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Hepatic Arterial Complications in Liver Transplant Recipients Treated with Pretransplantation Chemoembolization for Hepatocellular Carcinoma¹

¹ From the Department of Radiology, Division of Interventional Radiology (H.M.R., H.A.M., J.A.) and the Department of Biostatistics (W.Y.W.L.), Mount Sinai Hospital, New York, NY; the Department of Radiology, Division of Interventional Radiology, St Luke's Roosevelt Hospital Center, New York, NY (J.E.S.); and the Department of Radiology, Division of Interventional Radiology, INOVA Alexandria Hospital, Alexandria, Va (J.M.C.). From the 1997 RSNA scientific assembly. Received February 3, 1999; revision requested April 5; final revision received July 1; accepted July 26. Address reprint requests to H.M.R., Department of Diagnostic Imaging, Division of Interventional Radiology, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201-1595 (e-mail: howardrichard@alum.MIT.EDU).

PURPOSE: To compare the prevalence of hepatic arterial complications in patients who underwent hepatic arterial chemoembolization for hepatocellular carcinomas before orthotopic liver transplantation with the prevalence of hepatic arterial complications in the total population of liver transplant recipients.

MATERIALS AND METHODS: Forty-seven patients underwent selective hepatic arterial chemoinfusion with mitomycin C, doxorubicin hydrochloride, and cisplatin combined with embolization. The prevalence rates for hepatic arterial complications, including pseudoaneurysm, stenosis, anastomotic disruption, and thrombosis, were tabulated and compared with results in 1,154 patients who underwent orthotopic liver transplantation but not chemoembolization.

RESULTS: Of the 47 patients who had undergone preoperative hepatic arterial chemotherapy, 13% developed hepatic arterial complications within a mean of 7 days after transplantation; an 8% prevalence of hepatic arterial thrombosis was observed. Of the 1,154 patients who underwent orthotopic liver transplantation but not chemotherapy, 6% developed hepatic arterial complications; a 5% prevalence of hepatic arterial thrombosis was observed. There was no statistically significant difference in the prevalence rates for thrombosis and complications between the patients who underwent chemoembolization before orthotopic liver transplantation and those who did not. The mean interval between chemotherapy and orthotopic liver transplantation was 111 days (range, 3–428 days).

CONCLUSION: Patients who undergo hepatic arterial chemotherapy are not at an increased risk of developing hepatic arterial thrombosis or other hepatic arterial complications after orthotopic liver transplantation.

Index terms: Hepatic arteries, chemotherapeutic embolization, 952.1264, 952.1266 • Hepatic arteries, thrombosis, 952.751 • Liver neoplasms, angiography, 761.124 • Liver neoplasms, US, 761.12984 • Liver, transplantation, 761.45 • Vasculitis, 952.62

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