Mikel Gst , , , Jvier Gomez , Ignio Terreros

a Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bilbao, Spain

b University of the Basque Country, Bilbao, Spain

c Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario San Cecilio, Granada, Spain

d Interventional Radiology Unit, Hospital Universitario Cruces, Bilbao, Spain

To the Editor:

We read with great interest the recent article by Zhu et al. [1] .In the study, the authors analyzed the outcomes of 26 patients diagnosed with hepatic artery occlusion (HAO) and treated with an endovascular approach (EVT) within the first 30 days after orthotopic liver transplantation (LT). The median interval from LT to EVT was 7 days, most patients were treated with angioplasty and only two (7.7%) needed stent placement. The authors should be congratulated as they achieved a 100% of success rate with an 80.8% of 1-year survival rate.

Our experience is somehow different. During the first week after LT, seven patients were treated in our center due to HAO [2] .Five patients were initially treated with stent placement while two were treated with angioplasty. Both patients treated with angioplasty suffered recurrence after 30 and 35 days and were successfully treated with a second angioplasty and a stent placement, respectively. Overall, 6/7 of our patients needed a stent placement.In our series, the only complication related with the EVT was a femoral pseudoaneurysm. One of the stented patients died 2 months after LT due to a generalized sepsis of respiratory origin while the rest were alive after 36 to 88 months of follow-up. Currently, stenting is our first option in early HAO.

In our opinion, the differences in the type of EVT needed in both experiences may be explained by the fact that recipients were older in our series with a median age of 61 years (range 47-64) vs.52 years (range 42-56). We might assume that the quality of the arteries could be worst in the aged patients with the need of a stent placement instead of an angioplasty that would be enough for the younger patients. Moreover, the median age of our donors were 69 years (range 52-78) which might also have influenced the quality of the anastomosis. Another difference in both series was the definition of severe hepatic artery stenosis. While Zhu et al.treated patients with hepatic artery narrowing > 50%, we consider EVT in patients with narrowing > 70%. Probably, angioplasty may be more successful in less severe arterial stenosis.

While historically, many transplant centers have been reluctant to perform EVT early after LT because of the risk of severe arterial complications such as dissection or anastomosis rupture [ 3–5 ], our experiences showed that EVT, including angioplasty and stenting,is feasible and safe for the treatment of early HAO.

Acknowledgments

None.

CRediT authorship contribution statement

Mikel Gastaca: Conceptualization, Writing – original draft,Writing – review & editing. Javier Gomez: Writing – review & editing. Ignacio Terreros: Writing – review & editing.

Funding

None.

Ethical approval

Not needed.

Competing interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.