Intra-arterial thrombolysis for early hepatic artery thrombosis after liver transplantation  

作　　者：Ting Li Xiao-Dong Sun Ying Yu Guo-Yue Lv 

机构地区：[1]Department of Hepatobiliary and Pancreatic Surgery,The First Hospital of Jilin University,Changchun 130021,Jilin Province,China

出　　处：《World Journal of Clinical Cases》2021年第7期1592-1599,共8页世界临床病例杂志

基　　金：The Science and Technology Department of Jilin Province,No.20180622004JC and No.20190101002JH;the Finance Department of Jilin Province,No.2017F004 and No.2018SCZWSZX-044.

摘　　要：BACKGROUND Early hepatic artery thrombosis(E-HAT)is a serious complication after liver transplantation(LT),which often results in graft failure and can lead to patient deaths.Treatments such as re-transplantation and re-anastomosis are conventional therapeutic methods which are restricted by the shortage of donors and the patient’s postoperative intolerance to re-laparotomy.Due to the advances in interventional techniques and thrombolytics,endovascular treatments are increasingly being selected by more and more centers.This study reviews and reports our single-center experience with intra-arterial thrombolysis as the first choice therapy for E-HAT after deceased donor LT.AIM To evaluate the feasibility and reasonability of intra-arterial thrombolysis for EHAT after deceased donor LT.METHODS A total of 147 patients who underwent deceased donor LT were retrospectively reviewed in our hospital between September 2011 and December 2016.Four patients were diagnosed with E-HAT.All of these patients underwent intraarterial thrombolysis with alteplase as the first choice therapy after LT.The method of arterial anastomosis and details of the diagnosis and treatment of EHAT were collated.The long-term prognosis of E-HAT patients was also recorded.The median follow-up period was 26 mo(range:23 to 30 mo).RESULTS The incidence of E-HAT was 2.7%(4/147).E-HAT was considered when Doppler ultrasonography showed no blood flow signals and a definite diagnosis was confirmed by immediate hepatic arterial angiography when complete occlusion of the hepatic artery was observed.The patients were given temporary thrombolytics(mainly alteplase)via a 5-Fr catheter which was placed in the proximal part of the thrombosed hepatic artery followed by continuous alteplase using an infusion pump.Alteplase dose was adjusted according to activated clotting time.The recanalization rate of intra-arterial thrombolysis in our study was 100%(4/4)and no thrombolysis-related mortality was observed.During the follow-up period,patient survival rate was 75%(

关 键 词：Early hepatic artery thrombosis Liver transplantation Intra-arterial thrombolysis THROMBOLYTICS Hepatic arterial angiography PROGNOSIS 

分 类 号：R657.3[医药卫生—外科学]