Liver Posters

Monday July 02, 2018 from 16:30 to 17:30

Room: Hall 10 - Exhibition

P.823 Thr exprience of pseudoaneurysm rupture of the hepatic artery after living donor liver transplantation

Masashi Kadohisa, Japan

Kumamoto University Graduate School of Medical Sciences

Abstract

Thr Exprience of Pseudoaneurysm Rupture of the Hepatic Artery after Living Donor Liver Transplantation

Masashi Kadohisa1, Keiichi Uto1, Daiki Yoshi1, Shintaro Hayashida1, Yuki Oya1, Hidekazu Yamamoto1, Hirotoshi Yamamoto1, Yasuhiko Sugawara1, Yukihiro Inomata2, Taizo Hibi1.

1Department of Transplantation/Pediatric Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan; 2Kumamotorousai Hospital, Yatsushiro, Japan

Introduction: Pseudoaneurysm rupture of the hepatic artery is a rare but lethal complication after living donor liver transplantation (LDLT) and is often recognized after a sudden onset of gastrointestinal bleeding. We report our own experience of pseudoaneurysm rupture after LDLT.
Methods: Of 513 LDLTs between 1998 and 2017, three patients suffered pseudoaneurysm rupture of the hepatic artery. Retrospective chart review was performed to identify the interval after LDLT, initial symptoms, clinical course, and outcomes.
Results: All three patients were male and their age ranged between 59 and 62. Liver etiologies were idiopathic portal hypertension, hepatitis B cirrhosis, and familial amyloid polyneuropathy. Interval from LDLT to pseudoaneurysm rupture was 1, 2, and 19 months. Other complications included biliary stenosis (n=1) and acute cellular rejection (n=1). Initial symptoms were hematemesis (n=2) and tarry stool (n=1) and all three cases developed bleeding in the duodenal bulb. Transcatheter arterial coil embolization was the treatment of choice, which resulted in complete obstruction of the arterial inflow to the liver. Arterial reconstruction using the right gastroepiploic artery was successfully performed in one case; Of the remaining 2 cases that developed liver abscesses, one succumbed to sepsis and one survived with re-LDLT.
Conclusions: Emergent embolization to control bleeding and maintain hemodynamics is the first step for pseudoaneurysm rupture after LDLT. Patients are in life-threatening conditions and immediate surgical decision making without delay (arterial reconstruction vs. retransplantation) is of paramount importance.

Presentations by Masashi Kadohisa



© 2024 TTS2018