摘要
BACKGROUND: Hepatic artery thrombosis (HAT) which is a serious complication after orthotopic liver transplanta- tion (OLT) remains a significant cause of graft loss. The purpose of this study was to sum up our experiences in the prevention, diagnosis and management of HAT after liver transplantation. METHODS: From April 1993 to September 2003, a total of 198 patients underwent OLT at our hospital. The hepatic artery was anastomosed using 7/0 prolane with running continuous suture in 96 patients (group 1) and with inter- rupted suture in 102 (group 2). Ultrasonography was per- formed every day in two weeks after operation and selec- tively afterwards. RESULTS: HAT occurred in 6 patients (6.3%, 6/96) of group 1, and in 1 (1%, 1/102) of group 2 (x2=4.027, P= 0.045). Six patients received emergency thrombectomy, and 1 conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 patients af- ter thrombectomy of whom 2 died of liver failure and one waited for retransplantation. In the other 3 patients after thrombectomy, 1 died of renal failure, and 2 survived. The mortality of patients with HAT was 57.1% (4/7). CONCLUSIONS: The technique of hepatic arterial anasto- mosis is the key factor for the prevention of HAT. Routine ultrasonography is very important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.
BACKGROUND: Hepatic artery thrombosis (HAT) which is a serious complication after orthotopic liver transplanta- tion (OLT) remains a significant cause of graft loss. The purpose of this study was to sum up our experiences in the prevention, diagnosis and management of HAT after liver transplantation. METHODS: From April 1993 to September 2003, a total of 198 patients underwent OLT at our hospital. The hepatic artery was anastomosed using 7/0 prolane with running continuous suture in 96 patients (group 1) and with inter- rupted suture in 102 (group 2). Ultrasonography was per- formed every day in two weeks after operation and selec- tively afterwards. RESULTS: HAT occurred in 6 patients (6.3%, 6/96) of group 1, and in 1 (1%, 1/102) of group 2 (x2=4.027, P= 0.045). Six patients received emergency thrombectomy, and 1 conservative therapy but died from tumor recurrence eventually. Biliary complication developed in 3 patients af- ter thrombectomy of whom 2 died of liver failure and one waited for retransplantation. In the other 3 patients after thrombectomy, 1 died of renal failure, and 2 survived. The mortality of patients with HAT was 57.1% (4/7). CONCLUSIONS: The technique of hepatic arterial anasto- mosis is the key factor for the prevention of HAT. Routine ultrasonography is very important in early detection of HAT after OLT. Biliary complication is a severe outcome secondary to HAT.
作者
Shu-Sen Zheng, Zhi-Yong Yu, Ting-Bo Liang, Wei-Lin Wang, Yan Shen, Min Zhang, Xiao Xu and Jian Wu Hangzhou, China Centre of Organ Transplantation and Department o Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medica College, Zhcjiang University, Hangzhou 310003, China
