Hepatic Artery Angioplasty/Stenting in the Treatment of Hepatic Artery Stenosis after Liver Transplant

Monday, March 6, 2023

3:09 PM – 3:18 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

VJ

Vishal Jindal, BS

Medical Student
Touro University - California

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

MR

Michael Repajic, BA

Medical Student
Keck School of Medicine of USC
NB

Neelesh Bagrodia, BS

Medical Student
Keck School of Medicine of USC
MS

Mayilone Sathialingam, BS

Medical Student
Keck School of Medicine of USC
Jesse Han, BA (he/him/his)

Medical Student
Keck School of Medicine of USC
SS

Stuart Schroff, MD

Interventional Radiologist
Keck School of Medicine of USC
MK

Michael Katz, MD

Interventional Radiologist
Keck School of Medicine of USC
RT

Ramon Ter-Oganesyan, MD

Interventional Radiologist
University of Southern California
JV

Jenanan Vairavamurthy, MD

Assistant Professor, Interventional Radiologist
Keck School of Medicine, Univeristy of Southern California

Disclosure(s):

Vishal Jindal, BS: No financial relationships to disclose

Jesse Han, BA: No financial relationships to disclose

Purpose: Liver transplantation is the definitive treatment in end-stage liver disease. Hepatic artery stenosis (HAS) can lead to early failure of the organ, which is devastating considering limited organ availability. In this study, we aimed to retrospectively review a single center experience with transplant hepatic artery intervention to determine the efficacy of angioplasty and/or stent placement.

Materials and Methods:
A retrospective review of hepatic artery angioplasty/stent procedures was performed. Inclusion criteria were patients with HAS after liver transplantation. In total, 38 patients who fit study criteria that underwent hepatic artery arteriography with angioplasty/stent placement were identified over a 12 year period. Fifty angioplasty procedures were performed, of which 20 included stent placement on 17 different patients. Hepatic artery patency and patency rates were evaluated as main outcomes at 1, 3, 6, and 12 month intervals. Primary patency was defined as the time from initial intervention to last imaging with patency. Assisted primary patency was defined as the time from subsequent intervention to last imaging showing patency in patients with repeat intervention.

Results: Of the 38 patients, 28 (74%) required only one intervention. Of these 28, all had imaging follow up at 1 month, 9 at three months, 7 at six months, and 6 at twelve months. At all time points, 100% primary patency was seen. When analyzing follow-up imaging beyond one year, 25 patients had adequate imaging at various time points, and all 25 patients demonstrated patency. Of the original 38 patients, ten (26%) patients required repeat intervention for subsequent narrowing/stenosis with none experiencing complete thrombosis. Of the 10 patients that required repeat intervention, 9 had adequate 1-month and 3-month follow up to achieve a 100% 1-month and 3-month assisted primary patency rate, 8 had adequate 6-month follow up to achieve a 100% 6-month assisted primary patency rate, and 4 had adequate 12-month follow up to achieve a 100% 12-month assisted primary patency rate. A total of 20 patients had pre-intervention ascites. Eighteen (90%) patients demonstrated improvement in ascites. Of the 28 patients that had elevated liver enzymes, 23 (82%) experienced an improvement and overall reduction.

Conclusion: Based on patency data, improvement in ascites, and reduction in liver enzymes, angioplasty and/or stent placement are effective and durable interventions. With a larger patient cohort, future analysis may aid in determining efficacy and benefit to angioplasty and/or stent placement in this population.