Prevalence, presentation, and endovascular management of hemodynamically or clinically significant arterio-portal fistulae in living and cadaveric donor liver transplant recipients

Wael Saad, Allison Lippert, Mark Davies, Bulent Arslan, Sean Kumer, David Waldman, Ulku Turba, Timothy Schmitt, Alan Matsumoto, John Angle

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Purpose: To compare the prevalence (cadaveric vs. living donor transplants), clinical features, and the effectiveness of endovascular management of significant arterio-portal fistulae (APF) in liver transplant recipients. Methods: A retrospective audit of liver transplant recipients in two institutions was performed (1996-2009). Significant APF were included and were defined as symptomatic and/or hemodynamically significant (causing graft dysfunction and/or having abnormal Doppler findings in the portal vein). Patients with significant APF were evaluated for presenting symptoms, imaging features, size/branch order portal vein involvement, and effectiveness of the endovascular management (coil embolization). Results: Four significant APF were found in 1992 (0.2%) liver transplants. Two were symptomatic and two were asymptomatic but were hemodynamically significant with liver function test abnormalities. All four APF were found in cadaveric donor graft recipients (0.23%, N=4/1753) and none in 239 living donor graft recipients. However, there was no statistical difference between cadaveric and living donor graft recipients (p=1.0, odds ratio=1.23). Coil embolization was technically and clinically successful in all 4 without complications and causing normalization of the abnormal Doppler findings. Conclusion: Significant APF are a rare diagnosis (0.2% of transplants). Coil embolization is a safe and effective treatment option for APF in transplants.

Original languageEnglish (US)
Pages (from-to)532-538
Number of pages7
JournalClinical Transplantation
Volume26
Issue number4
DOIs
StatePublished - Jul 2012
Externally publishedYes

Keywords

  • Arterial
  • Embolization
  • Fistula
  • Portal
  • Transplant

ASJC Scopus subject areas

  • Transplantation

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