Lesions associated with ischemic injury to a liver transplant:
(1) hepatic artery thrombosis occurring early (1 month, <= 30 days) after the transplant procedure
(2) hepatic artery thrombosis occurring late (> 30 days) after the transplant
(3) hepatic artery stenosis
Risk factors for early hepatic artery thrombosis:
(1) age of the patient > 60 years
(2) bench reconstruction of anatomical variants of the hepatic artery
Risk factors for late hepatic artery thrombosis:
(1) use of an ilial conduit (an arterial anastomosis fashioned using an interpositional graft of donor iliac artery)
(2) donor who died of a cerebrovascular accident (stroke, other)
Risk factors for hepatic artery stenosis:
(1) history of a previous liver transplant
(2) cytomegalovirus (CMV) infection
where:
• Bench reconstruction involved reconstructing right accessory branches to the graft arising from the superior mesenteric artery. This involved an end-to-end anastomosis between the proximal stump of the celiac artery and the proximal stump of the superior mesenteric artery (page 1070).
• Hepatic artery stenosis may be suspected on Doppler ultrasonography if the resistive index is < 0.5 and the systolic acceleration time is prolonged.
A patient at risk for one or more complications should have the vascular anastomoses regularly monitored with Doppler ultrasonography at each outpatient visit. Suspicious findings are confirmed with hepatic artery angiography. Early detection of vascular problems allows for interventions that can usually preserve transplant function.
