Pseudoaneurysm of the hepatic artery as a cause of liver re-transplantation

Abstract

A 69-year-old man underwent liver transplantation with a deceased donor for cirrhosis secondary to steatohepatitis. The arterial anastomosis was performed between the celiac trunk of the donor and the hepatic artery of the recipient. In the second postoperative month, he developed abdominal pain and abnormal liver function tests. MRI angiography and subsequent digital angiography confirmed a 50 x 60 mm hepatic artery pseudoaneurysm (PAH) with dilation of the bile duct and bilomas in both hepatic lobes. Endovascular treatment could not be performed due to the absence of contrast passage to the intrahepatic branches during angiography. A surgical ligation and resection of the PAH that compromised both hepatic arteries was chosen. The primary anastomosis was not viable because it was not possible to identify a viable proximal end or ostium. Given the ischemic compromise of the bile duct, an exception route for re-transplantation was requested from INCUCAI, thus entering the waiting list and accessing a new graft 30 days later. His subsequent evolution was favorable. Now he's asymptomatic under follow-up after 9 years of the liver re-transplantation.