Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran.
Isfahan Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
BMC Surg. 2024 Feb 17;24(1):62. doi: 10.1186/s12893-024-02359-6.
Hepatic artery thrombosis (HAT) is one of the critical conditions after an orthotopic liver transplant (OLT) and leads to severe problems if not corrected promptly. However, multiple treatments have been proposed for HAT, in which surgical revascularization with either auto-hepatic conduit interposition (AHCI) or revision of the anastomosis is more familiar indeed indicated for some patients and in specific situations. In this study, we want to evaluate the success and outcomes of treating early HAT (E-HAT), which defines HAT within 30 days after OLT with either of the surgical revascularization techniques.
In this retrospective study, we collected information from the medical records of patients who underwent either of the surgical revascularization procedures for E-HAT after OLT. Patients who needed early retransplantation (RT) or died without surgical intervention for E-HAT were excluded. Demographic data, OLT surgery information, and data regarding E-HAT were gathered. The study outcomes were secondary management for E-HAT in case of improper inflow, biliary complications (BC), RT, and death.
A total of 37 adult patients with E-HAT after OLT included in this study. These E-HATs were diagnosed within a mean of 4.6 ± 3.6 days after OLT. Two patients had their HA revised for the initial management of E-HAT; however, it changed to AHCI intraoperatively and finally needed RT. Two and nine patients from the AHCI and revision groups had re-thrombosis (12.5% vs. 47.3%, respectively, p = 0.03). RT was used to manage rethrombosis in all patients of AHCI and two patients of the revision group (22.2%). In comparison to the AHCI, revision group had statistically insignificant higher rates of BC (47.4% vs. 31.2%); however, RT for nonvascular etiologies (12.5% vs. 5.3%) and death (12.5% vs. 10.5%) were nonsignificantly higher in AHCI group. All patients with more than one HA exploration who were in the revision group had BC; however, 28.5% of patients with just one HA exploration experienced BC (p < 0.001).
Arterial conduit interposition seems a better approach for the initial management of E-HAT in comparison to revision of the HA anastomosis due to the lower risk of re-thrombosis and the number of HA explorations; indeed, BC, RT, and death remain because they are somewhat related to the ischemic event of E-HAT than to a surgical treatment itself.
肝动脉血栓形成（HAT）是原位肝移植（OLT）后的危急情况之一，如果不及时纠正，会导致严重问题。然而，对于 HAT 已经提出了多种治疗方法，其中自体肝导管间置（AHCI）或吻合口修正的手术再血管化更为常见，确实适用于某些患者和特定情况。在这项研究中，我们旨在评估治疗早期 HAT（E-HAT）的成功率和结果，E-HAT 定义为 OLT 后 30 天内发生的 HAT，采用任何一种手术再血管化技术。
在这项回顾性研究中，我们从接受 OLT 后 E-HAT 手术再血管化的患者的病历中收集信息。排除需要早期再次移植（RT）或 E-HAT 无手术干预而死亡的患者。收集人口统计学数据、OLT 手术信息和 E-HAT 数据。研究结果为 E-HAT 次要管理，包括流入不良、胆道并发症（BC）、RT 和死亡。
共有 37 例成人 OLT 后 E-HAT 患者纳入本研究。这些 E-HAT 在 OLT 后平均 4.6±3.6 天被诊断。2 例患者最初接受 HA 修正治疗 E-HAT；然而，术中改为 AHCI，最终需要 RT。AHCI 和修正组各有 2 例和 9 例患者发生再血栓形成（12.5%比 47.3%，p=0.03）。所有 AHCI 组和 2 例修正组的再血栓形成患者均接受 RT 治疗。与 AHCI 相比，修正组的 BC 发生率更高（47.4%比 31.2%），但非血管病因 RT（12.5%比 5.3%）和死亡（12.5%比 10.5%）的发生率无统计学意义。修正组中所有接受超过一次 HA 探查的患者均有 BC；然而，只有一次 HA 探查的患者中，28.5%发生了 BC（p<0.001）。
与 HA 吻合口修正相比，动脉导管间置似乎是 E-HAT 初始治疗的更好方法，因为再血栓形成和 HA 探查的风险较低；事实上，BC、RT 和死亡仍然存在，因为它们与 E-HAT 的缺血事件有关，而与手术治疗本身无关。
