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Liver transplants are a major surgical undertaking, and vascular complications can cause graft failure and death. These complications include thrombosis (clot formation) in the hepatic (liver) artery, thrombosis of the portal vein, and rupture of the hepatic artery. A study was undertaken to determine the incidence, available treatment options, and outcomes of these complications. Within a 57-month period, 430 liver transplants were performed on 372 patients. The incidence of vascular complications was 9 percent, and included 24 incidents of hepatic artery thrombosis (76 percent of all complications), six cases of portal vein thrombosis, three cases of combined hepatic artery and portal vein thrombosis, and five patients with a ruptured hepatic artery. Among the 140 children included in the study, the main reason for transplant was biliary atresia (absence or underdevelopment of one or more of the normal bile duct structures causing liver damage). Among the adults, the main indication for transplant was liver cirrhosis, degenerative disease of the liver in which the lobes are covered with fibrous tissue and the lobules are infiltrated with fat. Complications were signaled by liver failure, graft dysfunction, and bile infection; problems were also identified by screening ultrasound. Treatment of the complications included revascularization, revascularization and retransplantation, only retransplantation, and some patients were just closely observed. Four patients had infectious arteritis (inflammation of the artery). The six-month survival was 70 percent for patients who developed vascular complications following liver transplantation. It is concluded that early diagnosis of transplant failure is essential, and surgical intervention usually is the main treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Budd-Chiari syndrome is a rare but often fatal condition caused by obstruction of the outflow of venous blood from the liver with resulting liver enlargement, ascites (abnormal fluid collection within the abdomen), development of extensive collateral (secondary) blood vessels, and severe portal hypertension (elevated pressure in the portal vein of the liver). Budd-Chiari syndrome should be suspected in any patient with sudden development of massive ascites. In about 90 percent of cases, patients come in for treatment with this sudden appearance of ascites as well as tender, enlarged liver. Patients may also have abdominal pain, jaundice (yellow skin and sclera) or gastrointestinal hemorrhage. At this initial presentation the patient usually does not have evidence of any significant liver dysfunction. Both magnetic resonance imaging (MRI) and dynamic computed tomography (CT) are helpful in diagnosing Budd-Chiari syndrome. The most definitive test is hepatic venography (X-ray examination of the veins following injection of radio-opaque contrast dye) as well as venographic study of the inferior vena cava (the two large veins emptying into the heart). Information obtained from percutaneous liver biopsy and the venographic studies should be used in planning the appropriate surgical management of the patient. Most patients with Budd-Chiari syndrome can be treated surgically with shunting procedures, which redirects blood from the affected area. If there is more than 75 percent occlusion of the vena cava, then mesoatrial shunt should be performed; otherwise a mesocaval shunt is preferred, since it carries a lower risk of thrombosis (abnormal condition in which clotting elements and cell debris accumulate and attach to a point on the interior wall of the vein). Patients with cirrhosis or liver failure are best treated by liver transplantation. (Consumer Summary produced by Reliance Medical Information, Inc.)