Vascular Complications After Orthotopic Liver Transplantation: Hepatic Artery Thrombosis
Vascular Complications After Orthotopic Liver Transplantation: Hepatic Artery Thrombosis
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DOI：
10.1016/j.transproceed.2010.07.063
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发表时间：
2010-10-01
影响因子：
0.9
通讯作者：
Mir, J.
中科院分区：
文献类型：
--
作者：
Pareja, E.;Cortes, M.;Mir, J.
介绍。肝动脉血栓形成（HAT）是继原发性无功能之后导致肝移植失败的第二个主要原因。它是原位肝移植（OLT）中最常见的动脉并发症。早期 HAT 定义的共识包括 OLT 后第一个月内检测到的动脉血栓形成。 HAT 与发病率显着增加相关，是移植物丢失 (53%) 和死亡率的主要原因。然而，术后护理的改进已导致其发生率显着降低。方法。我们对 1991 年 1 月至 2009 年 12 月期间接受肝移植的所有患者进行了回顾，涉及 1560 名接受 1674 次 OLT 的受试者，不包括儿童。为了分析研究时期对HAT的影响，我们定义了3个时期：第一个时期为1991年1月至1993年4月，第二个时期为1993年5月至2003年12月，最后一个时期为2004年1月至2009年12月。结果。 HAT 患者总数为 48 例（2.8%），其中早期 HAT 32 例（1.9%），晚期 HAT 16 例（0.9%）。随着手术团队经验的积累，HAT 的发生率从第一阶段的 9.3% 下降到最后阶段的 2.1%。大多数早期 HAT 患者出现急性暴发性肝衰竭 (30%)，大多数进行再移植 (81%)。讨论。一般来说，HAT 有 3 种方式：血运重建、再移植和观察。尽管再移植是大多数群体选择的治疗方法，但治疗方法的选择取决于诊断时间。最大限度地减少风险因素、早期检测方案和良好的手术技术应该成为所有中心的标准。
Introduction. Hepatic artery thrombosis (HAT) is the second main cause of liver graft failure after primary nonfunction. It is the most frequent arterial complication in orthotopic liver transplantation (OLT). The consensus for early HAT definition consists of an arterial thrombosis detected during the first month after OLT. HAT is associated with markedly increased morbidity, being the leading cause of graft loss (53%) and mortality. However, improvements in postoperative care have resulted in a marked reduction of its incidence.Methods. We performed a review of all patients who underwent liver transplantations from January 1991 to December 2009, involving 1560 subjects who underwent 1674 OLT, excluding children. To analyze the impact of the study period on HAT, we defined 3 periods: the first between January 1991 and April 1993, the second from May 1993 to December 2003, and the last from January 2004 to December 2009.Results. The total number of patients with HAT was 48 (2.8%) including 32 (1.9%) early HAT and 16 (0.9%) late HAT. The incidence of HAT diminished as the surgical team gained experience from 9.3% in the first period to 2.1% in the last. Most patients with early HAT presented acute fulminant hepatic failure (30%) and most were retransplantations (81%).Discussion. In general, there are 3 modalities for HAT: revascularization, retransplantation, and observation. The choice of the treatment depended on the time of diagnosis although retransplantation was the treatment of choice for most groups. Minimizing risk factors, protocols for early detection, and good operative techniques should be the standard in all centers.