Clinical transplantation · 2019
Primary angioplasty or stenting for hepatic artery stenosis treatment after liver transplantation.
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Magand Nicolas, Coronado José Luis, Drevon Harir, Manichon Anne-Frédérique, Mabrut Jean-Yves, Mohkam Kayvan, Ducerf Christian, Boussel Loïc, Rode Agnès
Аннотация
BACKGROUND: Endovascular treatment (EVT) by percutaneous transluminal angioplasty (PTA) or stent is the first-line treatment for hepatic artery stenosis (HAS) after liver transplantation, but there are no guidelines to help choose between PTA and stent.
METHODS: Retrospective review of HAS EVT after liver transplantation, between 1999 and 2017. HAS was treated by PTA or stent. We report EVT primary effectiveness, arterial patency after 1 year of follow-up, complications, HAS recurrence rate; comparing PTA to stent.
RESULTS: Fifty-two HAS were diagnosed in 42 patients. We performed 51 EVT; 34 PTA (66.7%) and 16 stents (31.4%). Global primary EVT effectiveness was 86.3%: 82.3% after PTA and 100% after stent (P = 1.00 after propensity score matching). Recurrent HAS was found in 22.0% of cases: 29.4% after PTA and 6.2% after stenting, (P = .053 after propensity score matching). Patency rate without recurrent HAS or HAT at 12 months was 73.5% with PTA and 93.8% with stent (P = .09), and globally this was 92.8%. There were 7.8% complications: 2.9% after PTA, 12.5% after stenting (P = .23).
CONCLUSION: Primary effectiveness was the same for PTA and stenting. There was a strong trend toward more HAS recurrence after PTA than after stenting suggesting that HAS should benefit from primary stenting.
METHODS: Retrospective review of HAS EVT after liver transplantation, between 1999 and 2017. HAS was treated by PTA or stent. We report EVT primary effectiveness, arterial patency after 1 year of follow-up, complications, HAS recurrence rate; comparing PTA to stent.
RESULTS: Fifty-two HAS were diagnosed in 42 patients. We performed 51 EVT; 34 PTA (66.7%) and 16 stents (31.4%). Global primary EVT effectiveness was 86.3%: 82.3% after PTA and 100% after stent (P = 1.00 after propensity score matching). Recurrent HAS was found in 22.0% of cases: 29.4% after PTA and 6.2% after stenting, (P = .053 after propensity score matching). Patency rate without recurrent HAS or HAT at 12 months was 73.5% with PTA and 93.8% with stent (P = .09), and globally this was 92.8%. There were 7.8% complications: 2.9% after PTA, 12.5% after stenting (P = .23).
CONCLUSION: Primary effectiveness was the same for PTA and stenting. There was a strong trend toward more HAS recurrence after PTA than after stenting suggesting that HAS should benefit from primary stenting.