Department of Surgery, Washington University in St. Louis School of Medicine, Saint Louis, MO, USA.
Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Ann Surg Oncol. 2023 Aug;30(8):4775-4780. doi: 10.1245/s10434-023-13652-8. Epub 2023 May 20.
Hepatic artery infusion pump (HAIP) therapy has become increasingly commonplace in the treatment of intrahepatic tumors. When combined with standard chemotherapy, HAIP therapy demonstrates a higher response rate than chemotherapy alone. Biliary sclerosis is observed in up to 22 % of patients, for whom no treatment has been standardized. This report describes orthotopic liver transplantation (OLT) both as a treatment for HAIP-induced cholangiopathy and as a possible definitive oncologic treatment after HAIP-bridging therapy.
A retrospective study reviewed patients who had undergone HAIP placement followed by OLT at the authors' institution. Patient demographics, neoadjuvant treatment, and postoperative outcomes were reviewed.
Seven OLTs were performed for patients with prior HAIP placement. The majority were women (n = 6), and the median age was 61 years (range, 44.5-65.5 years). Transplantation was performed for five patients due to biliary complications secondary to HAIP and two patients because of residual tumor after HAIP therapy. All the OLTs had difficult dissections due to adhesions. Because of HAIP-induced damage, atypical arterial anastomoses were required in six patients (2 patients used a recipient common hepatic artery below the gastroduodenal artery takeoff; 2 patients used recipient splenic arterial inflow; 1 patient used the junction of the celiac and splenic arteries; and 1 patient used the celiac cuff). The one patient with standard arterial reconstruction experienced an arterial thrombosis. The graft was salvaged with thrombolysis. Biliary reconstruction was duct-to-duct in five cases and Roux-en-Y in two cases.
The OLT procedure is a feasible treatment option for end-stage liver disease after HAIP therapy. Technical considerations include a more challenging dissection and an atypical arterial anastomosis.
肝动脉灌注泵（HAIP）治疗在治疗肝内肿瘤方面已越来越普遍。当与标准化疗联合使用时，HAIP 治疗比单独化疗的反应率更高。多达 22%的患者出现胆管硬化，对此尚无标准化治疗。本报告描述了原位肝移植（OLT）既是 HAIP 诱导胆管病的治疗方法，也是 HAIP 桥接治疗后可能的确定性肿瘤治疗方法。
回顾性研究回顾了在作者所在机构接受 HAIP 植入后行 OLT 的患者。回顾了患者的人口统计学、新辅助治疗和术后结果。
7 例 OLT 是为先前接受 HAIP 植入的患者进行的。大多数患者为女性（n=6），中位年龄为 61 岁（范围为 44.5-65.5 岁）。有 5 例患者因 HAIP 引起的胆道并发症而进行移植，有 2 例患者因 HAIP 治疗后残留肿瘤而进行移植。由于粘连，所有 OLT 均存在困难的解剖。由于 HAIP 引起的损伤，6 例患者需要进行非典型动脉吻合（2 例患者使用胃十二指肠动脉起始处下方的受体肝总动脉；2 例患者使用受体脾动脉流入；1 例患者使用腹腔动脉和脾动脉的交界处；1 例患者使用腹腔动脉袖套）。1 例接受标准动脉重建的患者发生动脉血栓形成。通过溶栓抢救移植物。5 例胆管重建为胆管对胆管，2 例为 Roux-en-Y。
OLT 手术是 HAIP 治疗后终末期肝病的可行治疗选择。技术考虑因素包括更具挑战性的解剖和非典型动脉吻合。
