Incidencia de complicaciones arteriales y biliares en pacientes trasplantados de hígado en Uruguay y utilidad de la ecografía Doppler para el diagnóstico de las mismas
Palabras clave:
TRASPLANTE DE HIGADO, ULTRASONOGRAFIA DOPPLER
Resumen
Introducción: el trasplante hepático constituye actualmente el tratamiento de elección de las hepatopatías crónicas en fase terminal. Este trabajo constituye el primer reporte sobre el tema a nivel nacional.
Objetivos: evaluar la incidencia de complicaciones arteriales y biliares en pacientes trasplantados de hígado en Uruguay y determinar el rendimiento de la ecografía Doppler para el diagnóstico de las mismas.
Material y método: se estudiaron retrospectivamente 13 trasplantes de hígado llevados a cabo en 12 pacientes entre marzo de 1998 y noviembre de 2001. En todos ellos se realizó ecografía Doppler.
Resultados: se diagnosticaron complicaciones arteriales en seis casos (estenosis: n = 3; trombosis: n = 1; trombosis y estenosis: n = 1; robo esplénico: n = 1) y complicaciones biliares en cuatro (estenosis: n = 2; estenosis y fuga: n = 2).
La sensibilidad de la ecografía Doppler para la detección de complicaciones arteriales y biliares fue de 83% y 50%, respectivamente.
Conclusiones: la incidencia de complicaciones arteriales fue mayor a la referida por otros grupos en tanto la incidencia de complicaciones biliares fue similar. La ecografía Doppler demostró ser de utilidad para la detección de ambas complicaciones.
Citas
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(2) Moser MA, Wall WJ. Management of biliary problems after liver transplantation. Liver Transpl 2001; 7(11 supp 1): S46-52.
(3) Bechstein WO, Blumhardt G, Ringe B, Lauchart W, Bunzendahl H, Burdelski M, et al. Surgical complications in 200 consecutive liver transplants. Transplant Proc 1987; 19(5): 3830-1.
(4) Wozney P, Zajko AB, Bron KM, Point S, Starzl TE. Vascular complications after liver transplantation: a 5-year-experience. AJR Am J Roentgenol 1986; 147(4): 657-63.
(5) Taylor KJ, Morse SS, Weltin GG, Riely CA, Flye MW. Liver transplant recipients: portable duplex ultrasound with correlative angiography. Radiology 1986; 159(2): 357-63.
(6) Garcia-Criado A, Gilabert R, Nicolau C, Real I, Arguis P, Bianchi L, Vilana R, et al. Early detection of hepatic artery trombosis alter liver transplantation by Doppler ultrasonography: prognostic implications. J Ultrasound Med 2001; 20(1): 51-8.
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(14) Sidhu PS, Ellis SM, Karani JB, Ryan SM. Hepatic artery stenosis following liver transplantation: significance of the tardus parvus waveform and the role of microbubble contrast media in the detection of a focal stenosis. Clin Radiol 2002; 57(9): 789-99.
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(16) Langnas AN, Marujo W, Stratta RJ, Wood RP, Shaw BW Jr. Vascular complications after orthotopic liver transplantation. Am J Surg 1991; 161(1): 76-83.
(17) Flint EW, Sumkin JH, Zajko AB, Bowen A. Duplex sonography of hepatic artery thrombosis alter liver transplantation. AJR Am J Roentgenol 1988; 151(3): 481-3.
(18) Manner M, Otto G, Senninger N, Kraus T, Goerich J, Herfarth C. Arterial steal: an unusual cause for hepatic hypoperfusion after liver transplantation. Transpl Int 1991; 4(2): 122-4.
(19) Geissler I, Lamesch P, Witzigmann H, Jost U, Hauss J, Fangmann J. Splenohepatic arterial steal syndrome in liver transplantation: clinical features and management. Transpl Int 2002; 15(2-3): 139-41.
(20) Sidhu PS, Shaw AS, Ellis SM, Karani JB, Ryan SM. Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography. Eur Radiol 2004; 14(1): 21-30.
(21) Rabkin JM, Orloff SL, Reed MH, Wheeler LJ, Corless CL, Benner KG, et al. Biliary tract complications of side-to-side without T tube versus end-to-end with or without T tube choledochocholedochostomy in liver transplant recipients. Transplantation 1998; 65(2): 193-9.
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(23) Lerut J, Gordon RD, Iwatsuki S, Esquivel CO, Todo S, Tzakis A, Starzl TE. Biliary tract complications in human orthotopic liver transplantation. Transplantation 1987; 43(1): 47-51.
(24) Sherman S, Jamidar P, Shaked A, Kendall BJ, Goldstein LI, Busuttil RW. Biliary tract complications after othotopic liver transplantation. Endoscopic approach to diagnosis and therapy. Transplantation 1995; 60(5): 467-70.
(25) Bauman J, Campbell WL, Demetris AJ, Zajko AB. Intrahepatic cholangiographic abnormalities in liver transplants: correlation with biopsy evidence of rejection and other disorders. AJR Am J Roentgenol 1989; 152(2): 275-9.
(26) Campbell WL, Sheng R, Zajko AB, Abu-Elmagd K, Memetris AJ. Intrahepatic biliary strictures after liver transplantation. Radiology 1994; 191(3): 735-40.
(27) Zoepf T, Maldonado-Lopez EJ, Hilgard P, Dechene A, Malago M, Broelsch CE, et al. Diagnosis of biliary strictures after liver transplantation. Which is the best tool? World J Gastroenterol 2005; 11(19): 2945-8.
(28) Lerut JP, Gordon RD, Iwatsuki S, Starzl TE. Human orthotopic liver transplantation: surgical aspects in 393 consecutive grafts. Transplant Proc 1988; 20(1 Suppl 1): 603-6.
(29) Tzakis AG. The dearterialized liver graft. Semin Liver Dis 1985; 5(4): 375-6.
(30) Zajko AB, Campbell WL, Bron KM, Schade RR, Koneru B, Van Thiel DH. Diagnostic and interventional radiology in liver transplantation. Gastroenterol Clin North Am 1988; 17(1): 105-43.
(31) Orons PD, Sheng R, Zajko AB. Hepatic artery stenosis in liver transplant recipients: prevalence and cholangiographic appearance of associated biliary complications. AJR Am J Roentgenol 1995; 165(5): 1145-9.
(32) Saad WE, Saad NE, Davies MG, Lee DE, Patel NC, Sahler LG,, et al. Transhepatic balloon dilation of anastomotic biliary strictures in liver transplant recipients: the significance of a patent hepatic artery. J Vasc Interv Radiol 2005; 16(9): 1221-8.
(33) Stafford-Johnson DB, Hamilton BH, Dong Q, Cho KJ, Turcotte JG, Fontana RJ, et al. Vascular complications of liver transplantation: evaluation with gadolinium-enhanced MR angiography. Radiology 1998; 207(1): 153-60.
(34) Kim BS, Kim TK, Jung DJ, Kim JH, Bae IY, Sung KB, Kim PN, et al. Vascular complicactions alter living related liver transplantation: evaluation with gadolinium-enhanced three dimensional MR angiography. AJR Am J Roentgenol 2003; 181(2): 467-74.
(35) Brancatelli G, Katyal S, Federle MP, Fontes P. Three-dimensional multislice helical computed tomography with the volume rendering technique in the detection of vascular complications after liver transplantation. Transplantation 2002; 73(2): 237-42.
(36) Laghi A, Pavone P, Panebianco V, Catalano C, Messina A, Lobina L, et al. Biliary complications of liver transplant. Role of cholangiography with magnetic resonante. Radiol Med (Torino) 1998; 95(1-2): 66-71.
(37) Fulcher AS, Turner MA. Orthotopic liver transplantation: evaluation with MR cholangiography. Radiology 1999; 211(3): 715-22.
(2) Moser MA, Wall WJ. Management of biliary problems after liver transplantation. Liver Transpl 2001; 7(11 supp 1): S46-52.
(3) Bechstein WO, Blumhardt G, Ringe B, Lauchart W, Bunzendahl H, Burdelski M, et al. Surgical complications in 200 consecutive liver transplants. Transplant Proc 1987; 19(5): 3830-1.
(4) Wozney P, Zajko AB, Bron KM, Point S, Starzl TE. Vascular complications after liver transplantation: a 5-year-experience. AJR Am J Roentgenol 1986; 147(4): 657-63.
(5) Taylor KJ, Morse SS, Weltin GG, Riely CA, Flye MW. Liver transplant recipients: portable duplex ultrasound with correlative angiography. Radiology 1986; 159(2): 357-63.
(6) Garcia-Criado A, Gilabert R, Nicolau C, Real I, Arguis P, Bianchi L, Vilana R, et al. Early detection of hepatic artery trombosis alter liver transplantation by Doppler ultrasonography: prognostic implications. J Ultrasound Med 2001; 20(1): 51-8.
(7) Miller WJ, Campbell WL, Zajko AB, Pinna A, Zetti G, Stieber AC, et al. Obstructive dilatation of extrahepatic recipient and donor bile ducts complicating orthotopic liver transplantation: imaging and laboratory findings. AJR Am J Roentgenol 1991; 157(1): 29-32.
(8) Bressler EL, Rubin JM, McCracken S. Sonographic parallel channel sign: a reappraisal. Radiology 1987; 164(2): 343-6.
(9) O’Connor TP, Lewis WD, Jenkins RL. Biliary tract complications after liver transplantation. Arch Surg 1995; 130(3): 312-7.
(10) Wojcicki M, Lubikowski J, Zeair S, Gasinska M, Butkiewicz J, Czuprynska M, et al. Biliary complications following adult liver transplantation with routine use of external biliary drainage. Ann Transplant 2005; 10(3): 21-5.
(11) Tzakis AG, Gordon RD, Shaw BW Jr, Iwatsuki S, Starzl TE. Clinical presentation of hepatic artery thrombosis after liver transplantation in the cyclosporine era. Transplantation 1985; 40(6): 667-71.
(12) Friend PJ, Lim S, Smith M, Jamieson NV, Rolles K, O’Grady J, et al. Liver transplantation in the Cambridge/King’s College Hospital series-the first 400 patients. Transplant Proc 1989; 21(1 Pt 2): 2397-8.
(13) Dodd GD 3rd, Memel DS, Zajko AB, Baron RL, Santaguida LA. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology 1994; 192(3): 657-61.
(14) Sidhu PS, Ellis SM, Karani JB, Ryan SM. Hepatic artery stenosis following liver transplantation: significance of the tardus parvus waveform and the role of microbubble contrast media in the detection of a focal stenosis. Clin Radiol 2002; 57(9): 789-99.
(15) Platt JF, Yutzy GG, Bude RO, Ellis JH, Rubin JM. Use of Doppler sonography for revealing hepatic artery stenosis in liver transplant recipients. AJR Am J Roentgenol 1997; 168(2): 473-6.
(16) Langnas AN, Marujo W, Stratta RJ, Wood RP, Shaw BW Jr. Vascular complications after orthotopic liver transplantation. Am J Surg 1991; 161(1): 76-83.
(17) Flint EW, Sumkin JH, Zajko AB, Bowen A. Duplex sonography of hepatic artery thrombosis alter liver transplantation. AJR Am J Roentgenol 1988; 151(3): 481-3.
(18) Manner M, Otto G, Senninger N, Kraus T, Goerich J, Herfarth C. Arterial steal: an unusual cause for hepatic hypoperfusion after liver transplantation. Transpl Int 1991; 4(2): 122-4.
(19) Geissler I, Lamesch P, Witzigmann H, Jost U, Hauss J, Fangmann J. Splenohepatic arterial steal syndrome in liver transplantation: clinical features and management. Transpl Int 2002; 15(2-3): 139-41.
(20) Sidhu PS, Shaw AS, Ellis SM, Karani JB, Ryan SM. Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography. Eur Radiol 2004; 14(1): 21-30.
(21) Rabkin JM, Orloff SL, Reed MH, Wheeler LJ, Corless CL, Benner KG, et al. Biliary tract complications of side-to-side without T tube versus end-to-end with or without T tube choledochocholedochostomy in liver transplant recipients. Transplantation 1998; 65(2): 193-9.
(22) Greif F, Bronsther OL, Van Thiel DH, Casavilla A, Iwatsuki S, Tzakis A, et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg 1994; 219(1): 40-5.
(23) Lerut J, Gordon RD, Iwatsuki S, Esquivel CO, Todo S, Tzakis A, Starzl TE. Biliary tract complications in human orthotopic liver transplantation. Transplantation 1987; 43(1): 47-51.
(24) Sherman S, Jamidar P, Shaked A, Kendall BJ, Goldstein LI, Busuttil RW. Biliary tract complications after othotopic liver transplantation. Endoscopic approach to diagnosis and therapy. Transplantation 1995; 60(5): 467-70.
(25) Bauman J, Campbell WL, Demetris AJ, Zajko AB. Intrahepatic cholangiographic abnormalities in liver transplants: correlation with biopsy evidence of rejection and other disorders. AJR Am J Roentgenol 1989; 152(2): 275-9.
(26) Campbell WL, Sheng R, Zajko AB, Abu-Elmagd K, Memetris AJ. Intrahepatic biliary strictures after liver transplantation. Radiology 1994; 191(3): 735-40.
(27) Zoepf T, Maldonado-Lopez EJ, Hilgard P, Dechene A, Malago M, Broelsch CE, et al. Diagnosis of biliary strictures after liver transplantation. Which is the best tool? World J Gastroenterol 2005; 11(19): 2945-8.
(28) Lerut JP, Gordon RD, Iwatsuki S, Starzl TE. Human orthotopic liver transplantation: surgical aspects in 393 consecutive grafts. Transplant Proc 1988; 20(1 Suppl 1): 603-6.
(29) Tzakis AG. The dearterialized liver graft. Semin Liver Dis 1985; 5(4): 375-6.
(30) Zajko AB, Campbell WL, Bron KM, Schade RR, Koneru B, Van Thiel DH. Diagnostic and interventional radiology in liver transplantation. Gastroenterol Clin North Am 1988; 17(1): 105-43.
(31) Orons PD, Sheng R, Zajko AB. Hepatic artery stenosis in liver transplant recipients: prevalence and cholangiographic appearance of associated biliary complications. AJR Am J Roentgenol 1995; 165(5): 1145-9.
(32) Saad WE, Saad NE, Davies MG, Lee DE, Patel NC, Sahler LG,, et al. Transhepatic balloon dilation of anastomotic biliary strictures in liver transplant recipients: the significance of a patent hepatic artery. J Vasc Interv Radiol 2005; 16(9): 1221-8.
(33) Stafford-Johnson DB, Hamilton BH, Dong Q, Cho KJ, Turcotte JG, Fontana RJ, et al. Vascular complications of liver transplantation: evaluation with gadolinium-enhanced MR angiography. Radiology 1998; 207(1): 153-60.
(34) Kim BS, Kim TK, Jung DJ, Kim JH, Bae IY, Sung KB, Kim PN, et al. Vascular complicactions alter living related liver transplantation: evaluation with gadolinium-enhanced three dimensional MR angiography. AJR Am J Roentgenol 2003; 181(2): 467-74.
(35) Brancatelli G, Katyal S, Federle MP, Fontes P. Three-dimensional multislice helical computed tomography with the volume rendering technique in the detection of vascular complications after liver transplantation. Transplantation 2002; 73(2): 237-42.
(36) Laghi A, Pavone P, Panebianco V, Catalano C, Messina A, Lobina L, et al. Biliary complications of liver transplant. Role of cholangiography with magnetic resonante. Radiol Med (Torino) 1998; 95(1-2): 66-71.
(37) Fulcher AS, Turner MA. Orthotopic liver transplantation: evaluation with MR cholangiography. Radiology 1999; 211(3): 715-22.
Publicado
2007-06-30
Cómo citar
1.
Kuster E, Ferencz E, Lavega I, González S, Scalone P, Harguindeguy M, Leites A, Gerona S. Incidencia de complicaciones arteriales y biliares en pacientes trasplantados de hígado en Uruguay y utilidad de la ecografía Doppler para el diagnóstico de las mismas. Rev. Méd. Urug. [Internet]. 30 de junio de 2007 [citado 14 de noviembre de 2024];23(2):84-1. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/622
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