Kim M, Lee HW, Yoon CJ, Lee B, Jo Y, Cho JY, Yoon YS, Lee JS, Han HS. Intra-arterial lipo-prostaglandin E1 infusion for arterial spasm in liver transplantation: A case report. World J Clin Cases 2023; 11(34): 8153-8157 [PMID: 38130782 DOI: 10.12998/wjcc.v11.i34.8153]
Corresponding Author of This Article
Hae Won Lee, MD, PhD, Professor, Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 13620, Gyeonggi-do, South Korea. lansh@hanmail.net
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 6, 2023; 11(34): 8153-8157 Published online Dec 6, 2023. doi: 10.12998/wjcc.v11.i34.8153
Intra-arterial lipo-prostaglandin E1 infusion for arterial spasm in liver transplantation: A case report
Moonhwan Kim, Hae Won Lee, Chang Jin Yoon, Boram Lee, Yeongsoo Jo, Jai Young Cho, Yoo-Seok Yoon, Jun Suh Lee, Ho-Seong Han
Moonhwan Kim, Hae Won Lee, Boram Lee, Yeongsoo Jo, Jai Young Cho, Yoo-Seok Yoon, Jun Suh Lee, Ho-Seong Han, Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si 13620, Gyeonggi-do, South Korea
Chang Jin Yoon, Department of Radiology, Seoul National University, Seongnam 463-707, South Korea
Author contributions: Kim M and Lee HW participated in the research design; Yoon CJ, Lee B, Jo Y, Cho JY, Yoon YS, Lee JS, and Han HS participated in the performance of the research and in the data analysis; Kim M and Lee HW participated in the writing of the article.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: There are no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hae Won Lee, MD, PhD, Professor, Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 13620, Gyeonggi-do, South Korea. lansh@hanmail.net
Received: July 12, 2023 Peer-review started: July 12, 2023 First decision: August 24, 2023 Revised: October 18, 2023 Accepted: November 27, 2023 Article in press: November 27, 2023 Published online: December 6, 2023
Abstract
BACKGROUND
Hepatic artery obstruction is a critical consideration in graft outcomes after living donor liver transplantation. We report a case of diffuse arterial vasospasm that developed immediately after anastomosis and was managed with an intra-arterial infusion of lipo-prostaglandin E1 (PGE1).
CASE SUMMARY
A 57-year-old male with hepatitis B virus-related liver cirrhosis and hepatocellular carcinoma underwent ABO-incompatible living donor liver transplant. The grafted hepatic artery was first anastomosed to the recipient’s right hepatic artery stump. However, the arterial pulse immediately weakened. Although a new anastomosis was performed using the right gastroepiploic artery, the patient’s arterial pulse rate remained poor. We attempted angiographic intervention immediately after the operation; it showed diffuse arterial vasospasms like ‘beads on a string’. We attempted continuous infusion of lipo-PGE1 overnight via an intra-arterial catheter. The next day, arterial flow improved without any spasms or strictures. The patient had no additional arterial complications or related sequelae at the time of writing, 1-year post-liver transplantation.
CONCLUSION
Angiographic evaluation is helpful in cases of repetitive arterial obstruction, and intra-arterial infusion of lipo-PGE1 may be effective in treating diffuse arterial spasms.
Core Tip: Diffuse arterial spasms are difficult to correct surgically, and there are no clear standard management protocols. This short report shows that angiography is helpful for evaluating the hepatic artery after liver transplantation and that intra-arterial infusion of lipo-prostaglandin E1 might be an effective non-surgical treatment option for diffuse arterial spasms.
