成人肝移植术后血管并发症的诊治

张佳斌; 栗光明

doi:10.3969/j.issn.1674-7445.2022.05.002

成人肝移植术后血管并发症的诊治

doi: 10.3969/j.issn.1674-7445.2022.05.002

张佳斌,
栗光明^,

100069 北京，首都医科大学附属北京佑安医院器官移植中心首都医科大学肝癌临床诊疗及研究中心

基金项目:

北京市医院管理中心重点医学专业发展计划 ZYLX202124

详细信息

作者简介:

通讯作者:
栗光明，Email：liguangming917@163.com

中图分类号: R617, R543
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- 文章访问数: 304
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- 被引次数: 0
出版历程
- 收稿日期: 2022-06-22
- 网络出版日期: 2022-09-14
- 刊出日期: 2022-09-15

Diagnosis and treatment of vascular complications after liver transplantation in adults

Zhang Jiabin,
Li Guangming^,

Organ Transplantation Center of Beijing You'an Hospital, Capital Medical University, Clinical Diagnosis, Treatment and Research Center for Liver Cancer, Capital Medical University, Beijing 100069, China

More Information

Corresponding author: Li Guangming, Email: liguangming917@163.com

摘要

摘要: 肝移植作为终末期肝病和肝脏原发恶性肿瘤的有效治疗方法已在世界范围内广泛开展，并逐渐取得人民群众的普遍认可。随着器官移植技术的发展，成人肝移植术后血管并发症已很少发生，但术后血栓形成、吻合口狭窄等血管并发症在活体肝移植、劈离式肝移植受者中仍较为常见，治疗不当可导致移植物丢失和受者死亡。笔者从事肝移植工作多年，见证了肝移植术后血管并发症诊治技术的不断发展，本文从肝动脉并发症、门静脉并发症、下腔静脉和肝静脉并发症的病因、临床表现、诊断及治疗方法，评述不同血管并发症的诊治现状和发展趋势，为进一步提高移植物和受者生存率，促进临床肝移植的发展提供参考。
- 血管并发症 /
- 肝移植 /
- 肝动脉 /
- 门静脉 /
- 下腔静脉 /
- 肝静脉 /
- 抗凝治疗 /
- 介入治疗
Abstract: As an efficacious treatment for end-stage liver diseases and primary malignant liver tumors, liver transplantation has been widely applied worldwide, and gradually receives widespread recognition from patients. With the development of organ transplant technique, vascular complications have rarely occurred after adult liver transplantation. However, vascular complications, such as postoperative thrombosis and anastomotic stenosis, are still common in the recipients undergoing living donor liver transplantation and split liver transplantation. Inappropriate treatment may lead to the loss of grafts and death of recipients. The authors have been engaged in liver transplantation for many years, witnessing persistent development of diagnostic and therapeutic technologies for vascular complications after liver transplantation. In this article, current status and development trend of diagnosis and treatment of different vascular complications were illustrated from the etiology, clinical manifestations, diagnosis and treatment of hepatic artery complications, portal vein complications, inferior vena cava and hepatic vein complications, aiming to further improve the survival rate of grafts and recipients and provide reference for promoting the development of clinical liver transplantation.
- Vascular complication /
- Liver transplantation /
- Hepatic artery /
- Portal vein /
- Inferior vena cava /
- Hepatic vein /
- Anticoagulant therapy /
- Interventional therapy

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参考文献(39)

[1]	PIARDI T, LHUAIRE M, BRUNO O, et al. Vascular complications following liver transplantation: a literature review of advances in 2015[J]. World J Hepatol, 2016, 8(1): 36-57. DOI: 10.4254/wjh.v8.i1.36.
[2]	中华医学会器官移植学分会围手术期管理学组. 肝移植围手术期血管并发症诊治专家共识(2021版)[J]. 临床肝胆病杂志, 2021, 37(9): 2054-2057. DOI: 10.3969/j.issn.1001-5256.2021.09.010. Perioperative Management Group, Chinese Society of Organ Transplantation, Chinese Medical Association. Expert consensus on perioperative vascular complications for liver transplantation (2021)[J]. J Clin Hepatol, 2021, 37(9): 2054-2057. DOI: 10.3969/j.issn.1001-5256.2021.09.010.
[3]	ASTARCIOGLU I, EGELI T, GULCU A, et al. Vascular complications after liver transplantation[J]. Exp Clin Transplant, 2019, DOI: 10.6002/ect.2018.0240[Epubahead of print].
[4]	PATEL P, DINORCIA J. The devil is in the detail: current management of perioperative surgical complications after liver transplantation[J]. Curr Opin Organ Transplant, 2019, 24(2): 138-147. DOI: 10.1097/MOT.0000000000000616.
[5]	DUFFY JP, HONG JC, FARMER DG, et al. Vascular complications of orthotopic liver transplantation: experience in more than 4, 200 patients[J]. J Am Coll Surg, 2009, 208(5): 896-905. DOI: 10.1016/j.jamcollsurg.2008.12.032.
[6]	KHALAF H. Vascular complications after deceased and living donor liver transplantation: a single-center experience[J]. Transplant Proc, 2010, 42(3): 865-870. DOI: 10.1016/j.transproceed.2010.02.037.
[7]	TANG W, QIU JG, CAI Y, et al. Increased surgical complications but improved overall survival with adult living donor compared to deceased donor liver transplantation: a systematic review and Meta-analysis[J]. Biomed Res Int, 2020: 1320830. DOI: 10.1155/2020/1320830.
[8]	HEJAZI KENARI SK, ZIMMERMAN A, ESLAMI M, et al. Current state of art management for vascular complications after liver transplantation[J]. Middle East J Dig Dis, 2014, 6(3): 121-130.
[9]	PÉREZ-SABORIDO B, PACHECO-SÁNCHEZ D, BARRERA-REBOLLO A, et al. Incidence, management, and results of vascular complications after liver transplantation[J]. Transplant Proc, 2011, 43(3): 749-750. DOI: 10.1016/j.transproceed.2011.01.104.
[10]	DELGADO-MORALEDA JJ, BALLESTER-VALLÉS C, MARTI-BONMATI L. Role of imaging in the evaluation of vascular complications after liver transplantation[J]. Insights Imaging, 2019, 10(1): 78. DOI: 10.1186/s13244-019-0759-x.
[11]	GOH Y, NEO WT, TEO YM, et al. Role of contrast-enhanced ultrasound in the evaluation of post-liver transplant vasculature[J]. Clin Radiol, 2020, 75(11): 832-844. DOI: 10.1016/j.crad.2020.05.003.
[12]	FELTRACCO P, BARBIERI S, CILLO U, et al. Perioperative thrombotic complications in liver transplantation[J]. World J Gastroenterol, 2015, 21(26): 8004-8013. DOI: 10.3748/wjg.v21.i26.8004.
[13]	张春, 刘司南, 师建华, 等. 成人原位肝移植后肝动脉血栓的诊断与治疗[J]. 中华消化外科杂志, 2021, 20(10): 1061-1067. DOI: 10.3760/cma.j.cn115610-20210913-00456. ZHANG C, LIU SN, SHI JH, et al. Diagnosis and treatment of hepatic artery thrombosis after adult orthotopic liver transplantation[J]. Chin J Dig Surg, 2021, 20(10): 1061-1067. DOI: 10.3760/cma.j.cn115610-20210913-00456.
[14]	TOKUNAGA K, FURUTA A, ISODA H, et al. Feasibility and mid- to long-term results of endovascular treatment for portal vein thrombosis after living-donor liver transplantation[J]. Diagn Interv Radiol, 2021, 27(1): 65-71. DOI: 10.5152/dir.2020.19469.
[15]	STANGE BJ, GLANEMANN M, NUESSLER NC, et al. Hepatic artery thrombosis after adult liver transplantation[J]. Liver Transpl, 2003, 9(6): 612-620. DOI: 10.1053/jlts.2003.50098.
[16]	CRAIG EV, HELLER MT. Complications of liver transplant[J]. Abdom Radiol (NY), 2021, 46(1): 43-67. DOI: 10.1007/s00261-019-02340-5.
[17]	LEE M, AGOSTINI-VULAJ D, GONZALEZ RS. Evaluation of histologic changes in the livers of patients with early and late hepatic artery thrombosis[J]. Hum Pathol, 2019, 90: 8-13. DOI: 10.1016/j.humpath.2019.04.019.
[18]	栗光明, 朱继业, 黄磊, 等. 421例同种原位肝移植肝动脉重建体会[J]. 中华普通外科杂志, 2007, 22(2): 113-115. DOI: 10.3760/j.issn:1007-631X.2007.02.010. LI GM, ZHU JY, HUANG L, et al. Evaluation of hepatic artery reconstruction in 421 cases of orthotopic liver transplantation[J]. Chin J Gen Surg, 2007, 22(2): 113-115. DOI: 10.3760/j.issn:1007-631X.2007.02.010.
[19]	曹阳, 张洪涛, 彭伟, 等. 公民逝世后器官捐献肝移植发生肝动脉并发症的影响因素分析[J]. 中华消化外科杂志, 2021, 20(10): 1055-1060. DOI: 10.3760/cma.j.cn115610-20210901-00429. CAO Y, ZHANG HT, PENG W, et al. Analysis of influencing factors for hepatic artery complications of liver transplantation from donation after citizen's death[J]. Chin J Dig Surg, 2021, 20(10): 1055-1060. DOI: 10.3760/cma.j.cn115610-20210901-00429.
[20]	PORRETT PM, HSU J, SHAKED A. Late surgical complications following liver transplantation[J]. Liver Transpl, 2009, 15(Suppl 2): S12-S18. DOI: 10.1002/lt.21893.
[21]	BALCI D, AHN CS. Hepatic artery reconstruction in living donor liver transplantation[J]. Curr Opin Organ Transplant, 2019, 24(5): 631-636. DOI: 10.1097/MOT.0000000000000697.
[22]	CHATZIZACHARIAS NA, ALY M, PRASEEDOM RK. The role of arterial conduits for revascularisation in adult orthotopic liver transplantation[J]. Transplant Rev (Orlando), 2017, 31(2): 121-126. DOI: 10.1016/j.trre.2016.10.008.
[23]	ZHU HK, ZHUANG L, CHEN CZ, et al. Safety and efficacy of an integrated endovascular treatment strategy for early hepatic artery occlusion after liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2020, 19(6): 524-531. DOI: 10.1016/j.hbpd.2020.09.014.
[24]	MONTALVÁ E, RODRíGUEZ-PERÁLVAREZ M, BLASI A, et al. Consensus statement on hemostatic management, anticoagulation, and antiplatelet therapy in liver transplantation[J]. Transplantation, 2022, 106(6): 1123-1131. DOI: 10.1097/TP.0000000000004014.
[25]	ULLER W, KNOPPKE B, SCHREYER AG, et al. Interventional radiological treatment of perihepatic vascular stenosis or occlusion in pediatric patients after liver transplantation[J]. Cardiovasc Intervent Radiol, 2013, 36(6): 1562-1571. DOI: 10.1007/s00270-013-0595-1.
[26]	WOO DH, LABERGE JM, GORDON RL, et al. Management of portal venous complications after liver transplantation[J]. Tech Vasc Interv Radiol, 2007, 10(3): 233-239. DOI: 10.1053/j.tvir.2007.09.017.
[27]	ALFARES BA, BOKKERS RPH, VERKADE HJ, et al. Portal vein obstruction after pediatric liver transplantation: a systematic review of current treatment strategies[J]. Transplant Rev (Orlando), 2021, 35(4): 100630. DOI: 10.1016/j.trre.2021.100630.
[28]	SHARSHAR M, YAGI S, ⅡDA T, et al. Liver transplantation in patients with portal vein thrombosis: a strategic road map throughout management[J]. Surgery, 2020, 168(6): 1160-1168. DOI: 10.1016/j.surg.2020.07.023.
[29]	KO GY, SUNG KB, GWON DI. The application of interventional radiology in living-donor liver transplantation[J]. Korean J Radiol, 2021, 22(7): 1110-1123. DOI: 10.3348/kjr.2020.0718.
[30]	刘文浩, 朱文科, 黄湘荣, 等. 血管内介入治疗肝移植术后门静脉狭窄或闭塞: 5例报告[J]. 中国介入影像与治疗学, 2021, 18(12): 714-717. DOI: 10.13929/j.issn.1672-8475.2021.12.003. LIU WH, ZHU WK, HUANG XR, et al. Intravascular interventional therapy for portal vein stenosis or occlusion after liver transplantation: a report of 5 cases[J]. Chin J Interv Imaging Ther, 2021, 18(12): 714-717. DOI: 10.13929/j.issn.1672-8475.2021.12.003.
[31]	SARE A, CHANDRA V, SHANMUGASUNDARAM S, et al. Safety and efficacy of endovascular treatment of portal vein stenosis in liver transplant recipients: a systematic review[J]. Vasc Endovascular Surg, 2021, 55(5): 452-460. DOI: 10.1177/1538574421994417.
[32]	PRICE A, SCHWERTNER A, TRAN D, et al. Outcomes of transjugular liver biopsies for liver transplant recipients with bicaval and piggyback hepatic vein anastomoses[J]. Acta Radiol, 2021, 62(12): 1537-1547. DOI: 10.1177/0284185120969953.
[33]	SZYMCZAK M, KALICIŃSKI PJ, KOWALEWSKI G, et al. Inferior vena cava and venous outflow reconstruction in living donor liver transplantation in children: a single-center retrospective study and literature review[J]. Ann Transplant, 2021, 26: e926217. DOI: 10.12659/AOT.926217.
[34]	KIM KS, LEE JS, CHOI GS, et al. Long-term outcomes after stent insertion in patients with early and late hepatic vein outflow obstruction after living donor liver transplantation[J]. Ann Surg Treat Res, 2018, 95(6): 333-339. DOI: 10.4174/astr.2018.95.6.333.
[35]	BALACEANU A. Deep vein thrombosis during long-term surveillance of patients with liver transplantation[J]. Ir J Med Sci, 2019, 188(4): 1191-1193. DOI: 10.1007/s11845-019-01998-6.
[36]	SANCHEZ-OCAÑA R, TEJEDOR-TEJADA J, CIMAVILLA-ROMAN M, et al. Utility of oral anticoagulants as prophylaxis of recurrent portal thrombosis after liver transplantation[J]. Transplant Proc, 2019, 51(1): 83-86. DOI: 10.1016/j.transproceed.2018.07.014.
[37]	陈文忠, 张升宁, 钟粤明, 等. 肝移植术后下腔静脉和肝静脉并发症的血管内介入治疗[J]. 血管与腔内血管外科杂志, 2020, 6(3): 199-201, 254. DOI: 10.19418/j.cnki.issn2096-0646.2020.03.003. CHEN WZ, ZHANG SN, ZHONG YM, et al. Endovascular interventional treatment of the complications of inferior vena cava and hepatic vein after liver transplantation[J]. J Vasc Endovascular Surg, 2020, 6(3): 199-201, 254. DOI: 10.19418/j.cnki.issn2096-0646.2020.03.003.
[38]	杜瑶, 陈大宇, 彭进, 等. 华法林预防肝移植术后人工血管重建的下腔静脉血栓有效性及安全性研究[J]. 药学与临床研究, 2022, 30(2): 143-146, 165. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLY202202010.htm DU Y, CHEN DY, PENG J, et al. Efficacy and safety of warfarin in preventing artificial vascular recon-structed inferior vena cava thrombosis after liver transplantation[J]. Pharm Clin Res, 2022, 30(2): 143-146, 165. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLY202202010.htm
[39]	KIRCHNER VA, O'FARRELL B, IMBER C, et al. What is the optimal management of thromboprophylaxis after liver transplantation regarding prevention of bleeding, hepatic artery or portal vein thrombosis? a systematic review of the literature and expert panel recommendations[J]. Clin Transplant, 2022, DOI: 10.1111/ctr.14629[Epubahead of print].