Clinical presentation of hepatic artery thrombosis after liver transplantation in the cyclosporine era

Abstract

Hepatic artery thrombosis is a dreadful complication of orthotopic liver transplantation. It should be suspected in cases of fulminant liver failure, delayed bile leak, or intermittent sepsis of unknown cause after liver transplantation. Accurate diagnosis is assisted by ultrasound and computerized tomography scans, but usually requires arteriography. Prompt retransplantation is required in most of the cases.

Figure 1

(A, B, C). Graphic presentations of typical cases of (A) fulminant (OLT 267), (B) delayed-bile-leak (OLT 320a) and (C) septic (312a) hepatic artery thrombosis seen clinically after orthotopic liver transplantation. The cyclosporine dose represents both i.v. and oral cyclosporine given daily, the i.v. dose converted by a factor of 3 for simplicity.

Figure 1

(A, B, C). Graphic presentations of typical cases of (A) fulminant (OLT 267), (B) delayed-bile-leak (OLT 320a) and (C) septic (312a) hepatic artery thrombosis seen clinically after orthotopic liver transplantation. The cyclosporine dose represents both i.v. and oral cyclosporine given daily, the i.v. dose converted by a factor of 3 for simplicity.

Figure 1

(A, B, C). Graphic presentations of typical cases of (A) fulminant (OLT 267), (B) delayed-bile-leak (OLT 320a) and (C) septic (312a) hepatic artery thrombosis seen clinically after orthotopic liver transplantation. The cyclosporine dose represents both i.v. and oral cyclosporine given daily, the i.v. dose converted by a factor of 3 for simplicity.

Figure 2

Arteriogram obtained two weeks after transplantation showing thrombosed aortic conduit.

Figure 3

Follow-up arteriogram, obtained six weeks after the arteriogram in Figure 4, showing arterial collaterals from the superior mesenteric artery filling the right and left hepatic arteries.