Center for Liver & Pancreatobiliary Cancer, National Cancer Center, Goyang-si, Korea.
J Hepatobiliary Pancreat Sci. 2020 Aug;27(8):548-554. doi: 10.1002/jhbp.771. Epub 2020 Jul 2.
Hepatic artery thrombosis (HAT) following liver transplantation is a serious complication that may lead to graft loss and ultimately death. Retransplantation and surgical recanalization for HAT have traditionally been the predominant methods of treatment. However, with the development of endovascular therapies, including percutaneous transluminal angioplasty, thrombolysis, and stent insertion, these methods are now mainly used because they allow prompt management.
From January 2005 to December 2018, 756 patients underwent liver transplantation at our institution, and 14 of those patients developed early HAT. All patients underwent endovascular arteriography immediately after the diagnosis of thrombosis. We retrospectively reviewed the 14 patients with HAT.
Hepatic artery thrombosis following liver transplantation occurred in 14 patients (1.9%) within 1 month after transplantation. The final success rate of radiological intervention was 71.4% (n = 10). Of the four patients in whom intravenous procedures failed, two ultimately underwent retransplantation and one patient underwent surgical revision of the hepatic artery. Bleeding and rebound thrombosis after the intervention occurred in three patients (21.4%) and four patients (28.6%), respectively.
Endovascular procedures can be safe and provide prompt recovery in early HAT patients following liver transplantation to prevent graft loss and patient mortality despite the presence of hemorrhage and rebound thrombosis. Immediate endovascular procedure after the end of the transplantation is also necessary in intraoperatively developed HAT instead of several trials of arterial anastomoses to revascularization.
肝移植术后肝动脉血栓形成（HAT）是一种严重的并发症，可能导致移植物丢失，最终导致死亡。传统上，肝动脉血栓形成的治疗方法主要是再次肝移植和手术再通。然而，随着血管内治疗方法的发展，包括经皮腔内血管成形术、溶栓和支架置入术，这些方法现在主要用于治疗，因为它们可以进行及时的管理。
从 2005 年 1 月至 2018 年 12 月，我院共进行了 756 例肝移植手术，其中 14 例患者发生早期 HAT。所有患者在诊断为血栓形成后立即进行血管内血管造影。我们回顾性分析了 14 例 HAT 患者。
肝移植后 HAT 发生于 14 例（1.9%）患者，发生于移植后 1 个月内。放射介入治疗的最终成功率为 71.4%（n=10）。静脉内治疗失败的 4 例患者中，2 例最终进行了再次肝移植，1 例患者进行了肝动脉手术修正。3 例（21.4%）患者和 4 例（28.6%）患者在介入治疗后分别发生出血和再发血栓形成。
血管内治疗可安全有效地治疗肝移植术后早期 HAT 患者，防止移植物丢失和患者死亡，尽管存在出血和再发血栓形成。对于术中发现的 HAT，也需要在移植结束后立即进行血管内手术，而不是多次尝试动脉吻合以重新血管化。
