Vascular complications following liver transplantation: A literature review of advances in 2015

Table 3 Hepatic artery stenosis highlights

Summary of the clinical characteristics about HAS
Significant HAS is defined as a narrowing of the transverse diameter > 50% on the angiogram associated with clinical suspicion, with a resistive index < 0.5 and a peak systolic velocity > 400 cm/s detected by DUS
HAS occurs in 2% to 13% of transplants, at the level of the anastomosis (59% of cases), graft HA (41%) or recipient HA (2.6%)
HAS has been speculated to progress to HAT in 65% of cases at 6 mo for untreated HAS
The median time to diagnosis is 100 (range: 1-1220) d following OLT
Most of patients with HAS are asymptomatic and most commonly present only with abnormal liver function tests and in rare cases with graft failure
Routine screening by DUS during the postoperative period is mandatory because of the insidious clinical presentation
The risk factors are not really known, but among these, technical and surgical factors (vascular injury such as clamp injury, intimal dissection, faulty placement of anastomotic sutures, excessive length with kinking and angulation, differences in the vessel caliber that require and oblique anastomosis, vasa vasorum disruption) or acute cellular rejection
DUS is a non-invasive method for the assessment of HA patency, but a contrast-enhanced CT scan and angiography are required to confirm the diagnosis
Radiological endovascular intervention by PTA with or without stent placement is often used to treat post-transplant HAS and are both efficacious, with 7% to 12% of complications including dissection and arterial rupture, restenosis or thrombosis (25%) and 12% failed attempts
Surgical revision and retransplant showed a high rate of success, but the overall mortality rate was as high as 20%. In some case, HAS may be an early sign of chronic rejection

DUS: Doppler ultrasound; HA: Hepatic artery; HAT: Hepatic artery thrombosis; HAS: Hepatic artery stenosis; OLT: Orthotopic liver transplantation; PTA: Percutaneous transluminal angioplasty; CT: Computed tomography.