Interventional therapy and timing of retransplantation for hepatic artery stenosis after orthotopic liver transplantation

Objective To evaluate the effectiveness of interventional therapy(IT) and timing of retransplantation for treatment of hepatic artery stenosis(HAS) after orthotopic liver transplantation(OLT).Methods The clinical data of 20 patients diagnosed as hepatic artery stenosis(HAS) were retrospectively analyzed.Among them,6 cases underwent retransplantation.HAS was confirmly by digital subtraction angiography(DSA).All patients were treated with percutaneous interventional management including percutaneous transluminal angioplasty(PTA) and stent-graft placement.Results After IT in the 8 patients with early HAS(within 1 month of transplantation),liver function improved in 6 cases,one underwent retransplantation due to deterioration of liver function,and one died of acute liver failure during awaiting a proper liver for retransplantation.After IT in the 12 patients with late HAS(after 1 month of liver transplantation),one died of severe sepsis 38 days after transplantation,five patients underwent late retransplantation due to ischemic-type biliary strictures or recurrent attacks of cholangitis,and one of these patients died 11 days after retransplantation.The median follow-up of 17 patients was 13 months after liver transplantation.Two patients died of severe cholangitis and recurrence of hepatocellular carcinoma unrelated to HAS,and 3 patients developed recurrent hepatic arterial stenosis and were successfully treated with second interventional therapy.Eight patients(40%) developed ischemic-type biliary strictures and underwent interventional treatment.Graft function in 5 of the 8 patients improved.The Kaplan-Meier curve of survival showed the 1,and 2 year cumulated survival rates of early HAS and late HAS were 87.5%,43.8% and 81.5%,54.3%,respectively.There was no significant difference in 1 and 2 year survival rates between early HAS and late HAS(log-rank test,P=0.976).Conclusions Interventional therapy is the treatment of choice for HAS after OLT when the HAS has not resulted in severe hepatic dysfunction,but the incidence of ischemic biliary tract stenosis is relatively high.Liver transplantatation is the only effective theropy when HAS induced irreversible hepatic dysfunction.