Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1592-1599
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1592
Intra-arterial thrombolysis for early hepatic artery thrombosis after liver transplantation
Ting Li, Xiao-Dong Sun, Ying Yu, Guo-Yue Lv
Ting Li, Xiao-Dong Sun, Ying Yu, Guo-Yue Lv, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Li T collected, analyzed data and wrote the paper; Sun XD performed the study; Yu Y collected the data; Lv GY designed and supervised the study.
Supported by The Science and Technology Department of Jilin Province, No. 20180622004JC and No. 20190101002JH; and the Finance Department of Jilin Province, No. 2017F004 and No. 2018SCZWSZX-044.
Institutional review board statement: This research was approved by the Ethical Committee of First Hospital of Jilin University.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Data sharing statement: Original data are available from the corresponding author at lgy08@sina.com.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Yue Lv, PhD, Professor, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun 130021, Jilin Province, China. lgy08@sina.com
Received: October 26, 2020
Peer-review started: October 26, 2020
First decision: December 8, 2020
Revised: December 22, 2020
Accepted: December 28, 2020
Article in press: December 28, 2020
Published online: March 6, 2021
ARTICLE HIGHLIGHTS
Research 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. Besides re-transplantation and re-anastomosis, endovascular treatments have increasingly been selected in recent years, yet the efficacy of intra-arterial thrombolysis has not yet been demonstrated.

Research motivation

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.

Research objectives

To evaluate the feasibility and reasonability of intra-arterial thrombolysis for E-HAT after LT.

Research methods

A total of 147 patients who underwent LT were retrospectively reviewed. The patients who were diagnosed with E-HAT underwent intra-arterial thrombolysis with alteplase as the first choice therapy. The method of arterial anastomosis and details of the diagnosis and treatment of E-HAT were collated. The long-term prognosis of E-HAT patients was also recorded.

Research results

The incidence of E-HAT was 2.7% (4/147). E-HAT was suspected following Doppler ultrasonography and confirmed by hepatic arterial angiography. The patients were given temporary thrombolytics (mainly alteplase) 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% (3/4), and biliary complications were present in 50% of patients (2/4).

Research conclusions

Intra-arterial thrombolysis can be considered first-line treatment for E-HAT after deceased donor LT. Early diagnosis of E-HAT is important and follow-up is necessary even if recanalization is successful.

Research perspectives

Further research is required to understand and reduce the incidence of E-HAT and subsequent biliary complications following the conservative management of these patients.