Korean J Radiol.  2004 Sep;5(3):164-170. 10.3348/kjr.2004.5.3.164.

Causes of Arterial Bleeding After Living Donor Liver Transplantation and the Results of Transcatheter Arterial Embolization

• Kim JH
• Ko GY
• Yoon HK
• Song HY
• Lee SG
• Sung KB

• KMID: 1118821
• DOI: http://doi.org/10.3348/kjr.2004.5.3.164

Abstract

OBJECTIVE
To analyze the causes of arterial bleeding after living donor liver transplantation (LDLT) and to evaluate the efficacy of transcatheter arterial embolization (TAE). MATERIALS AND METHODS: Forty-two sessions of conventional arteriography were performed in 32 of the 195 patients who underwent LDLT during the past 2 years. This was done in search of bleeding foci of arterial origin. TAE was performed with microcoils or gelatin sponge particles. The causes of arterial bleeding, the technical and clinical success rates of TAE and the complications were retrospectively evaluated. RESULTS: Forty-two bleeding foci of arterial origin were identified on 30 sessions of arteriography in 21 patients. The most common cause of bleeding was percutaneous procedures in 40% of the patients (17 of the 42 bleeding foci) followed by surgical procedures in 36% (15/42). The overall technical and clinical success rates of TAE were 21 (70%) and 20 (67%) of the 30 sessions, respectively. The overall technical success rate of TAE for the treatment of bleeding from the hepatic resection margin, hepatic artery anastomotic site and hepaticojejunostomy was only 18% (2/11), whereas for the treatment of bleeding in the other locations the technical and clinical success rates of TAE were 100% and 95%, respectively. No procedure-related major complications occurred. CONCLUSION: In the case of arterial bleeding after LDLT, percutaneous procedure-related hemorrhages were as common as surgery-related hemorrhages. There were technical difficulties in using TAE for the treatment of hepatic arterial bleeding. However, in the other locations, TAE seems to be safe and effective for the control of arterial bleeding in LDLT recipients.

Keyword

Liver, transplantation; Arteries, therapeutic embolization; Hemorrhage; Surgery, complications

MeSH Terms

Adolescent
Adult
Child
Embolization, Therapeutic/instrumentation/*methods
Female
Humans
Liver/radiography
Liver Diseases/etiology/*therapy
Liver Transplantation/*adverse effects
*Living Donors
Male
Middle Aged
Postoperative Hemorrhage/etiology/*therapy
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 A 48-year-old man presenting with an abruptly increased amount of fresh blood draining from a Jackson-Pratt drain. Two weeks previously, he underwent stent placement because of portal vein stenosis. A. Common hepatic arteriogram shows a pseudoaneurysm (arrow) supplied by the segment V hepatic artery. B. The supplying hepatic artery was successfully embolized with microcoils. After embolization, the patient clinically improved.

• 

  Fig. 2 A 47-year-old woman with arterial bleeding through a Jackson-Pratt drain. A. Right 10th intercostal arteriogram shows extravasation of contrast media (arrow). B. Right 10th intercostal artery was embolized with gelfoam particles and microcoils. After embolization, the stain disappeared. The patient clinically improved.

• 

  Fig. 3 A 47-year-old man presenting with arterial bleeding through a Jackson-Pratt drain. A. Common hepatic arteriogram shows extravasation of contrast media (arrow). B. A branch of the supplying hepatic artery was embolized with a straight microcoil. C. Post-embolization hepatic arteriogram shows residual stain fed from fine collateral vessels. D. Immediately after embolization, CT shows collection of contrast media along the hepatic resection margin. Afterwards, the patient underwent additional surgery to control the residual bleeding.

Reference

1. Raia S, Nery JR, Mies S. Liver transplantation from live donors. Lancet. 1989. 2:497.

2. Samstein B, Emond J. Liver transplants from living related donors. Annu Rev Med. 2001. 52:147–160.

3. Belghiti J, Durand F. Living donor liver transplantation: present and future. Br J Surg. 2000. 87:1441–1443.

4. Ozaki CF, Katz SM, Monsour HP Jr, Dyer CH, Wood RP. Surgical complications of liver transplantation. Surg Clin North Am. 1994. 74:1155–1167.

5. Testa G, Malago M, Broelsch CE. Bleeding problems in patients undergoing segmental liver transplantation. Blood Coagul Fibrinolysis. 2000. 11:S81–S85.

6. Koneru B, Tzakis AG, Bowman J 3rd, Cassavilla A, Zajko AB, Starzl TE. Postoperative surgical complications. Gastroenterol Clin North Am. 1988. 17:71–91.

7. Clavien PA, Camargo CA Jr, Croxford R, Langer B, Levy GA, Greig PD. Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation. Ann Surg. 1994. 220:109–120.

8. Nakajima I, Fuchinoue S, Tanaka K, et al. Clinical study of living-related liver transplantation. Transplant Proc. 1998. 30:138–141.

9. Tojimbara T, Fuchinoue S, Nakajima I, et al. Factors affecting survival after living-related liver transplantation. Transpl Int. 2000. 13:S136–S139.

10. Sauer IM, Pascher A, Steinmuller T, et al. Split liver and living donation liver transplantation: the Berlin experience. Transplant Proc. 2001. 33:1459–1460.

11. Bell R, Sheil AG, Thompson JF, et al. Vascular complications following orthotopic liver transplantation. Aust N Z J Surg. 1990. 60:193–198.

12. Patenaude YG, Dubois J, Sinsky AB. Liver transplantation: review of the literature part 2: vascular and biliary complications. Canad Assoc Radiol J. 1997. 48:231–242.

13. de Villa VH, Chen CL, Chen YS, et al. Split liver transplantation in Asia. Transplant Proc. 2001. 33:1502–1503.

14. Kirby RM, McMaster P, Clements D, et al. Orthotopic liver transplantation: postoperative complications and their management. Br J Surg. 1987. 74:3–11.

15. Lebeau G, Yanaga K, Marsh JW, et al. Analysis of surgical complications after 397 hepatic transplantations. Surg Gynecol Obstet. 1990. 170:317–322.

16. Madariaga J, Tzakis A, Zajko AB, et al. Hepatic artery pseudoaneurysm ligation after orthotopic liver transplantation - a report of 7 cases. Transplantation. 1992. 54:824–828.

17. Marshall MM, Muiesan P, Srinivasan P, et al. Hepatic artery pseudoaneurysms following liver transplantation: incidence, presenting features and management. Clin Radiol. 2001. 56:579–587.

18. Koep LJ, Starzl TE, Weil R 3rd. Gastrointestinal complications of hepatic transplantation. Transplant Proc. 1979. 11:257–261.