Transplantation 1991 Jan;51(1):86-90

Hepatic allograft rescue following arterial thrombosis. Role of urgent revascularization

Langnas AN, Marujo W, Stratta RJ, Wood RP, Li SJ, Shaw BW
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280
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 retransplantation or providing a
bridge until a suitable donor becomes available