Endovascular treatment of hepatic artery stenosis (HAS) after liver transplantation offers a less invasive alternative to surgical revision or retransplantation. However, outcomes following endovascular treatment remain ill-defined. We conducted a single center retrospective review of endovascular treatment of hepatic artery stenosis following liver transplantation from August 2009 – December 2013. Forty-two patients diagnosed with HAS on ultrasound (peak systolic velocity > 400 cm/sec, resistive index <0.5) underwent angioplasty alone or primary stent placement. Transplant characteristics included mean recipient age (51.2 ± 10.9), BMI (28.5 ± 6.6), MELD (23.1 ± 8.6), donor age (32.6 ± 15.1) and cold ischemia time (5.4 ± 1.6h). During the study period, the overall rate of hepatic artery stenosis was 6.4%. Sixty-two interventions were performed in 42 patients with HAS with a mean follow-up of 34.0 ± 13.3 months. Primary hepatic artery patency rates at 1, 6 and 12 months after initial intervention were significantly better for initial stent placement (91%, 81.3%, 77%) versus angioplasty alone (68.8%, 57.1%, 44%). Fourteen patients required re-intervention for recurrent stenosis (8 stents, 6 repeat angioplasties). Overall primary-assisted patency was 96 and 93% at 12 and 24 months, respectively. Major complications included one arterial rupture and two hepatic artery dissections. In the entire patient cohort, risk of hepatic artery thrombosis was 4.8%. Biliary strictures developed in 7 patients (16.6%) with only one diffuse-type cholangiopathy requiring retransplantation. All focal biliary strictures were successfully treated endoscopically. Graft survival rates at 6, 12 and 24 months after the initial endovascular were 92.7%, 87.7% and 79.2% respectively. Patient survival rates at 6, 12 and 24 months were 97.6%, 92.6% and 81.6% respectively. Endovascular treatment of critical hepatic artery stenosis offers a minimally invasive approach with high rates of primary patency and liver allograft survival. Initial use of a stent significantly decreased the need for re-intervention.

« Back to 2015 American Transplant Congress