Objective: To evaluate the safety and efficacy of interventional radiological techniques in management of early hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT).
Methods: Nine patients with HAT after OLT, 8 males and 1 female, aged 47.6 (32-63), presenting elevation of liver enzymes and bilirubin, whose diagnosis was suggested by Doppler ultrasonography and confirmed by angiography 16 hours to 10 days after the OLT, underwent interventional radiological techniques, including indwelling transcatheter hepatic artery (HA) thrombolysis with a low dose of urokinase, and stent placement into the stenotic segment of HA. Contemporaneous systemic low dose of heparin was given intravenously. Ultrasonography was performed every 12 hours during the intra-arterial (IA) thrombolysis.
Results: HA flow was established in 7 of the 9 patients (78%) 12 hours to 9 days (on average 4.8 days) after the IA thrombolysis with significant improvement of liver functions. HA stenosis (HAS) at the anastomotic stoma was found in 6 of these 7 patients, and stent placement at the stenotic segment was performed successfully in 6 of them with a degree of stenosis over 90%. IA thrombolysis failed in 2 cases. One patient with intraperitoneal hemorrhage 12 hours after the treatment underwent emergent graft revision and the bleeding place was found at the HA anastomotic stoma. One patient remained completely occluded of the HA 7 days after the treatment; however, the collateral flow to the liver was identified. His liver function was improved without further intervention. Follow-up of 6 months (2-14 months) showed that the 7 patients with successful HA recanalization had a good clinical course with normal graft function.
Conclusion: Transcatheter endovascular interventional techniques are effective on treatment of early HAT after OLT.