Hepatic Artery Pseudoaneurysm Following Orthotopic Liver Transplantation: Increasing Clinical Suspicion for a Rare but Lethal Pathology

Abstract

BACKGROUND Despite an incidence of between 1% and 2%, the mortality rate in ruptured hepatic artery pseudoaneurysm after orthotopic liver transplantation approaches 69%. Our aim is to report operative and outcomes data for 7 patients with pseudoaneurysm following transplant at 1 institution, with emphasis on suspected risk factors for aneurysm formation. From these risk factors, we performed a systematic review to assess their clinical saliency. MATERIAL AND METHODS Using PRISMA guidelines, we completed a PubMed and online database review to gather studies addressing risk factors for pseudoaneurysm following transplant. We cross-compared infection, Roux-en-Y hepaticojejunostomy, bile leak, and primary sclerosing cholangitis as independent risk factors in order to identify concomitance between each and pseudoaneurysm. RESULTS The incidence of pseudoaneurysm was 0.94%. Of pseudoaneurysm patients, 77.8% had documented infection. Of these, 36.5% had Roux-en-Y hepaticojejunostomy and 33.3% had a documented bile leak. Infection was present in 70% of patients with Roux-en-Y hepaticojejunostomy, 84% of patients with bile leak, and 93% of patients with primary sclerosing cholangitis. CONCLUSIONS Roux-en-Y hepaticojejunostomy, bile leak, and primary sclerosing cholangitis are important risk factors for pseudoaneurysm in the setting of infection. Occurring together, these risk factors should heighten clinical suspicion for their formation in the postoperative period.