Urgent revascularization of liver allografts after early hepatic artery thrombosis
Urgent revascularization of liver allografts after early hepatic artery thrombosis
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DOI：
10.1097/00007890-199612150-00010
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发表时间：
1996-12-15
期刊：
影响因子：
6.2
通讯作者：
Fung, JJ
中科院分区：
文献类型：
--
作者：
Pinna, AD;Smith, CV;Fung, JJ
在1993年4月至1995年5月期间，17例成人原位肝移植受者在术后平均7天（平均11天）后发现早期肝动脉血栓形成（HAT）。所有病例均经双功超声诊断为HAT。血栓切除术与紧急血运重建（UR），使用从尸体肝脏供体获得的插入动脉移植物，并通过术中血管造影术验证动脉通畅性。在7例病例中，在血栓切除术后给予动脉内尿激酶。15例（88%）肝脏在整个随访期间（中位数，15个月）保持动脉化;其余2例患者在6个月和8个月后复发HAT。虽然后续并发症的发生率很高，但11例（65%）患者没有再次移植而存活，平均随访17个月。尽管有一个开放的肝动脉，其余6名患者（35%）死于感染并发症，通常是在UR之前。因此，UR有效地恢复了88%的早期HAT患者的动脉流入。最终结果主要由UR时腹腔内并发症的存在决定。总之，对于移植后早期发生HAT的患者，应将UR而不是再次移植作为首选治疗方案。
Between April 1993 and May 1995, 17 adult orthotopic liver transplant recipients were found to have early hepatic artery thrombosis (HAT) after a median of 7 postoperative days (mean, 11). The HAT was diagnosed in all cases by duplex ultrasound. Thrombectomy was performed with urgent revascularization (UR), using an interposition arterial graft procured from the cadaveric liver donor, and arterial patency was verified with intraoperative angiography. In seven cases, intra-arterial urokinase was administered after the thrombectomy. Fifteen (88%) of the livers remained arterialized throughout the follow-up period (median, 15 months); the remaining two patients developed recurrent HAT after 6 and 8 months. Although there was a high rate of subsequent complications, 11 (65%) of the patients are alive without retransplantation, with a mean follow-up of 17 months. Despite having a patent hepatic artery, the remaining six patients (35%) died from infectious complications that usually were present before the UR. Thus, UR effectively restored arterial inflow in 88% of the patients with early HAT. The ultimate outcome was determined mainly by the presence of intra-abdominal complications at the time of UR. In conclusion, UR, rather than retransplantation, should be considered the prime treatment option for patients who develop early posttransplant HAT.