Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Hepatic Artery Stenosis (HAS) is a significant complication after liver transplantation associated with morbidity. The primary aim of this study is to determine if endovascular intervention for HAS reduces the risk of hepatic artery thrombosis (HAT). We also investigated the risks of adverse outcomes associated with HAS.
*Methods: In this retrospective single center cohort study, we reviewed chart data for adult patients who underwent liver transplantation at our institute from 2013 to 2018. A total of 341 patients were included. Donor and recipient demographics, graft characteristics, perioperative variables were collected (Tables 1 & 2). The presence of HAS, type of endovascular intervention, and use of antiplatelet agents were collected. The primary outcome was development of HAT. Secondary outcomes included biliary stricture, restenosis, graft failure, and mortality. Univariate and multivariate logistic regression was used to ascertain odds ratio of developing HAS for donor and recipient characteristics. Fisher’s exact test was used to compare outcomes between types of interventions among patients with HAS. P-values less than 0.05 were considered significant.
*Results: 64 patients (18.7%) were identified to have HAS. The odds of HAS in patients receiving livers from DCD donors was doubled (OR = 2.16 (0.98, 0.99); P = 0.04). Of the 64 patients with HAS, 53 had an angiogram and 43 of these had an endovascular intervention. Patients who underwent angioplasty alone experienced restenosis (66.7%) at a significantly higher rate in comparison with other interventions such as stenting (P=0.001). There was no significant difference in the prevalence of biliary stricture, or HAT between the HAS patients that had any type of endovascular intervention compared to those that did not. Those receiving an intervention were more likely to receive antiplatelet therapy (P < 0.001; Table 3). Patients with HAS had 4.8 times higher odds of biliary strictures compared to patients without HAS (OR=4.77 (2.52, 9.05); P <0.001). Patients who have HAS had lower probability of graft survival and overall survival compared to patients who did not have HAS (log rank P< 0.001 and P= 0.01) respectively.
*Conclusions: We observed significant increase in HAS in recipients of DCD grafts. Patients with HAS who underwent intervention with angioplasty alone had higher restenosis rate. Endovascular interventions did not reduce HAT progression or biliary stricture development. HAS itself is associated with increased biliary stricture, poor graft survival and increased mortality.
To cite this abstract in AMA style:Bommena S, Joshi I, Kang P, Chaly T, Seetharam A, Patel N, Fallon MB, Mehta S. Management of Hepatic Artery Stenosis Post Liver Transplant [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/management-of-hepatic-artery-stenosis-post-liver-transplant/. Accessed November 24, 2020.
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