Treatment of vascular complications following liver transplantation: Multidisciplinary approach

Background/Aims: Complications affecting the vascularization of the graft f ollowing orthotopic liver transplantation still represent a significant cau se of graft loss and patient mortality. Strategies have recently been devel oped for the early detection and treatment of these complications before ir reversible graft failure takes place. Methodology: A series of 429 consecutive liver transplants performed on 384 patients between April 1986 and December 1998 was retrospectively rewieved to assess the incidence of all the vascular complications and the results of their treatment with either surgery or interventional radiology. Results: The incidence of vascular complications was 6.06% for the hepatic artery, 2.56% for the inferior vena cava and 1.16% for the portal vein. As regards anastomotic stenosis and thrombosis, the requirement of retransplan tation decreased progressively with the advent of systematic postoperative screening with duplex Doppler ultrasonography and the introduction of graft -salvage procedures, falling from 50% for those cases diagnosed before 1996 to 19% for those diagnosed from 1996 on. Mortality following 18 graft-salv age procedures was 11.1% versus 41.6% following retransplantation. Graft-sa lvage procedures were successful in 14 out of 18 cases. Conclusions: Close surveillance of the vascular anastomoses and multidiscip linary approach to the treatment of vascular complication after liver trans plantation considerably reduces graft loss and patient mortality.