HEPATIC-ARTERY ANGIOPLASTY AFTER LIVER-TRANSPLANTATION - EXPERIENCE IN 21 ALLOGRAFTS

PURPOSE: To assess whether percutaneous transluminal angioplasty (PTA) can help prolong allograft survival and improve allograft function in patients with hepatic artery stenosis after liver transplantation. PA TIENTS AND METHODS: Hepatic artery PTA was attempted in 19 patients wi th 21 allografts over 12 years, The postangioplasty clinical course wa s retrospectively analyzed. Liver enzyme levels were measured before a nd after PTA to determine if changes in liver function occurred after successful PTA. RESULTS: Technical success was achieved in 17 allograf ts (81%). Retransplantation was required for four of 17 allografts (24 %) in which PTA was successful and four of four allografts in which PT A was unsuccessful; this difference was significant (P = .03), Two maj or procedure-related complications occurred: an arterial leak that req uired surgical repair and an extensive dissection that necessitated re transplantation 14 months after PTA. Hepatic failure necessitated repe at transplantation in seven cases from 2 weeks to 27 months (mean, 8.4 months) after PTA. Six patients died during follow-up, three of whom had undergone repeat transplantation. Markedly elevated liver enzyme l evels at presentation were associated with an increased risk of retran splantation or death regardless of the outcome of PTA. CONCLUSION: PTA of hepatic artery stenosis after liver transplantation is relatively safe and may help decrease allograft loss due to thrombosis, Marked al lograft dysfunction at presentation is a poor prognostic sign; thus, t imely intervention is important.