Korean J Transplant.  2021 Dec;35(4):268-274. 10.4285/kjt.21.0009.

Salvage aorto-hepatic jump graft for hepatic artery thrombosis following living donor liver transplantation: a case report with 10-year follow-up

• Choi JU
• Hwang S
• Ahn CS
• Moon DB
• Park GC

• KMID: 2523678
• DOI: http://doi.org/10.4285/kjt.21.0009

Abstract

Hepatic artery thrombosis (HAT) following living donor liver transplantation (LDLT) is a lethal complication. We present the case of a patient who underwent salvage redo hepatic artery reconstruction using an aorto-hepatic jump graft because of HAT following LDLT. A 64-year-old female patient diagnosed with hepatitis C virus-associated liver cirrhosis and hepatocellular carcinoma underwent salvage LDLT using a modified right liver graft. Partial graft infarct was identified at posttransplant day 4, and by day 9, it had spread. Celiac arteriography showed complete occlusion of the graft hepatic artery. We performed redo hepatic artery reconstruction using a fresh iliofemoral artery homograft 10 days after the LDLT operation because such a vessel homograft was available at our institutional tissue bank. The infrarenal aorta was dissected and an iliofemoral artery graft was anastomosed. Soon after hepatic artery revascularization, liver function progressively improved, and the infarct area at the liver graft was reduced. The patient has been doing well for 10 years without any vascular complications. In conclusion, our experience with this case suggests that salvage redo hepatic artery reconstruction using an aorto-hepatic jump graft is a feasible option to treat HAT following LDLT, as in deceased donor liver transplantation.

Keyword

Aorto-hepatic reconstruction; Hepatic artery thrombosis; Redo anastomosis; Hepatic failure; Retransplantation; Case report

Figure

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  Fig. 1 Initial perioperative findings. (A) A 5-cm-sized hepatocellular carcinoma is located at segment VII (arrow). (B) Partial hepatectomy is performed. (C, D) Ascites occurred following hepatectomy.

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  Fig. 2 Gross photograph of the explanted liver. There was mixed macro- and micronodular cirrhosis associated with hepatitis C virus infection. A 1.9-cm-sized hepatocellular carcinoma was identified.

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  Fig. 3 Computed tomography findings taken on posttransplant day 9. (A, B) The extent of the parenchymal infarct is expanded. (C, D) Graft hepatic artery is tapered off (arrows), indicating hepatic arterial insufficiency.

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  Fig. 4 Peritransplant recipient hepatic artery findings. (A, B) Pretransplant computed tomography arteriography shows the small-sized right hepatic artery of the recipient. (C, D) Celiac arteriography taken on posttransplant day 9 shows complete occlusion of the graft hepatic artery (arrows).

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  Fig. 5 Hepatic artery findings at 1 day after hepatic artery revascularization. (A, B) Computed tomography sectional images show the running course of the interposed iliofemoral artery homograft (red arrows). (C, D) Computed tomography arteriography shows the running courses of the interposed iliofemoral artery homograft from the infrarenal aorta (red arrows) and the interposed superior mesenteric artery homograft between the graft hepatic artery and iliofemoral artery homograft (green arrows).

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  Fig. 6 Posttransplant computed tomography findings. (A, B) Images taken at 1 month after transplantation show marked reduction of the graft infarct area and patent hepatic artery inflow (arrow). (C, D) Images taken at 9 years 8 months following transplantation show the patent iliofemoral graft (arrow) and absence of perfusion abnormality of the liver graft.

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