Kose A, Ince V, Ozdemir F, Kutlu R, Bayindir Y, Yilmaz S
Inonu University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey.
Inonu University Faculty of Medicine, Liver Transplant Institute, Malatya, Turkey.
Int J Organ Transplant Med. 2020;11(4):196-201.
Synthetic vascular grafts are commonly used in liver transplantation. Thrombosis is a possible complication of using expanded polytetrafluoroethylene (e-PTFE) grafts. Herein, we report on 3 cases of liver recipients who died of intermittent sepsis episodes emerged concurrently with the thrombosis in synthetic vascular grafts and inferior vena cava (IVC) vein. Right lobe liver transplantation from living donors was performed for 3 patients by using e-PTFE grafts between the liver and IVC. Although heparin had been administered, thrombosis was developed in vascular graft and IVC extending to the right atrium; it was developed within 1-4 months of transplantations. All 3 patients suffered from recurrent sepsis episodes (4, 5, and 6 attacks for each patient) by different multidrug-resistant bacterial species. Treatment attempts including thrombolytic and antimicrobial drugs made, and surgical, endoscopic and radiological interventions could not resolve the clinical situation. The patients died of septic complications. We concluded that severe recurrent sepsis attacks may develop in liver transplant recipients when IVC and synthetic vascular graft were thrombosed. Removing the e-PTFE graft may be benefit for the treatment.
人工血管移植物常用于肝移植。血栓形成是使用膨体聚四氟乙烯（e-PTFE）移植物可能出现的并发症。在此，我们报告3例肝移植受者，他们死于与人工血管移植物和下腔静脉（IVC）血栓形成同时出现的间歇性脓毒症发作。对3例患者进行了活体供者右半肝移植，在肝脏和IVC之间使用了e-PTFE移植物。尽管使用了肝素，但血管移植物和IVC仍发生了血栓形成，并延伸至右心房；血栓形成发生在移植后的1 - 4个月内。所有3例患者均因不同的多重耐药菌而反复发生脓毒症发作（每位患者分别发作4次、5次和6次）。尝试了包括溶栓和抗菌药物在内的治疗方法，以及手术、内镜和放射学干预，但均未能改善临床状况。患者死于脓毒症并发症。我们得出结论，当IVC和人工血管移植物发生血栓形成时，肝移植受者可能会发生严重的反复脓毒症发作。移除e-PTFE移植物可能对治疗有益。
