Vascular Thrombosis

Vascular thrombosis is probably the most serious post-transplantation technical complication and most often involves the hepatic arterial system. Thrombosis of the portal or hepatic veins or vena cava are much less common. Arterial thrombosis most frequently occurs during the first several weeks after transplantation, with a later and smaller increase occurring 1 - 3 years after transplantation. The clinical manifestations depend on the time after transplantation, which in turn, determines whether arterial collateral circulation has had time to develop. Therefore, the clinical presentation may vary from acute hepatic failure to relapsing febrile episodes or be completely asymptomatic. It is important to remember however, that the hepatic artery is the sole source blood supply to the biliary tree and arterial thrombosis frequently results in necrosis of bile ducts. This can cause biliary leaks, sludge and/or obstruction. Therefore, any time biliary tract pathology is seen in a liver allograft, one should think of arterial insufficiency.

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