Hann Angus, Seth Rashmi, Mergental Hynek, Hartog Hermien, Alzoubi Mohammad, Stangou Arie, El-Sherif Omar, Ferguson James, Roberts Keith, Muiesan Paolo, Oo Ye, Issac John R, Mirza Darius, Perera M Thamara P R
Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom.
Transplant Direct. 2020 Dec 15;7(1):e643. doi: 10.1097/TXD.0000000000001092. eCollection 2021 Jan.
Hepatic artery stenosis (HAS) following liver transplantation results in hypoperfusion and ischemic damage to the biliary tree. This study aimed to investigate how vascular intervention, liver function test derangement, and time point of HAS onset influence biliary complications.
A single-center retrospective study of adult patients that underwent primary liver transplantation. Patients were grouped according to the presence or absence of HAS and then into early (≤90 d) or late (>90 d) subgroups. Biliary complications comprised anastomotic (AS) or non ASs (NASs).
Computed tomography angiography confirmed HAS was present in 39 of 1232 patients (3.2%). This occurred at ≤90 and >90 days in 20 (1.6%) and 19 (1.5%), respectively. The incidence of biliary strictures (BSs) in the group with HAS was higher than the group without (13/39; 33% versus 85/1193; 7.1%, = 0.01). BS occurred in 8/20 (40.0%) and 5/19 (26.3%) of the early and late groups, respectively. The need for biliary intervention increased if any liver function test result was ≥3× upper limit of normal ( = 0.019).
BS occurs at a significantly higher rate in the presence of HAS. Onset of HAS at ≤90 or ≥90 days can both be associated with morbidity. Significant liver function test derangement at HAS diagnosis indicates a higher likelihood of biliary intervention for strictures.
肝移植术后肝动脉狭窄（HAS）会导致肝血流灌注不足以及胆管树的缺血性损伤。本研究旨在探讨血管介入、肝功能检查紊乱以及HAS发病时间点如何影响胆道并发症。
对接受初次肝移植的成年患者进行单中心回顾性研究。患者根据是否存在HAS进行分组，然后再分为早期（≤90天）或晚期（>90天）亚组。胆道并发症包括吻合口（AS）或非吻合口（NAS）。
计算机断层血管造影证实1232例患者中有39例（3.2%）存在HAS。分别在≤90天和>90天发生HAS的患者有20例（1.6%）和19例（1.5%）。有HAS组的胆道狭窄（BS）发生率高于无HAS组（13/39；33%对85/1193；7.1%，P = 0.01）。早期和晚期组中分别有8/20（40.0%）和5/19（26.3%）发生BS。如果任何肝功能检查结果≥正常上限的3倍，则需要进行胆道介入的可能性增加（P = 0.019）。
在存在HAS的情况下，BS的发生率显著更高。HAS在≤90天或≥90天发病均可能与发病相关。HAS诊断时显著的肝功能检查紊乱表明因狭窄进行胆道介入的可能性更高。
