein thrombosis and hepatic vein stenosis occurred in 1 patient (5%). Complications were identified with duplex ultrasonography and confirmed with computed tomographic angiography and direct angiography when needed. Multidisciplinary treatment included percutaneous transarterial or transvenous thrombolysis with or without balloon dilation and stenting, open surgical exploration with thrombectomy, vascular revision, or retransplant. There were no intraoperative deaths, but mortality occurred in 15 of 20 patients (75%). Survival ranged from 6 days to 70 months. Preoperative portal vein thrombosis was observed in 3 of 7 patients (43%) who had postoperative portal vein thrombosis.
Major vascular complications in living-donor liver transplant recipients have poor outcome despite early detection and prompt multidisciplinary intervention. Preoperative recipient portal vein thrombosis is a risk factor for postoperative portal vein thrombosis.
肝动脉、门静脉和肝静脉的血栓形成及狭窄等血管问题是活体肝移植术后的严重并发症，可导致发病率增加、移植物丢失和患者死亡。本研究的目的是评估埃及一家中心活体肝移植受者血管并发症的发生率、治疗方法及结局。
2006年11月至2014年3月期间，我们在埃及十月六日城的福阿德医院为225例患者进行了226例活体肝移植。对所有发生血管并发症的患者进行了回顾。
225例受者中有20例（8.9%）发生了血管并发症，发生时间为术后0至14天（平均5.6±3.4天）。并发症包括7例（35%）孤立性肝动脉血栓形成、6例（30%）孤立性门静脉血栓形成、3例（15%）孤立性肝静脉狭窄和1例（5%）孤立性肝动脉狭窄。2例（10%）发生门静脉血栓形成合并肝动脉血栓形成，1例（5%）发生门静脉血栓形成合并肝静脉狭窄。并发症通过双功超声检查发现，必要时通过计算机断层血管造影和直接血管造影确诊。多学科治疗包括经皮经动脉或经静脉溶栓，可联合或不联合球囊扩张和支架置入、开放性手术探查取栓、血管修复或再次移植。术中无死亡病例，但20例患者中有15例（75%）死亡。生存时间为6天至70个月。7例术后发生门静脉血栓形成的患者中有3例（43%）术前存在门静脉血栓形成。
尽管早期发现并及时进行多学科干预，活体肝移植受者的主要血管并发症结局仍较差。术前受者门静脉血栓形成是术后门静脉血栓形成的危险因素。
