Rescue of early hepatic artery thrombosis after orthotopic liver transplantation: a single center 12-year experience
10.3760/cma.j.cn421203-20231107-00157
- VernacularTitle:救治原位肝移植术后早期肝动脉血栓：单中心12年经验
- Author:
Yu LI
1
;
Chun ZHANG
;
Ruitao WANG
;
Sinan LIU
;
Xuefeng LIANG
;
Bo WANG
;
Yi LYU
;
Xuemin LIU
Author Information
1. 西安交通大学第一附属医院肝胆外科，西安 710061
- Publication Type:Journal Article
- Keywords:
Liver transplantation;
Orthotopic liver transplantation;
Hepatic artery thrombosis;
Intervention treatment;
Re-anastomosis of hepatic artery;
Complication
- From:
Chinese Journal of Organ Transplantation
2025;46(1):55-62
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the treatment approaches and outcomes of early hepatic artery thrombosis (E-HAT) in adult recipients following orthotopic liver transplantation (OLT).Methods:A retrospective analysis was conducted on clinical data of E-HAT cases after adult OLT at the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to June 2022. Clinical characteristics, treatment methods, therapeutic outcomes, long-term survival of recipients and grafts, and the incidence of long-term complications were summarized. The Kaplan-Meier method was utilized to calculate recipient survival rates.Results:Among 1 016 OLT recipients, 22 cases (2.2%) developed postoperative E-HAT. There were 19 males and 3 females, with a age of 44.81±9.98 years. E-HAT was diagnosed via angiography at a median of 3.5 (1.0, 7.0) days post-OLT. Twenty recipients underwent vascular intervention therapy, achieving clinical success in 14 cases (70.0%) with a mean thrombolysis duration of 5.1±3.2 days. Twelve cases (60.0%) experienced complications, including abdominal bleeding (10 cases), gastrointestinal bleeding (1 case), catheter-related infection (1 case), subcutaneous bleeding (1 case), and hepatic artery dissection (1 case). Five recipients underwent hepatic artery re-anastomosis, including two initial cases and three following failed interventional therapy. Surgery was performed at a median of 5.0 (1.0, 15.3) days post OLT, with 4 successful cases. Through combined interventional and surgical treatment, 81.8% (18/22) of grafts were salvaged. However, the success rate was significantly lower in cases with marked transaminase (AST, ALT) and total bilirubin elevation (16/18 vs 2/4). Nineteen E-HAT survivors were followed for a median of 22 (5, 52) months. During follow-up, 2 cases experienced thrombus recurrence, and 12 cases developed biliary complications, including ischemic biliary stenosis (11 cases), extensive liver necrosis (1 case), localized liver abscess (1 case), and biliary anastomotic stenosis (1 case). Seven recipients died due to graft failure. The 1-year, 3-year and 5-year cumulative survival rates were 67.2%, 60.5% and 34.5%, respectively.Conclusions:Combined interventional and surgical treatment demonstrates a high success rate for managing E-HAT, particularly when addressed before significant graft damage. Ischemic biliary stenosis remains the most common long-term complication.
