Omar Abd El Aziz, Abstract Co-Author: Nothing to Disclose

Ayman Amin, Abstract Co-Author: Nothing to Disclose

Shinji Uemoto MD, MBA, Abstract Co-Author: Nothing to Disclose

Sally Emad Ahmed MD, Abstract Co-Author: Nothing to Disclose

Thomas Josef Vogl MD, Abstract Co-Author: Nothing to Disclose

Mohamed Mostafa, Presenter: Nothing to Disclose

To study the feasibility of transarterial thrombolysis in the management of early hepatic artery thrombosis after living donor liver transplantation (LDLT) and to clarify its role as a less invasive alternative to open surgery.

The study was approved by the institutional review board and informed consent was obtained from patients. A retrospective review of 320 recipients who underwent LDLT between August 2001 and January 2010. Early hepatic artery thrombosis (HAT) within 2 weeks post operative developed in 12 cases (2.5%). Radiological diagnosis was done by Doppler, CT and conventional angiography. Diagnostic angiography was performed with standard catheter techniques. Once HAT was confirmed, a microcather was introduced into the thrombus followed by injection of a bolus dose of 150,000 unit streptokinase. If the artery did not recanalize, continuous infusion at a rate of 100,000 unit/hr was performed for 12 hours under close follow up by Doppler. After recanalization, follow up was done by daily Doppler US till hospital discharge.

Successful surgical reconstruction was performed in 3 cases when HAT occurred within the first 3 days postoperative. Intraoperative US revealed underlying stricture. Transarterial thrombolysis was performed in 9 patients. The initial technical success rate was 77.7% (7 cases). The failure rate was 22.2% (2 cases). The long term success rate (up to 1 year follow-up) was 44.4% (4 cases), their initial angiograms revealed no underlying cause for thrombosis. Rebound thrombosis developed in 3 cases (33.3%) after 2, 6 and 12 hours from successful recanalization, their angiograms revealed underlying stenosis in 2 cases (one of them underwent successful surgical reconstruction), while the third case proved graft rejection by biopsy. Out of 9 cases, two patients developed serious bleeding that required blood transfusion with an overall major complication rate of 22.2%.

Transarterial thrombolysis is feasible in the management of early HAT after liver transplantation with an initial success rate of 77.7% and long term success rate of 44.4%. However, it carries a risk of serious bleeding . The major complication rate was 22.2%.

In early hepatic artery thrombosis after liver transplantation, transarterial thrombolytic therapy may avoid surgical reconstruction or re-transplantation.

Abd El Aziz, O, Amin, A, Uemoto, S, Ahmed, S, Vogl, T, Mostafa, M, Transarterial Thrombolysis for Early Hepatic Artery Thrombosis after Living Donor Liver Transplantation.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006719.html