Hepatic allograft rescue following arterial thrombosis: Role of urgent revascularization

Alan Norman Langnas, W. Marujo, R. J. Stratta, R. P. Wood, S. Li, B. W. Shaw

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Hepatic artery thrombosis is a continuing source of morbidity and mortality following orthotopic liver transplantation. The cornerstone of therapy has been urgent retransplantation that is limited by organ availability. For this reason we developed a policy of urgent revascularization for allograft rescue. Hepatic artery thrombosis developed following 15 transplants of which 11 underwent urgent rearterialization. The diagnosis was made a mean of 4.8 days (range 1-10) following transplantation. Duplex ultrasonography was diagnostic in all patients and confirmed by angiography in 4 (36%). Three patients with hepatic artery thrombosis were identified following screening ultrasonography and were clinically unsuspected. Upon reexploration, a specific technical reason for hepatic artery was found in 4 patients (36%). Twelve arterial revascularization procedures were performed in 11 patients including: Thrombectomy alone (n = 4); revision of anastomosis with thrombectomy (n = 5); and thrombectomy with placement of vascular conduit (n = 3). Following revascularization, 8 patients maintained hepatic artery patency. Three patients eventually required retransplantation secondary to biliary sepsis. Biliary tract complications developed in 6 patients, at a mean of 23 days following revascularization and included: Breakdown of the biliary anastomosis (n = 4); stricture (n = 1); and sludge formation (n = 1). The overall graft and patient survival are 74% and 82% respectively, with a mean follow-up of 6.8 months. Hepatic allograft rescue with the use of urgent revascularization following hepatic artery thrombosis appears to be an effective means of either avoiding re-transplantation or providing a bridge until a suitable donor becomes available.

Original languageEnglish (US)
Pages (from-to)86-90
Number of pages5
JournalTransplantation
Volume51
Issue number1
StatePublished - Jan 1991

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Allografts
Hepatic Artery
Thrombosis
Liver
Thrombectomy
Ultrasonography
Transplantation
Biliary Tract
Graft Survival
Sewage
Liver Transplantation
Blood Vessels
Sepsis
Angiography
Pathologic Constriction
Tissue Donors
Morbidity
Transplants
Mortality

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Langnas, A. N., Marujo, W., Stratta, R. J., Wood, R. P., Li, S., & Shaw, B. W. (1991). Hepatic allograft rescue following arterial thrombosis: Role of urgent revascularization. Transplantation, 51(1), 86-90.

Hepatic allograft rescue following arterial thrombosis : Role of urgent revascularization. / Langnas, Alan Norman; Marujo, W.; Stratta, R. J.; Wood, R. P.; Li, S.; Shaw, B. W.

In: Transplantation, Vol. 51, No. 1, 01.1991, p. 86-90.

Research output: Contribution to journalArticle

Langnas, AN, Marujo, W, Stratta, RJ, Wood, RP, Li, S & Shaw, BW 1991, 'Hepatic allograft rescue following arterial thrombosis: Role of urgent revascularization', Transplantation, vol. 51, no. 1, pp. 86-90.
Langnas, Alan Norman ; Marujo, W. ; Stratta, R. J. ; Wood, R. P. ; Li, S. ; Shaw, B. W. / Hepatic allograft rescue following arterial thrombosis : Role of urgent revascularization. In: Transplantation. 1991 ; Vol. 51, No. 1. pp. 86-90.
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