Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1592
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
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.
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.
To evaluate the feasibility and reasonability of intra-arterial thrombolysis for E-HAT after LT.
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.
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).
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.
Further research is required to understand and reduce the incidence of E-HAT and subsequent biliary complications following the conservative management of these patients.