Tran Tri Thanh, Phan Kiet Tuan, Ho Duy Phi, Trinh Vi Nguyen Ha, Luu Thuan Nguyen An, Bui Trung Hai
Department of Hepato-Pancreato-Biliary Diseases and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Viet Nam; Faculty of Pharmacy and Nursing, Tay Do University, Can Tho City, Viet Nam.
Department of Hepato-Pancreato-Biliary Diseases and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Viet Nam.
Int J Surg Case Rep. 2025 Aug;133:111638. doi: 10.1016/j.ijscr.2025.111638. Epub 2025 Jul 9.
Early hepatic artery thrombosis is a serious complication following pediatric liver transplantation, often associated with high morbidity and mortality. While surgical revascularization and retransplantation are the standard treatments, thrombolytic therapy has emerged as a potential alternative. However, clinical reports remain limited and standardized protocols are lacking.
A 13-month-old infant with biliary atresia post-Kasai procedure underwent living donor liver transplantation. On postoperative day 9, Doppler ultrasound detected signs of impending hepatic artery thrombosis, which was confirmed by computed tomography angiography. The patient was treated with intravenous alteplase at a dose of 0.3 mg/kg/h. After 3.5 hours of infusion, Doppler ultrasound showed improved hepatic artery flow. The infusion was stopped early due to intra-abdominal bleeding, which was managed conservatively. The patient stabilized without surgical intervention and was discharged on postoperative day 32 with stable hepatic artery flow. At six-month follow-up, the hepatic artery remained patent, and the patient was clinically stable.
This case supports the effectiveness of alteplase administration in treating incomplete hepatic artery thrombosis, despite its bleeding risk. We recommend lower dose regimens to reduce hemorrhagic complications. However, further studies are needed to optimize the alteplase dosage.
Thrombolytic therapy with alteplase is a possible and effective alternative in managing eHAT, particularly where conventional options are not indicated or limited.
早期肝动脉血栓形成是小儿肝移植术后的一种严重并发症，常伴有高发病率和死亡率。虽然手术血管重建和再次移植是标准治疗方法，但溶栓治疗已成为一种潜在的替代方法。然而，临床报告仍然有限，且缺乏标准化方案。
一名13个月大的患有胆道闭锁且已接受葛西手术的婴儿接受了活体供肝肝移植。术后第9天，多普勒超声检测到即将发生肝动脉血栓形成的迹象，计算机断层血管造影证实了这一情况。患者接受了剂量为0.3毫克/千克/小时的静脉注射阿替普酶治疗。输注3.5小时后，多普勒超声显示肝动脉血流改善。由于腹腔内出血，输注提前停止，对出血进行了保守处理。患者未进行手术干预病情稳定，术后第32天出院，肝动脉血流稳定。在6个月的随访中，肝动脉保持通畅，患者临床状况稳定。
该病例支持阿替普酶给药治疗不完全性肝动脉血栓形成的有效性，尽管存在出血风险。我们建议采用较低剂量方案以减少出血并发症。然而，需要进一步研究以优化阿替普酶剂量。
使用阿替普酶进行溶栓治疗是处理早期肝动脉血栓形成的一种可行且有效的替代方法，特别是在传统方法不适用或受限的情况下。
