Am J Surg 1991 Jan;161(1):76-82; discussion 82-3

Vascular complications after orthotopic liver transplantation

Langnas AN, Marujo W, Stratta RJ, Wood RP, Shaw BW Jr

Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.

Abstract

Over a 57-month period, we performed 430 orthotopic liver transplants in 372
patients. A total of 38 vascular complications were identified including hepatic
artery thrombosis (n = 24), portal vein thrombosis (n = 6), combined hepatic
artery thrombosis/portal vein thrombosis (n = 3), and hepatic artery rupture (n
= 5). A number of potential risk factors for the development of vascular
thrombosis were evaluated with only children, weight less than 10 kg, and cold
ischemia time found to be significant. The clinical presentation included
fulminant hepatic failure, allograft dysfunction, biliary sepsis, and screening
ultrasound. Duplex ultrasonography was diagnostic in nearly all cases.
Therapeutic modalities included revascularization, revascularization followed by
retransplantation, retransplantation alone, and observation. Five cases of
hepatic artery rupture occurred in four patients. Infectious arteritis was
present in four patients. The 6-month actuarial survival in patients with
vascular complications was 70%. Early diagnosis is critical for graft salvage,
with surgical intervention the mainstay of therapy