HEPATIC ALLOGRAFT ABSCESS WITH HEPATIC ARTERIAL THROMBOSIS

BACKGROUND: Intrahepatic abscess (IA) is an uncommon complication afte r liver transplantation (OLTx) usually found in the setting of hepatic arterial thrombosis (HAT) often with associated biliary tree necrosis and/or stricture. Conventional treatment of IA in this setting has re quired retransplantation. METHODS: A retrospective review of 274 patie nts (287 OLTx) from September 1991 through September 1996 was performe d. Median follow-up was 3.6 years. Diagnosis of HAT was confirmed by a rteriography and IA was documented by computerized tomography. Percuta neous drainage of the abscess and stenting of biliary strictures, if p resent, was achieved using conventional interventional radiology techn iques. RESULTS: The diagnosis of hepatic artery complication was made in 14 patients (5.1%), 2 of whom required retransplantation. Hepatic a rtery thrombosis associated with solitary IA was found in 3 patients ( 1%) who were transplanted in our center and in 1 additional patient fo llowed up at our center but transplanted elsewhere. All 4 patients had complete resolution of IA using this approach. Three of the 4 patient s are alive and well, with the fourth patient succumbing to recurrent hepatitis B infection resulting in allograft failure. CONCLUSIONS: Sol itary hepatic allograft abscesses associated with HAT respond to percu taneous drainage and antibiotics, obviating the need for retransplanta tion in this setting. (C) 1998 by Excerpta Medica, Inc.