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Transplantation. 2014 Jan 27;97(2):235-44. doi: 10.1097/TP.0b013e3182a9029a.

Combined surgical and interventional radiologic management strategies in patients with arterial pseudo-aneurysms after multivisceral transplantation.

Author information

  • 11 Department of Radiology, University of Pittsburgh Medical Center Health System, Pittsburgh, PA. 2 Department of Transplant Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA. 3 Department of Surgery/Transplant, Cleveland Clinic Foundation, Cleveland, OH. 4 Address correspondence to: Nikhil B. Amesur, M.D., Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop Street, PST 4886, Pittsburgh, PA.

Abstract

BACKGROUND:

Multivisceral transplantation has recently evolved to be a life-saving procedure for patients with intestinal failure and complex abdominal pathology. A composite aortic graft is always needed to restore the arterial flow to the transplanted organs. Accordingly, arterial complications can be life-threatening requiring prompt intervention. Herein, we describe innovative technical approaches in seven recipients who developed pseudo-aneurysm (PA) after transplantation.

METHODS:

With a total of 285 composite visceral transplants, 15 (5.2%) patients experienced vascular complications. Of these, 7 were life-threatening PAs that were diagnosed 61 to 2677 days after transplantation. Due to the anatomic and technical complexity of the allograft vasculature, endovascular techniques were introduced alone (n=2) or in conjunction with surgical intervention (n=5) in an attempt to rescue patients and salvage the transplanted organs.

RESULTS:

The endovascular and surgical technical approaches used for each of the 7 PA actively bleeding patients was successful in 5 (71%). Of these, 2 (40%) are alive 86 to 117 months after the intervention. The remaining 5 recipients died of recurrent hemorrhage (n=2), liver failure (n=1), and pneumonia (n=1). The cause of death was unknown in the remaining patient. Retransplantation and intra-abdominal infections were major risk factors. Candida was the most common isolated microorganism.

CONCLUSIONS:

Recipients of composite visceral allografts are at risk of developing life-threatening PAs, particularly in those with early posttransplantation abdominal infections. Prompt multidisciplinary diagnosis and therapeutic approaches are crucial management strategies.

PMID:
24121734
[PubMed - indexed for MEDLINE]
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