EARLY DIAGNOSIS AND MANAGEMENT OF VASCULAR COMPLICATIONS FOLLOWING LIVINGDONOR LIVER TRANSPLANTATION
Mohamed Riad Warda;
Abstract
C
ollectively, post-liver transplant vascular complications are not uncommon and require vigilant imaging and clinical follow-up to diagnose in a timely fashion.
Our conclusions are based mostly on our long-standing experience in liver transplantation comparable to that of other centres worldwide. Thus, we conclude:
For the Hepatic Artery:
- Doppler ultrasound examination is a valuable method for use in the monitoring of vascular blood flow in the transplanted liver.
- Microsurgical techniques allow for the creation of a single arterial trunk, which results in hemodynamic sufficiency of the arterial anastomosis.
- Early HAT and late HAT, Computed tomography angiography is the key to management decisions. There is a role for early revascularization. . Morbidity and mortality are associated with early re-transplantation. Conservative management should be used in selected cases if there is significant transaminitis and definite parenchymal ischemia on contrast computed tomography, so revascularization is likely to produce a significant reperfusion injury that might endanger the patient. In our patient after conservative management of thrombosed hepatic artery, intrahepatic arterial flow was detected, probably coming from the adhesions to the hepatic capsule.
- Concurrent HAT and PVT early in the aftermath of OLT are devastating complications leading to loss of allograft and necessitating retransplantation. However if the event occurs late, simple observation may suffice provided that the robustness of collateral circulation and reconstitution of intrahepatic blood flow are elucidated angiographically.
- Our basic concept is to create the best possible conditions for anastomosis and to perform a simple end-to-end anastomosis. Hepatic arterial anastomosis using surgical loupes tended to be time-saving and to yield similar results like traditional microscope-anastomosis.
- The number and character of complications does not differ from those reported by other centres.
- Recipient re-transplantation is the most effective treatment method in cases of hepatic arterial occlusion.
ollectively, post-liver transplant vascular complications are not uncommon and require vigilant imaging and clinical follow-up to diagnose in a timely fashion.
Our conclusions are based mostly on our long-standing experience in liver transplantation comparable to that of other centres worldwide. Thus, we conclude:
For the Hepatic Artery:
- Doppler ultrasound examination is a valuable method for use in the monitoring of vascular blood flow in the transplanted liver.
- Microsurgical techniques allow for the creation of a single arterial trunk, which results in hemodynamic sufficiency of the arterial anastomosis.
- Early HAT and late HAT, Computed tomography angiography is the key to management decisions. There is a role for early revascularization. . Morbidity and mortality are associated with early re-transplantation. Conservative management should be used in selected cases if there is significant transaminitis and definite parenchymal ischemia on contrast computed tomography, so revascularization is likely to produce a significant reperfusion injury that might endanger the patient. In our patient after conservative management of thrombosed hepatic artery, intrahepatic arterial flow was detected, probably coming from the adhesions to the hepatic capsule.
- Concurrent HAT and PVT early in the aftermath of OLT are devastating complications leading to loss of allograft and necessitating retransplantation. However if the event occurs late, simple observation may suffice provided that the robustness of collateral circulation and reconstitution of intrahepatic blood flow are elucidated angiographically.
- Our basic concept is to create the best possible conditions for anastomosis and to perform a simple end-to-end anastomosis. Hepatic arterial anastomosis using surgical loupes tended to be time-saving and to yield similar results like traditional microscope-anastomosis.
- The number and character of complications does not differ from those reported by other centres.
- Recipient re-transplantation is the most effective treatment method in cases of hepatic arterial occlusion.
Other data
| Title | EARLY DIAGNOSIS AND MANAGEMENT OF VASCULAR COMPLICATIONS FOLLOWING LIVINGDONOR LIVER TRANSPLANTATION | Other Titles | الاكتشاف المبكر للمضاعفات التي تحدث بعد عملية زرع الكبد من متبرع حي و المتعلقة بالأوعية الدموية للكبد و طرق العلاج | Authors | Mohamed Riad Warda | Issue Date | 2015 |
Recommend this item
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.