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Early hepatic arterial thrombosis in liver transplantation: Systemic intravenous alteplase as a potential rescue treatment after failed surgical revascularization
Author(s) -
Feier Flávia H.,
Melere Melina U.,
Trein Cristine S.,
Silva Carolina Soares,
Lucchese Angelica,
Horbe Alex,
Tonet Fabio,
Ricachinevsky Claudia,
Ferreira Cristina T.,
Chedid Marcio F.,
Kalil Antonio N.
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13902
Subject(s) - medicine , surgery , thrombosis , liver transplantation , complication , revascularization , transplantation , anesthesia , myocardial infarction
eHAT is one of the most dreaded post‐LT complication. Treatment approaches include retransplantation, revascularization, or observation. Systemic thrombolytic therapy is used in pediatric patients with thromboembolic events. However, there is no previous study reporting on the use of systemic r‐tPA to treat eHAT. The treatment strategies used in patients with eHAT are described, focusing on two children who failed SR and were treated with systemic heparinization plus systemic r‐tPA infusion. r‐tPA‐RP consists of intravenous systemic infusion at a dose of 0.3 mg/kg/h during 6 hours, for 5 days. First case (3‐year) was transplanted with a whole liver, and second case (6‐year) received a LLS from a living donor. HAT was diagnosed by doppler US and confirmed by angioCT scan in both patients in the first day after LT. They underwent SR and were clinically stable. Re‐thrombosis occurred in both patients the day after, and r‐TPA‐RP was started—one patient required two r‐TPA‐RP for HAT recurrence. They presented minor bleeding, without repercussion. Hepatic artery recanalized after 10 and 3 days in the first and second patient, respectively. Retransplant was avoided, and one developed biliary strictures, successfully managed in the follow‐up. r‐TPA‐RP avoided retransplantation after eHAT in these cases. To our knowledge, this is the first report of the use of systemic r‐TPA to treat eHAT in children. This strategy may compose an algorithm to treat eHAT that failed SR in stable patients.