Obed Mikal, Othman Mohammad Ibrahim, Siyam Mahmoud, Hammoudi Saeb, Jarrad Anwar, Bashir Abdalla, Obed Aiman
From the Hepatology, Gastroenterology, and Hepatobiliary/Transplant Unit, Jordan Hospital, Amman, Jordan.
Exp Clin Transplant. 2021 Aug;19(8):826-831. doi: 10.6002/ect.2020.0565. Epub 2021 May 6.
Early hepatic artery thrombosis is a serious complication that may follow living donor liver transplant. Acute graft loss and patient morbidity and mortality are possible consequences. The therapeutic algorithm includes surgical or interventional revascularization, conservative approaches, or retransplantation.
Among 155 patients who underwent living donor liver transplant at our transplant center from 2004 to 2020, there were 5 who developed hepatic artery thrombosis. From our 13- year experience, we herein present their demographic and clinical characteristics, radiological imaging findings, perioperative courses, and the postoperative follow-up.
All patients displayed advanced liver disease with a Child-Pugh score of C and a mean Model for End-Stage Liver Disease score of 32. Underlying causes for end-stage liver disease included hepatitis B and C infection and cryptogenic liver cirrhosis. The mean patient age was 49 years; 2 patients were female. Living donor liver transplant was performed with donor tissue from immediate kin, according to Jordanian allocation rules. The diagnosis of hepatic artery thrombosis was made by Doppler ultrasonography and confirmed via computed tomography. After surgical revision of the anastomosis, our first patient experienced thrombotic recurrence. All patients received interventional catheterization with local thrombolysis and subsequently developed rethrombosis. Despite prevalent thrombosis, 4 patients achieved long-term survival without further deterioration of liver function. Cumulative 1-year, 5-year, and 10-year survival rates were 80%, 80%, and 60%, respectively. Spontaneous recanalization of the hepatic artery was observed in 1 patient.
Favorable long-term outcomes are achievable in patients with persistent hepatic artery thrombosis. When retransplant is not feasible and interventional approaches fail, conservative treatment with careful observation of liver function should be implemented. Attentive observation of collateral circulation toward the liver, distal of the thrombosis, may be beneficial to both graft and patient survival.
早期肝动脉血栓形成是活体肝移植后可能出现的严重并发症。可能导致急性移植物丢失以及患者发病和死亡。治疗方案包括手术或介入性血管重建、保守治疗或再次移植。
2004年至2020年在我们移植中心接受活体肝移植的155例患者中，有5例发生了肝动脉血栓形成。基于我们13年的经验，本文介绍了他们的人口统计学和临床特征、放射影像学检查结果、围手术期过程以及术后随访情况。
所有患者均表现为晚期肝病，Child-Pugh评分为C级，终末期肝病模型平均评分为32分。终末期肝病的潜在病因包括乙型和丙型肝炎感染以及隐源性肝硬化。患者平均年龄为49岁；2例为女性。根据约旦的分配规则，采用直系亲属的供体组织进行了活体肝移植。通过多普勒超声诊断肝动脉血栓形成，并经计算机断层扫描确诊。在对吻合口进行手术修复后，我们的首例患者出现血栓复发。所有患者均接受了局部溶栓的介入导管治疗，随后再次形成血栓。尽管普遍存在血栓形成，但4例患者实现了长期存活，肝功能未进一步恶化。1年、5年和10年累积生存率分别为80%、80%和60%。1例患者观察到肝动脉自发再通。
持续性肝动脉血栓形成的患者可获得良好的长期预后。当再次移植不可行且介入治疗失败时，应实施密切观察肝功能的保守治疗。仔细观察血栓远端肝脏的侧支循环可能有利于移植物和患者存活。
