Angiogenesis after Hepatic Arterial Occlusion in Liver Transplant Patients

The authors describe 10 liver transplant recipients who developed occlusion of the hepatic artery or aortic conduit. Since all potential collateral arterial supply to the transplant is severed at hepatectomy, hepatic artery occlusion is usually a catastrophic event that necessitates repeat transplantation. Four patients died within 8 weeks of transplantation. The remaining six developed spontaneous arterial liver revascularization. This phenomenon is believed to be an example of neovascularization through angiogenesis. Radiologic studies, particularly duplex sonography and angiography, were helpful in the evaluation of transplant vascular integrity. The tissues of the omentum and the mesentery have known angiogenic ability. The authors postulate that in transplantation techniques in which these tissues are placed close to the transplanted liver (eg, Roux-en-Y choledochojejunostomy), the omental and mesenteric tissues may be the source of neovascularity.