Mini-invasive treatment of arteria and biliary complication after-orthotopic Iiver transplantation.

POSTOPERATIVE arterial and biliary complications contribute significantly to morbidity and mortality of liver transplant recipients.1–3 Surgery remains the mainstay of therapy, however, the management of these complications requires a multidisciplinary approach in which interventional radiological techniques have made important progress.4–8 The aim of the present study was to evaluate the role of mini-invasive treatment of hepatic artery stenosis (HAS) and biliary strictures (BS) in our over 13-year experience. MATERIALS AND METHODS From April 1986 to October 1999, 508 OLT were performed in 452 patients. Arterial complications were 38 of 508 (7.4%). A conventional arterial anastomosis was performed in 28 patients, an iliac artery graft was used in nine cases, and a vascular prosthesis was used in one patient. In the arterial complications group, HAS occurred in three patients (18.4%). The HAS was diagnosed by routine Doppler ultrasound within 1 month after OLT. Management was by percutaneous transluminal angioplasty (PTA) in two patients and PTA plus stent in one patient. A choledochocholedochostomy was performed in all patients. Biliary complications were 35 of 508 (6.8%). Biliary strictures occurred in 22 patients, with more anastomotic strictures (16 patients) than nonanastomotic strictures (six patients). Twelve liver transplant patients with BS underwent mini-invasive treatments: balloon dilation (n 5 4) and stent implantation (n 5 8). RESULTS Two of three HAS were successfully treated by balloon dilation and are alive and well at 33 and 20 months. One patient required surgical revision due to arterial dissection and re-OLT and is alive at 65 months. Seven patients were successfully treated by balloon dilation (n 5 3) and stent (n 5 4), with a mean follow-up of 60.5 months (range 1 to 118 months). Balloon dilation failed in other five patients, and they were treated surgically with an Roux-en-Y jejunum loop anastomosis; among them one patient died. A choledochojejunostomy was performed in other five patients not previously treated, and two of them died. One patient required surgical revision and three patients underwent re-OLT; all are alive and well. One more patient is waiting for balloon dilation. CONCLUSIONS HAS is an infrequent occurrence after OLT, and PTA is an effective procedure of improving blood flow in these cases, reducing the risk of thrombosis. An early nonsurgical revision of the HAS may avoid the development of biliary strictures, allowing for good long-term graft function in the majority of OLT recipients. Transhepatic balloon dilation and stenting of the choledochocholedochostomy represents an effective and relatively safe treatment of BS in OLT recipients. These mini-invasive procedures provide a cure in many arterial and biliary complications after OLT, and thus, surgery may be avoided in selected liver transplant recipients.