Emergency interventional endovascular treatment for early disorder of arterial blood flow in the liver graft

Introduction. Liver transplantation is considered the most effective treatment for patients with end-stage liver disease. X-ray endovascular interventions show good results in the treatment of vascular complications after transplantation. The timing, indications and choice of treatment methods require clarification.

Objective. To evaluate the safety and efficacy of emergency X-ray endovascular interventions for arterial complications in the early period after liver transplantation.

Material and methods. In the period from October 2016 by July 2021, 88 liver transplants were performed. The graft was obtained from a posthumous donor in 75 cases, and from a living donor (right lobe of the liver) in 13 cases. Arterial complications were registered in 10 cases: thrombosis of the hepatic artery in 7 (8.0%), constriction in 3 (3.4%); 4 patients underwent retransplantation due to thrombosis. This analysis included 6 patients aged 27 to 51 years, including 4 men and 2 women. In the early postoperative period (0–14 days), according to laboratory parameters, ultrasound Doppler, and computed tomography with a contrast agent, an impairment of the arterial blood supply of the graft was revealed, for which the patients underwent emergency X-ray image-guided surgical endovascular interventions.

Results. Restoration of adequate arterial blood supply to the liver graft was achieved in all six patients. At the time of this writing, the graft function and patency of the hepatic artery were preserved at follow-up periods of 6, 11, 12, 22 (in two patients), and 26 months with a median of 17 months. Four patients developed biliary complications that required surgical correction.

Conclusion. X-ray image-guided endovascular interventions can be considered effective and relatively safe in the treatment of patients with arterial complications after liver transplantation. The period of graft arterial ischemia should be minimized as much as possible in order to prevent biliary complications.

1. Devcic Z, Toskich BB, Livingston D, Crome KP, Lewis AR, Ritchie Ch, et al. Endovascular treatment of aortohepatic conduit stenosis following liver transplant. Transplant Proc. 2020;52(3):943– 948. PMID: 32139279 https://doi. org/10.1016/j.transproceed.2020.01.017

2. Alconchel F, Martínez-Insfran LA, Cascales-Campos PA, Febrero B, Martínez-Alarcón L, Ríos A, et al. Impact of hepatic artery thrombosis on the success of a liver transplant because of hepatocellular carcinoma. Transplant Proc. 2020;52(2):559–561. PMID: 32029319 https://doi.org/10.1016/j.transproceed.2019.11.037

3. Roussel N, Otal P, Revel P, Zadro Ch, Meyrignac O, Mokrane F, et al. Intervention in the liver transplant patient. Chapter 38. In: Image-guided interventions. 3rd ed. Saunders; 2020. (A volume in Expert Radiology). p. 309–314.e3. https://doi. org/10.1016/B978-0-323-61204-3.00038- 5

4. Granov DA, Polikarpov AA, Tileubergenov II, Zhuikov VN, Moiseenko AV, Sheralierv AR, et al. A case report of successful liver retransplantation in patient with early hepatic artery thrombosis complicated by bile ducts necrosis and sepsis. Russian journal of transplantology and artificial organs. 2019;3(21):76-83. (In Russ.). https://doi.org/10.15825/1995-1191- 2019-3-76-83

5. Kok B, Dong V, Karvellas CJ. Graft dysfunction and management in liver transplantation. Crit Care Clin. 2019;35(1):117–133. PMID: 30447775 https://doi.org/10.1016/j.ccc.2018.08.002

6. Hamby BA, Ramirez DE, Loss GE, Bazan HA, Smith TA, Bluth E, et al. Endovascular treatment of hepatic artery stenosis after liver transplantation. J Vasc Surg. 2013;57(4):1067–1072. PMID: 23332988 https://doi.org/10.1016/j. jvs.2012.10.086

7. Rostambeigi N, Hunter D, Duval S, Chinnakotla S, Golzarian J. Stent placement versus angioplasty for hepatic artery stenosis after liver transplant: a meta-analysis of case series. Eur Radiol. 2013;23(5):1323–1334. PMID: 23239061 https://doi.org/10.1007/s00330-012- 2730-9

8. Gastaca M, Gomez J, Terreros I, Izquierdo J, Ruiz P, Prieto M, et al. Endovascular therapy of arterial complications within the first week after liver transplant. Transplant Proc. 2020;52(5):1464– 1467. PMID: 32220478 https://doi. org/10.1016/j.transproceed.2020.02.075

9. Novruzbekov MS, Olisov OD. Vascular complications after orthotopic liver transplantation. Transplantologiya. The Russian Journal of Transplantation. 2017;9(1):35–50. (In Russ.). https://doi. org/10.23873/2074-0506-2017-9-1-35-50

10. Sakuraoka Y, da Silva Boteon APC, Brown R, Perera MThPR. Severe atherosclerosis of donor hepatic arteries is a salvageable condition in liver transplantation to optimise the graft utilisation: A case series and review of the literature. Int J Surg Case Rep. 2019;59:190 196. PMID: 31176087 https://doi. org/10.1016/j.ijscr.2019.05.048

11. Goto Y, Shirahama N, Sasaki S, Ishikawa H, Hisaka T, Ogata T, et al. Endovascular treatment for very early hepatic artery stenosis following livingdonor liver transplantation: report of two case. Transplant Proc. 2018;50(5):1457– 1460. PMID: 29880370 https://doi. org/10.1016/j.transproceed.2018.02.074

12. Goldsmith LE, Wiebke K, Seal J, Brinster C, Smith TA, Bazan HA, et al. Complications after endovascular treatment of hepatic artery stenosis after liver transplantation. J Vasc Surg. 2017;66(5):1488–1496. PMID: 28697937 https://doi.org/10.1016/j.jvs.2017.04.062

13. Le L, Terral W, Zea N, Bazan HA, Smith TA, Loss GE, et al. Primary stent placement for hepatic artery stenosis after liver transplantation. J Vasc Surg. 2015;62(3):704–709. PMID: 26054583 https://doi.org/10.1016/j.jvs.2015.04.400

14. Zhang H, Qian Sh, Liu R, Yuan W, Wang J-H. Interventional treatment for hepatic artery thrombosis after liver transplantation. J Vasc Interv Radiol. 2017;28(8):1116–1122. PMID: 28610742 ttp://doi.org/10.1016/j.jvir.2017.04.026

15. Forcella R Jr, Shahid MU, Kumar A, Shukla P, Riccardi J. Endovascular treatment of post–orthotopic liver transplant hepatic artery complication: single transplant center review. J Vasc Interv Radiol. 2019;30 [Abstract International Symposium on Endovascular Therapy (ISET)- 2019, (USA, Hollywood, Florida, January 26-29 2019)]:e11–e12.

16. Reese T, Raptis DA, Oberkofler CE, de Rougemont O, Györi GP, GosteliPeter M, et al. A systematic review and meta-analysis of rescue revascularization with arterial conduits in liver transplantation. Am J Transplant. 2019;19(2):551– 563. PMID: 29996000 https://doi. org/10.1111/ajt.15018

17. Naidu S, Alzubaidi S, Knuttinen G, Patel I, Fleck A, Sweeney J, et al. Treatment of hepatic artery stenosis in liver transplant patients using drug-eluting versus bare-metal stents. J Clin Med. 2021;10(3):380. PMID: 33498286 https:// doi.org/10.3390/jcm10030380

18. Granov DА, Tarazov PG, Polikarpov AA, Borovik VV, Rutkin IO, Tileubergenov II. Splenic artery embolization in patients undergoing orthotopic liver transplantation. Russian Journal of Transplantology and Artificial Organs. 2016;1(18):17–21. (In Russ.). https://doi. org/10.15825/1995-1191-2016-1-17-21

19. Moisyuk YaG, Gegenava BB, Ammosov AA, Porshennikov IA, Sidorenko AB, Pavlik VN, et al. Split liver transplantation in two recipients for urgent indications: an example and logistics of interregional cooperation. Annaly khirurgicheskoy gepatologii=Annals of HPB Surgery. 2020;4(25):71–84. (In Russ.). https://doi.org/10.16931/1995- 5464.2020471-84

20. Piardi T, Lhuaire M, Bruno O, Memeo R, Pessaux P, Kianmanesh R, et al. Vascular complications following liver transplantation: A literature review of advances in 2015. World J Hepatol. 2016;8(1):36–57. PMID: 26783420 https://doi.org/10.4254/wjh.v8.i1.36

21. Granov DA, Maystrenko DN, Tarazov PG, Tileubergenov II, Polikarpov AA, Moiseenko AV. Endovascular interventions in correction of arterial complications after orthotopic liver transplantation. Journal diagnostic & interventional radiology. 2021;15(1):51– 58. (In Russ.). https://doi.org/10.25512/ DIR.2021.15.1.05

22. Sanyal R, Zarzour JG, Ganeshan DM, Bhargava P, Lall ChG, Little MD. Postoperative doppler evaluation of liver transplants. Indian J Radiol Imaging. 2014;24(4):360–366. PMID: 25489129 https://doi.org/10.4103/0971- 3026.143898

23. Delgado-Moraleda JJ, BallesterValles C, Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation. Insights Imaging. 2019;10(1):78. PMID: 31414188 https://doi.org/10.1186/ s13244-019-0759-x