Hepatic artery stenosis after pediatric liver transplantation: The potential role of conservative management.

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-10-07 DOI:10.1016/j.dld.2024.09.021

Weihao Li, Thomai Kotsou, Hermien Hartog, Rene Scheenstra, Vincent E de Meijer, Martin W Stenekes, Martijn V Verhagen, Reinoud P H Bokkers, Hubert P J van der Doef

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Abstract

Aim: This study aimed to investigate the outcomes and effectiveness of various treatment strategies in patients with hepatic artery stenosis (HAS) after pediatric liver transplantation (pLT).

Methods: This is a single center observational cohort study between January 1st, 2004 and August 1st, 2023, including pLT recipients aged <18 years. The primary outcome was graft and patient survival. The secondary outcomes included incidence of biliary complications, technical success of surgery or endovascular therapy (EVT), and changes in liver function. The cut-off for early and late HAS was 14 days after pLT.

Results: Among a total of 327 pLT patients, 4 % (n = 13) developed HAS (n = 3 early; n = 10 late). Treatments included surgical revascularization for one early HAS, conservative management with anticoagulation for one early and four late HAS, and EVT for one early and six late HAS. Over a median follow-up of 28.2 months after the diagnosis of HAS, graft survival was 100 % and 83 % in early and late HAS groups, and patient survival reached 100 % in both groups. One graft loss occurred in the conservative group. Conversely, graft survival in the EVT group was 100 %.

Conclusion: The long-term outcomes of HAS after pLT are excellent. Both EVT and conservative management exhibited high graft survival rates for late HAS, with EVT achieving high technical success.

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小儿肝移植术后肝动脉狭窄：保守治疗的潜在作用。

目的：本研究旨在探讨小儿肝移植（pLT）后肝动脉狭窄（HAS）患者各种治疗策略的结果和有效性：这是一项2004年1月1日至2023年8月1日期间的单中心观察性队列研究，研究对象包括年龄较大的小儿肝移植受者：在总共 327 例 pLT 患者中，4%（n = 13）出现 HAS（n = 3 例早期患者；n = 10 例晚期患者）。治疗方法包括：对 1 例早期 HAS 实施血管重建手术；对 1 例早期 HAS 和 4 例晚期 HAS 实施抗凝保守治疗；对 1 例早期 HAS 和 6 例晚期 HAS 实施 EVT。在确诊 HAS 后 28.2 个月的中位随访期间，早期和晚期 HAS 组的移植物存活率分别为 100% 和 83%，两组患者的存活率均为 100%。保守治疗组出现了一次移植物丢失。相反，EVT 组的移植物存活率为 100%：结论：PLT术后HAS的长期疗效非常好。EVT和保守治疗对晚期HAS的移植物存活率都很高，其中EVT的技术成功率很高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.