Surgery News - February 2009 - (Page 14) 14 TRANSPLANT FEBRUARY 2009 • SURGERY NEWS Thromboses After Liver Transplant Cut Patient Survival BY DAMIAN MCNAMARA Else vier Global Medical Ne ws PA L M B E A C H , F L A . — Although thrombosis of the hepatic artery and portal vein each reduce graft survival after orthotopic liver transplantation, portal vein thrombosis also significantly reduces patient survival, according to a single-center study of more than 4,000 consecutive transplants over 24 years. The long-term outcomes in patients who experience these vascular complications remain undefined. For that reason, Dr. John P. Duffy and his associates reviewed portal vein thrombosis (PVT) and hepatic artery thrombosis (HAT) experience for 4,234 orthotopic liver transplants in 3,558 patients at the University of California, Los Angeles. The median followup was 6 years, and 80% were adults. PVT, which occurred in 84 patients (2%), significantly decreased patient survival after orthotopic liver transplanta- tion. At 1 year, for example, 73% of those with PVT survived, compared with 83% of the no-PVT group; at 5 years, survival rates were 58% and 74%, respectively; and at 10 years, 58% and 71%, said Dr. Duffy at the annual meeting of the Southern Surgical Association. PVT also significantly reduced graft survival. At 1 year, graft survival was 37%, versus 85% in the no-PVT group; at 5 years, it was 27% versus 81%; and at 10 years, it was 24% versus 79%. These NOW AVAILABLE differences were significant. PVT is not readily treatable with retransplantation, and thromboendovenectomy is the treatment of choice, said Dr. Duffy, a surgeon in the division of liver, pancreas, and intestinal transplantation at the university. A total of 80% of PVT patients had thromboendovenectomy, and the remaining 20% had venous grafting. HAT occurred in 203 cases (5%), including 69 pediatric transplants. The mean age of patients experiencing this complication was 31 years. Overall survival of patients with HAT did not significantly differ, compared with the 95% of patients who did not ex‘We need improved protocols for early recognition of the prethrombotic state.’ DR. DUFFY The American College of Surgeons ATLS Program was developed to teach doctors one safe, reliable method for assessing and initially managing the trauma patient. The course teaches an organized approach for evaluation and management of seriously injured patients and offers a foundation of common knowledge for all members of the trauma team. The emphasis is on the critical “first hour” of care, focusing on initial assessment, lifesaving intervention, reevaluation, stabilization, and, when needed, transfer to a trauma center. The 8th edition has been redesigned for readability and to improve comprehension and retention of knowledge. It features new, up-to-date technical content and references and includes a DVD with skills from the course demonstrated in video segments. Price: $100 each. To obtain an ATLS for Doctors Student Course Manual, visit the American College of Surgeons online publication catalog at https://web2.facs.org/timssnet464/acspub/frontpage.cfm?product_class=trauma perience HAT. For example, at 1 year post transplant, 87% of the HAT group survived, as did 84% of the no-HAT group. Five-year survival rates were 76% and 75%, respectively, and 10-year survival rates were 73% and 71%. HAT significantly reduced graft survival, however. At 1 year, 32% of grafts survived in the HAT group, versus 86% in the no-HAT patients; at 5 years, survival was 25% versus 82%; and at 10 years, graft survival fell to 23% and 80%. Retransplantation was required in most cases, with 58 patients (29%) requiring urgent retransplantation. Among the HAT interventions were thrombectomy or revision, performed in 90 patients; primary retransplantation in 59 patients; and catheter-based thrombolytic therapy in 4 patients. Retransplantation was “clinically superior” to revision or thrombolysis, Dr. Duffy said. Retransplantation improved patient survival in the first year but not significantly thereafter. Thrombectomy, revision, and catheter-directed thrombolysis had limited success, he said. “It is critical to lower the number of retransplantations [in patients with HAT], with the number of patients awaiting livers and dying on waiting lists,” said Dr. Devin Eckhoff, an ACS Fellow and director of the division of transplantation surgery, University of Alabama at Birmingham, a study discussant. “We might be able to salvage more of these patients using thrombectomy, revision, or catheter-based therapy if we could identify those in a pre-embolic state,” said study coauthor Dr. Ronald W. Busuttil, an ACS Fellow and chair of the surgery department at the University of California, Los Angeles. Dr. Duffy agreed, stating “we need improved protocols for early recognition of the prethrombotic state.” In 2002, the university began to use early common hepatic artery inflow occlusion in transplant patients. This procedure lowered the incidence of HAT from 3.7% to 1.1% in adult patients. https://web2.facs.org/timssnet464/acspub/frontpage.cfm?product_class=trauma
Table of Contents Feed for the Digital Edition of Surgery News - February 2009 Surgery News - February 2009 Contents The 20/20 Vision ICD-10 Looms News From the College: MedPAC Flak Oncology: Best for Breast General Surgery: Weighty Problem Surgery News - February 2009 Surgery News - February 2009 - Contents (Page 1) Surgery News - February 2009 - Contents (Page 2) Surgery News - February 2009 - Contents (Page 3) Surgery News - February 2009 - Contents (Page 4) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 5) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 6) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 7) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 8) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 9) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 10) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 11) Surgery News - February 2009 - Oncology: Best for Breast (Page 12) Surgery News - February 2009 - Oncology: Best for Breast (Page 13) Surgery News - February 2009 - Oncology: Best for Breast (Page 14) Surgery News - February 2009 - Oncology: Best for Breast (Page 15) Surgery News - February 2009 - Oncology: Best for Breast (Page 16) Surgery News - February 2009 - Oncology: Best for Breast (Page 17) Surgery News - February 2009 - Oncology: Best for Breast (Page 18) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 19) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 20)
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