HEPATIC-ARTERY STENOSIS AFTER LIVER-TRANSPLANTATION - INCIDENCE, PRESENTATION, TREATMENT, AND LONG-TERM OUTCOME

Little is known about hepatic artery (HA) patency and patient clinical course when the nonthrombosed HA has been revised We undertook this s tudy to evaluate the risk factors in the development of HA stenosis an d to assess the impact of HA revision on the outcome, A total of 857 a dult consecutive OLT in 780 patients performed over a g-year period we re studied Patients who underwent revision of their nonthrombosed but stenotic HA were reviewed for patient/graft survival, method of HA rev ision, incidence of biliary strictures, and long-term IIA patency, Ove rall 39 patients (5%) with 41 allografts underwent HA revision for ste nosis, Median time to diagnosis was 100 days posttransplant (range 1-1 220 days), HA flow at the time of OLT was found to be the only signifi cant variable of an anastomotic stenosis, No risk factor could be iden tified for the graft HA stenosis, Treatment methods included resection of the stenotic segment with primary reanastomosis (n = 17), aortohep atic iliac artery graft (n = 11), interposition vein graft (n = 4), ve in patch angioplasty (n = 2), interposition artery graft (n = 1), and percutaneous transluminal balloon angioplasty (n = 6), Postrevisional HA patency was demonstrated in 32 (78%) cases, At a median follow-up o f 25 months, 26 patients (67%) were asymptomatic with good liver funct ion. Nine patients had developed biliary strictures, Seven patients ha d undergone retransplantation and 8 patients had died, The actuarial p atient and graft survivals at 4 years in the patients with revised HA were 65% and 56%, respectively, HA stenosis requiring revision is an i nfrequent occurrence after OLT, Long-term patency of the revised HA is good, Revision of the HA may help prevent biliary strictures and allo w for good long-term graft function in the majority of patients.