Hsieh Chia-En, Chou Chen-Te, Lin Chia-Cheng, Chen Chia-Bang, Lin Kuo-Hua, Lin Ping-Yi, Chen Yao-Li
From the Department of Liver Transplantation, Changhua Christian Hospital, Changhua, Taiwan.
Exp Clin Transplant. 2017 Aug;15(4):474-476. doi: 10.6002/ect.2015.0013. Epub 2016 Jan 20.
We present a patient with portal vein thrombosis due to chronic cholangitis after undergoing a living-donor liver transplant.
A 52-year-old woman with a history of hepatitis B virus-related liver cirrhosis underwent a living-donor liver transplant. After the surgery, the patient had recurrent episodes of cholangitis because of common and intrahepatic bile duct stricture. Biliary stricture because of cholangitis eventually resulted in acute portal vein thrombosis. A stent was inserted by percutaneous transluminal portography. Blood flow through the portal vein progressively improved from the third through the 10th day after stent placement. The anticoagulation regimen was change to acetylsalicylic acid and clopidogrel hydrogen sulfate (Plavix). On poststenting day 10, a follow-up computed tomographic scan showed good patency of the main portal vein and no evidence of arterioportal shunting.
Cholangitis after living-donor liver transplant is a rare cause of portal vein thrombosis. Regular follow-up examinations with color Doppler ultrasound are required to monitor portal vein flow in patients with biliary complications after living-donor liver transplant.
我们报告一例活体肝移植术后因慢性胆管炎导致门静脉血栓形成的患者。
一名52岁有乙型肝炎病毒相关性肝硬化病史的女性接受了活体肝移植。术后，由于肝外和肝内胆管狭窄，患者反复发生胆管炎。胆管炎所致的胆管狭窄最终导致急性门静脉血栓形成。通过经皮腔内门静脉造影术置入了支架。支架置入后第3天至第10天，门静脉血流逐渐改善。抗凝方案改为阿司匹林和硫酸氢氯吡格雷（波立维）。支架置入后第10天，随访计算机断层扫描显示门静脉主干通畅良好，无动静脉分流迹象。
活体肝移植术后胆管炎是门静脉血栓形成的罕见原因。对于活体肝移植术后有胆道并发症的患者，需要定期进行彩色多普勒超声随访检查以监测门静脉血流。
