Intensive Doppler Ultrasonography for Early Detection of Hepatic Artery Thrombosis After Adult Living Donor Liver Transplantation
| Autor: | Leo Leung-Chit Tsang, Tung-Liang Huang, Pi-Ling Chiang, Chee-Chien Yong, Chao-Long Chen, Hsien-Wen Hsu, Yu-Fan Cheng, Chun-Yen Yu, Hsin-You Ou, Wei-Xiong Lim |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Arterial Occlusive Diseases Liver transplantation Hepatic Artery Occlusion medicine Living Donors Humans Thrombolytic Therapy Thrombus Ultrasonography Doppler Color Computed tomography angiography Aged Retrospective Studies Transplantation Original Paper medicine.diagnostic_test business.industry Liver Diseases Thrombosis Ultrasonography Doppler General Medicine Thrombolysis Middle Aged medicine.disease Liver Transplantation medicine.anatomical_structure Female Radiology Complication business Artery |
| Zdroj: | Annals of Transplantation |
| ISSN: | 2329-0358 |
| Popis: | BACKGROUND Early hepatic artery thrombosis (eHAT) is a severe arterial complication leading to biliary complications and graft failure in living donor liver transplantation (LDLT). This study sought to early identify the abnormal waveforms of eHAT by using intensive Doppler ultrasonography (DUS) after LDLT and to assess the clinical outcome in these eHAT patients. MATERIAL AND METHODS DUS for 419 adult LDLT recipients was performed twice after vascular anastomosis during liver transplantation and once a day at the bedside for at least 2 weeks. RESULTS Nine adult LDLT recipients with eHAT were identified by using bedside DUS with subsequent computed tomography angiography (CTA). All eHAT cases were noted in the first 2 weeks. Five patients with CTA findings of partial thrombus with the small visualized intrahepatic hepatic artery (HA) were treated with intravenous thrombolysis (IVT) (medical group). Another 4 patients with CTA findings of extrahepatic HA occlusion and nonvisualization of intrahepatic HAs were treated by arterial re-anastomosis (surgical group). The prevalence of long-term non-anastomotic biliary strictures was 33.3% in the surgical group. Intensive post-LDLT DUS is a convenient and sensitive tool for eHAT detection. CONCLUSIONS Subsequent CTA gives valid information on occluded arteries and associated findings, which impact decision-making and are correlated with patient outcome. Our protocol of DUS has high sensitivity and diagnostic accuracy for use in in eHAT patients with partial occlusion, and it can be applied for IVT treatment, avoiding the need for reoperation and preventing long-term biliary complications. |
| Databáze: | OpenAIRE |
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