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Intrahepatic Arterioportal Fistula: A Rare Cause of Portal Hypertension After Deceased Donor Liver Transplant
Ist Teil von
Experimental and clinical transplantation, 2020-10, Vol.18 (5), p.645-648
Ort / Verlag
Başkent Üniversitesi
Erscheinungsjahr
2020
Quelle
EZB Electronic Journals Library
Beschreibungen/Notizen
A 43-year-old male patient, who received a deceased
donor liver transplant for background ethanol-related
decompensated cirrhosis, presented 7 months after
transplant with mild abdominal distension and pain.
On evaluation, the patient had thrombocytopenia,
high serum-ascites albumin gradient ascites, and
deranged liver functions. The Doppler study of the
splenoportal axis showed hepatofugal flow in the
recipient’s portal vein, normal hepatic veins, a normal
liver, splenomegaly, mild ascites, and multiple
periportal collaterals. A transjugular liver biopsy and
a hepatic venous pressure gradient measurement
were done, which suggested mild portal tract
inflammation with portal tract fibrosis with prominent
portal venous thickening and normal hepatic venous
pressure gradient (4 mm). However, the patient had a
progressive increase in ascites and a dramatic increase
in serum bilirubin level. A triple-phase computed
tomography was done that showed rapid contrast
flow in both the portal and hepatic arterial phase,
suggesting arterialization of the portal flow with
possible suspicion of a communicating arterioportal
fistula. The patient underwent digital subtraction
angiography, which was followed by an embolization
of the arterioportal fistula. After embolization, serum
bilirubin gradually decreased and ascites resolved. A
repeat Doppler of the portal venous system showed
established hepatopetal flow with progressively rising
portal flow velocities.