BACKGROUND: Hepatic artery stenosis (HAS) is a serious complication of liver transplantation but data on the most effective endovascular management are lacking. We aimed to compare percutaneous balloon angioplasty (PBA) with stent placement. METHODS: We searched MEDLINE, Cochrane, Web of Science, EMBASE, SCOPUS, and Biosis Previews between 1970 and December 2011 and performed meta-analysis of short-term (procedural success, complications) and long-term outcomes (liver function, arterial patency, survival, re-intervention, re-transplantation). Random effects models were used for the analysis and meta-regression performed for the year of study. RESULTS: A total of 263 liver transplants in 257 patients [age 43 (±8) years] underwent 147 PBAs and 116 stents. Transplanted livers were from deceased donors in 240 (91 %). Follow-up was 1 month to 4.5 years (median 17 months). PBA and stent had similar procedural success (89 % vs. 98 %), complications (16 % vs. 19 %), normal liver function tests (80 % vs. 68 %), arterial patency (76 % vs. 68 %), survival (80 % vs. 82 %), and requirement for re-intervention (22 % vs. 25 %) or re-transplantation (20 % vs. 24 %) (P non-significant). In the most recent studies re-transplantation was reported less compared to older series (P = 0.04). CONCLUSION: Both PBA and stent offer comparable results for HAS. These techniques have contributed to a recent decline in re-transplantation. KEY POINTS: • Interventional radiological procedures are often used to treat post-transplant hepatic artery stenosis. • Meta-analysis shows that percutaneous balloon angioplasty and stent placement are both efficacious. • Percutaneous balloon angioplasty and stent placement appear to have similar complication rates. • Re-transplantation rates have declined, partly due to interventional management for arterial stenosis.
BACKGROUND:Hepatic artery stenosis (HAS) is a serious complication of liver transplantation but data on the most effective endovascular management are lacking. We aimed to compare percutaneous balloon angioplasty (PBA) with stent placement. METHODS: We searched MEDLINE, Cochrane, Web of Science, EMBASE, SCOPUS, and Biosis Previews between 1970 and December 2011 and performed meta-analysis of short-term (procedural success, complications) and long-term outcomes (liver function, arterial patency, survival, re-intervention, re-transplantation). Random effects models were used for the analysis and meta-regression performed for the year of study. RESULTS: A total of 263 liver transplants in 257 patients [age 43 (±8) years] underwent 147 PBAs and 116 stents. Transplanted livers were from deceased donors in 240 (91 %). Follow-up was 1 month to 4.5 years (median 17 months). PBA and stent had similar procedural success (89 % vs. 98 %), complications (16 % vs. 19 %), normal liver function tests (80 % vs. 68 %), arterial patency (76 % vs. 68 %), survival (80 % vs. 82 %), and requirement for re-intervention (22 % vs. 25 %) or re-transplantation (20 % vs. 24 %) (P non-significant). In the most recent studies re-transplantation was reported less compared to older series (P = 0.04). CONCLUSION: Both PBA and stent offer comparable results for HAS. These techniques have contributed to a recent decline in re-transplantation. KEY POINTS: • Interventional radiological procedures are often used to treat post-transplant hepatic artery stenosis. • Meta-analysis shows that percutaneous balloon angioplasty and stent placement are both efficacious. • Percutaneous balloon angioplasty and stent placement appear to have similar complication rates. • Re-transplantation rates have declined, partly due to interventional management for arterial stenosis.
Authors: Saher S Sabri; Wael E A Saad; Timothy M Schmitt; Ulku C Turba; Sean C Kumer; Auh-Whan Park; Alan H Matsumoto; John F Angle Journal: Vasc Endovascular Surg Date: 2011-05-13 Impact factor: 1.089
Authors: Monika Pakosz-Golanowsha; Jerzy Lubikowski; Mariola Post; Konrad Jarosz; Katarzyna Zasada-Cedro; Piotr Milkiewicz; Maciej Wójcicki Journal: Hepatogastroenterology Date: 2010 Nov-Dec
Authors: U Tannuri; M C P Velhote; M M Santos; N E Gibelli; A A Ayoub; J G Maksoud-Filho; M M Silva; M L Pinho; H T Miyatani; J G Maksoud Journal: Transplant Proc Date: 2004-05 Impact factor: 1.066
Authors: Alexander Copelan; Daniel George; Baljendra Kapoor; Hahn Vu Nghiem; Jonathan M Lorenz; Brian Erly; Weiping Wang Journal: Semin Intervent Radiol Date: 2015-06 Impact factor: 1.513
Authors: Vinko Vidjak; Karlo Novačić; Filip Matijević; Lovro Kavur; Marko Slavica; Anna Mrzljak; Tajana Filipec-Kanižaj; Nikola Ivan Leder; Dinko Škegro Journal: Pol J Radiol Date: 2015-06-16
Authors: Mark Barahman; Lourdes Alanis; Joseph DiNorcia; John M Moriarty; Justin P McWilliams Journal: World J Gastroenterol Date: 2020-01-28 Impact factor: 5.742