Valente J F, Alonso M H, Weber F L, Hanto D W
Department of Surgery, University of Cincinnati College of Medicine, Ohio 45267-0558, USA.
Transplantation. 1996 Jan 15;61(1):61-5. doi: 10.1097/00007890-199601150-00013.
Hepatic artery thrombosis (HAT) after liver transplantation is a potentially life-threatening complication that occurs in 2-25% of patients, depending on several risk factors and the patient population studied. Arterial thrombosis occurring early after liver transplantation is associated with acute fulminant hepatic failure, biliary tract necrosis and leaks, or relapsing bacteremia and is associated with a high rate of graft loss and patient mortality. The onset of late posttransplant HAT (after 6 months) has been thought to have a more benign and often asymptomatic course. The reasons for the differences between the manifestations of early and late HAT are not well understood. We reviewed the adult liver transplant experience at the University of Cincinnati and found four patients with late HAT, three of whom developed severe intrahepatic biliary necrosis. Two patients were successfully retransplanted and 1 patient who refused retransplantation died. One patient had mild, transient graft damage due to gradual arterial stenosis and the development of arterial collaterals prior to thrombosis. Late HAT has a significant potential for irreversible graft damage requiring retransplantation. Screening for the development of hepatic artery stenosis prior to late thrombosis may be worthwhile.
肝移植后肝动脉血栓形成（HAT）是一种潜在的危及生命的并发症，其发生率在2%至25%之间，具体取决于多种风险因素以及所研究的患者群体。肝移植术后早期发生的动脉血栓形成与急性暴发性肝衰竭、胆道坏死及渗漏或复发性菌血症相关，且与高移植肝丢失率和患者死亡率相关。移植后晚期HAT（6个月后）的发病被认为病程更为良性且通常无症状。早期和晚期HAT表现差异的原因尚不清楚。我们回顾了辛辛那提大学成人肝移植经验，发现4例晚期HAT患者，其中3例发生严重的肝内胆管坏死。2例患者成功再次移植，1例拒绝再次移植的患者死亡。1例患者因逐渐出现的动脉狭窄及血栓形成前动脉侧支循环的发展而出现轻度、短暂的移植肝损伤。晚期HAT有导致不可逆的移植肝损伤而需要再次移植的巨大潜在风险。在晚期血栓形成前筛查肝动脉狭窄的发生可能是值得的。
