Rescue of liver grafts from hepatic artery occlusion in living-related liver transplantation

Background: Hepatic artery thrombosis after liver transplantation remains a significant cause of graft loss and death. Retransplantation is a difficul t option after living-related liver transplantation in Japan. Methods: Twenty-seven patients underwent living-related liver transplantati on with left-sided liver grafts donated from their relatives. The hepatic a rtery was anastomosed end to end under a surgical microscope. Anticoagulant therapy was maintained for 2 weeks after operation. Routine post-transplan t Doppler ultrasonography together with serum blood tests were performed tw ice a day during the first 2 weeks. Results: Three patients developed hepatic artery occlusion, which was ident ified by routine Doppler ultrasonography before the serum transaminase valu es increased on days 7, 7 and 3 after surgery respectively. In two of the t hree patients, no apparent arterial thrombosis was recognized and vasospasm was therefore considered to be the cause of the occlusion. Arterial patenc y was restored by urgent revascularization with reanastomosis in all patien ts, but one patient with a functional graft died from a cerebral haemorrhag e on day 47. Conclusion: Early diagnosis of hepatic artery occlusion by routine Doppler ulnasonography and revascularization of the graft is an indispensable strat egy for preventing graft loss after living-related liver transplantation.