Drazan K, Shaked A, Olthoff K M, Imagawa D, Jurim O, Kiai K, Shackelton C, Busuttil R
Dumont-UCLA Transplant Center, Los Angeles, California.
Am Surg. 1996 Mar;62(3):237-40.
Hepatic artery thrombosis (HAT) after adult orthotopic liver transplantation (OLT) is associated with fulminant sepsis and irretrievable loss of the graft. The purpose of this study was 1) to identify recipients at risk for the development of HAT; 2) to define early signs and methods for diagnosis; 3) to determine surgical treatment strategies following diagnosis of HAT. The charts of 680 adults who underwent primary OLT were reviewed. Eleven patients were symptomatic from HAT. Operative data revealed problematic arterial reconstruction in 9/11, and were related to inadequate recipient inflow, necessitating an interposition allogeneic iliac graft in seven patients, or anastomosis to aberrant right hepatic artery in two recipients. Early HAT in 4/11 occurred within 4 weeks after transplantation, whereas late thrombosis in 7/11 was identified 30 days to 1 year after OLT. The postthrombosis course was manifested by elevated liver transaminases (7/11), sepsis and recurrent cholangitis (9/11), or gas gangrene of the liver (4/11). The treatment modalities included thrombectomy and revision of the arterial anastomosis (1/11), emergency hepatectomy with temporary portocaval shunt (2/11), and urgent retransplantation (5/11). Antibiotic therapy and elective retransplantation was the treatment in 4/11. Overall 1-year patient survival and satisfactory graft function was 45 percent.
成人原位肝移植（OLT）后发生的肝动脉血栓形成（HAT）与暴发性脓毒症及移植肝不可挽回的丧失有关。本研究的目的是：1）识别有发生HAT风险的受者；2）明确早期体征及诊断方法；3）确定HAT诊断后的手术治疗策略。回顾了680例接受初次OLT的成人患者的病历。11例患者出现了HAT相关症状。手术数据显示，11例中有9例存在动脉重建问题，与受者流入道不足有关，7例患者需要植入一段同种异体髂动脉移植物，2例受者需要与异常的右肝动脉进行吻合。11例中有4例早期HAT发生在移植后4周内，而11例中有7例晚期血栓形成在OLT后30天至1年被发现。血栓形成后的病程表现为肝转氨酶升高（11例中的7例）、脓毒症和复发性胆管炎（11例中的9例）或肝气性坏疽（11例中的4例）。治疗方式包括血栓切除术和动脉吻合口修复（11例中的1例）、急诊肝切除术并临时行门腔分流术（11例中的2例）以及紧急再次移植（11例中的5例）。11例中有4例采用抗生素治疗和择期再次移植。总体而言，患者1年生存率及移植肝功能良好率为45%。
