Safety and Efficacy of Early Primary Stent Placement for Hepatic Artery Stenosis in Liver Transplant Recipients

Vijay Ramalingam; Sheikh Muhammad Usman Shami; Jeffrey Weinstein; David Lee; Michael Curry; Devin Eckhoff; Muneeb Ahmed; Ammar Sarwar

doi:10.1016/j.jvir.2024.11.019

Safety and Efficacy of Early Primary Stent Placement for Hepatic Artery Stenosis in Liver Transplant Recipients

J Vasc Interv Radiol. 2024 Nov 23:S1051-0443(24)00725-5. doi: 10.1016/j.jvir.2024.11.019. Online ahead of print.

Authors

Vijay Ramalingam¹, Sheikh Muhammad Usman Shami², Jeffrey Weinstein², David Lee³, Michael Curry⁴, Devin Eckhoff³, Muneeb Ahmed², Ammar Sarwar²

Affiliations

¹ Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA. Electronic address: vramali1@bidmc.harvard.edu.
² Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.
³ Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.
⁴ Division of Hepatology, Department of Gastroenterology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.

PMID: 39586537
DOI: 10.1016/j.jvir.2024.11.019

Abstract

Purpose: To evaluate the outcomes of early primary stent placement (within 30 days of liver transplantation) for hepatic artery stenosis (HAS).

Methods: Patients who underwent liver transplantation between 02/2001 and 02/2024 were evaluated for hepatic artery stenosis. Patients who underwent primary stent placement were selected and stratified based on the time from anastomosis to intervention. Early intervention were defined as primary stent placement within 30 days of surgical anastomosis. Kaplan-Meyer analysis was performed for primary patency.

Results: HAS occurred in 83/779 (11%) patients (Median Age 55 (Interquartile Range: 48 - 63), 27 (48%) females) with 56 patients meeting inclusion criteria. Stent placement performed within 0-6 days of the anastomosis in 11 (20%), 7-14 days in 11 (20%), 15-30 days in 7 (12%), 31-70 days in 9 (16%) and >70 days in 18 (32%) patients. Technical success was 100%. Primary patency rates were 89%, 87%, and 87% at 1, 3, and 5 years, respectively. Primary assisted patency rates were 100% at 1, 3, and 5 years. Early interventions at 0-6 days, 7-14 days, and 15-30 days showed primary patency rates of 100%, 90%, and 86% respectively at 1 year (p = 0.58). There was no difference in primary patency between the early (<30d) and late (>30d) cohorts (p = 0.88). There was 1 Grade 4 adverse event. There were no cases of anastomotic rupture, hepatic artery dissection, or graft failure.

Conclusion: Hepatic artery stent placement within 30 days of liver transplantation is safe and technically successful with excellent long-term primary patency.