Abstract:

Introduction: arterial complications after orthotopic liver transplantation are common cause of graft loss (10-40%).

Aim: was to estimate efficiency of endovascular interventions in correction of revealed arterial complications in patients after OLT.

Material and methods: for the period of 2015-2020, arterial complications after 104 OLT were revealed in 24(23%) pts and were divided into 4 groups: «steal»-syndrome (n=8), hepatic artery thrombosis (n=7), combination of hepatic artery stenosis and «steal» syndrome (n=6), hepatic artery stenosis (n=3). Endovascular interventios such as splenic artery embolization, direct thrombolysis, stenting and balloon plastic were performed for correction of these complications.

Results: using of endovascular treatment, we successfully identified and correct complications with saving of the graft in 14 pts (58%), 10 pts died because of biliary necrosis, sepsis and graft loss.

Conclusion: early detection and elimination of emerging arterial complications after OLT play a keyrole in saving of organs and patients’ life.

References

1.     Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2018 году. 11th report from the registry of the Russian Transplant Society. Russian journal of transplantology and artificial organs. 2019; 21(3): 7-32 [In Russ].

2.     Buck DG, Zajko AB. Biliary complications after orthotopic liver transplantation. Tech Vasc Interv Radiol. 2008; 11(01): 51-59.

3.     Seehofer D, Eurich D, Veltzke-Shlieker W, et al. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant. 2013; 13(02): 253-265.

4.     Ingraham C, Montenovo M. Ishemic complications after liver transplantation. Dig Dis Interv. 2018; 2: 244-248.

5.     Goldsmith LE, Wiebke K, Seal J, et al. Complications after endovascular treatment of hepatic artery stenosis after liver transplantation. J Vasc Surg. 2017; 66(5): 1488-1496.

6.     Prieto M, Gastaca M, Valdivieso A, et al. Does low hepatic artery flow increase rate of biliary strictures in deceased donor liver transplantation? Transplantation. 2017; 101(9): 311.

7.     Chen J, Weinstein J, Black S, et al. Surgical and endovascular treatment of hepatic arterial complications following liver transplant. Clin Transplant. 2014; 28(12): 1305-1312.

8.     Kim PT, Fernandez H, Gupta A, et al. Low measured hepatic artery flow increases rate of biliary strictures in deceased donor liver transplantation: an age-dependent phenomenon. Transplantation. 2017; 101(2): 332-340.

9.     Galperin EI, Kunichan MD. Manometric and debitometric study in bile ducts. Surgery. 1969; 8: 74-78 [In Russ].

10.   Polikarpov АА, Tarazov PG, Polekhin AS, et al. Biliary manometric test (BMT) to assess the effectiveness balloon plasty of strictures of the bile ducts after orthotopic liver transplantation (OLT). Modern technologies in medicine. 2017; 9(4): 60-65 [In Russ].

11.   Buis CI, Verdonk RC, Van der Jagt EJ, et al. Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs late presentation. Liver Transpl. 2007; 13: 708-718.

12.   Moiseenko AV, Polikarpov АA, Tarazov PG, et al. Method for invasive graft perfusion determination. Russian patent № 270496: 23.10.2019 2019. № 30 [In Russ].

13.   Pinto S, Reddy SN, Horrow MM, et al. Splenic artery syndrome after orthotopic liver transplantation: a review. Int J Surg. 2014; 12(11): 1228-34.

14.   Mogl N, N?ssler N, Presser S, et al. Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation. Transpl. Int. 2010; 23(8): 831-841.

15.   Dokmak S, Aussilhou B, Belghiti J. Liver transplantation and splenic artery steal syndrome: the diagnosis should be established preoperatively. Liver Transpl. 2013; 19(6): 667-668.

16.   Grieser С, Denecke T, Steffen I, et al. Computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation. Eur. Radiol. 2010; 20(1): 108-117.

17.   Li H, Gao K, Huang Q, et al. Successful management of splenic artery steal syndrome with hepatic artery stenosis in an orthotopic liver transplant recipient. Ann. Transplant. Q. Pol. Transplant. 2014; 145-148.

18.   Strain D, Brady P, Matalon T, et al. Splenic artery embolization as treatment for splenic artery steal syndrome after liver transplantation. J. Vasc. Intervent. Radiol. 2013; 24(4): 159-160.

19.   G?m?n G, Gelley F, Doros A, et al. Biliary complications after orthotopic liver transplantation: The Hungarian Experience. Transplantation Proceedings. 2013; 45: 3695-3697.

20.   Lee IJ, Kim SH, Lee SD, et al. Feasibility and midterm results of endovascular treatment of hepatic artery occlusion within 24 hours after living-donor liver transplantation. J Vasc Interv Radiol. 2017; 28(2): 269-275.

21.   Fujiki M, Hashimoto K, Palaios E, et al. Probability, management, and long-term outcomes of biliary complications after hepatic artery thrombosis in liver transplant recipients. Surgery. 2017; 162(5): 1101-1111.

Abstract:

A 57-year-old woman was on the waiting list of Orthotopic Liver Transplantation (OLT) due to cirrhosis of viral etiology MSCT with contrast enhancement showed two aneurysms of the splenic artery, stenosis of the celiac trunk with aneurysm of the pancreaticoduodenal artery Taking into account asymptomatic course, we decided to eradicate vascular changes during the forthcoming OLT OLT performed 6 month later, was technically difficult and complicated by massive blood loss and episodes of unstable hemodynamics, so surgical correction of aneurysms was not performed because of high risk. The patient was well and asymptomatic for 2 years after the OLT, but then she developed abdominal pain. MSCT showed progression of vascular changes. Successful endovascular treatment included celiac trunk stenting and embolization of aneurysms. 

References

1.      Unger L, Stork T, Bucsics T, et al. The role of TIPS in the management of liver transplant candidates. United Eur. Gastroenterol. J. 2017; 5 (8): 1100-1107.

2.      Garcia-Pagan JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N. Engl. J. Med. 2010; 362 (25): 2370-2379.

3.      Bacalbasa N, Balescu I, Brasoveanu V. Celiac Trunk Stenosis Treated by Resection and Splenic Patch Reconstruction - A Case Report and Literature Review. In Vivo. 2018; 32 (3): 699-702.

4.      Degheili J., Chediak A., Dergham M, et al. Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review. Hindawi. Case reports in radiology. Volume 2017, Article ID 6989673,7 pages.

5.      Uchida H, Sakamoto S, Matsunami M., et al. Hepatic artery reconstruction preserving the pancreaticoduodenal arcade in pediatric liver transplantation with celiac axis compression syndrome: report of a case. Pediatr. Transplant. 2014; 18 (7): 232-235.

6.      Katsura M, Gushimiyagi M, Takara H, et al. True aneurysm of the pancreaticoduodenal arteries: a single institution experience. Journal of Gastrointestinal Surgery. 2010; 14 (9): 1409-1413.

7.      Chiang K, Johnson C, McKusick M, et al. Management of inferior pancreaticoduodenal artery aneurysms: a 4-year, single centre experience. CardioVascular and Interventional Radiology. 1994; 17 (4): 217-221.

8.      Koganemaru M, Abe T, Nonoshita M, et al. Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography. Diagnostic and Interventional Radiology. 2014; 20 (2): 129-135.

9.      Bastante D, Raya M, Rabelo V., et al. Analysis of ischemic cholangiopathy after treatment of arterial thrombosis in liver transplantation in our series. Transplant Proc. 2018; 50 (2): 628-630.

10.    Polikarpov AA, Tarazov PG, Granov DA, Polysalov VN. Arterial aneurysm of internal organs: the role of angiography and transcatheter embolization. Regional blood circulation and microcirculation. 2002; 1 (2): 30-36 [In Russ].

11.    Tien Y-W, Kao H-L, Wang H-P. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery. Journal of Gastroenterology. 2004; 39 (1): 81-85.

12.    Granov AM, Granov DA, Zherebcov FK, Polysalov VN, Gerasimova OA et al. Experience of 100 liver transplantation in RSCRST. Herald of surgery I.I. Grekov. 2012; 171 (2): 74-77 [In Russ].

13.    Gautier SV, Moysuk YG, Homyakov SM. Organ donation and transplantation in Russian Federation in 2014. 7-th report of National Register. Russian Journal of Transplantology and Artificial Organs. 2015; 17 (2): 7-22 [In Russ].

14.    Tarazov PG, Granov DA, Polikarpov AA, Generalov MI. Orthotopic liver transplantation: The role of interventional radiology. Herald of transplantology and artificial organs. 2009; 3: 42-50 [In Russ].