ARTERIELLE KOMPLIKATIONEN NACH LEBERTRANSPLANTATION

Disturbances of the arterial perfusion of the graft following liver transplantation (LTx) are mainly of technical origin and contribute considerably to the postoperative morbidity and lethality. Aim of this retrospective survey was to determine the incidence and the consequences of hepatic artery thrombosis (HAT) and stenosis (HAS) in 203 patients (pts.) who underwent 246 liver transplantations. HAT was identified in 22 pts. by clinical, laboratory and sonographic and/or angiographic means. In 4 pts. HAT was asymptomatic and was detected during routine examination. Two pts. underwent immediate retransplantation, of which only one survived. Primary revascularization was performed in 16 pts., but was successfully only in 5 pts. Six pts. eventually underwent retransplantation with only one survivor. Biliary complications after HAT were observed in 10 pts. (45%), presenting in 8 pts. as biliary leak, in 2 pts. as bile duct stenosis. In the 12 patients with HAT who died the leading causes of death were sepsis (n = 3) and mutiple organ failure (n = 3). HAS was observed in 11 pts., of which one was asymptomatic. Ten pts. underwent surgical revision. Redo of the arterial anastomosis was the most common procedure. Four pts. survived long term. Biliary tract complications were seen in 3 pts. (leak 1, stenosis 2). Three pts. died secondary to HAS from sepsis. These results confirm the lifethreatening character of any arterial complication after LTx. Because other reasons are rarely detected, the majority is attributable to technical faults. In order to avoid arterial complications extraordinary care has to be taken in the surgical handling of the arterial supply of the graft during harvesting, back table work and transplantation.