TY - JOUR
T1 - A successful case of deceased donor liver transplantation for a patient with intrahepatic arterioportal fistula
AU - Takagi, Kosei
AU - Yagi, Takahito
AU - Yoshida, Ryuichi
AU - Shinoura, Susumu
AU - Umeda, Yuzo
AU - Nobuoka, Daisuke
AU - Watanabe, Nobuyuki
AU - Kuise, Takashi
AU - Sui, Kenta
AU - Hirose, Akira
AU - Tsuboi, Makiko
AU - Ogasawara, Mitsunari
AU - Iwasaki, Shinji
AU - Saibara, Toshiji
AU - Fujiwara, Toshiyoshi
N1 - Publisher Copyright:
© 2016 The Authors Hepatology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Hepatology
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension that is often difficult to treat with interventional radiology or surgery. Liver transplantation for IAPF is extremely rare. We report a case of bilateral diffuse IAPF with severe portal hypertension requiring deceased donor liver transplantation (DDLT). A 51-year-old woman with no past medical history was admitted to another hospital complaining of abdominal distension and marasmus. A computed tomography scan and digital subtraction angiography indicated a massive pleural effusion, ascites, and a very large IAPF. Several attempts of interventional embolization of the feeding artery failed to ameliorate arterioportal shunt flow. As ruptures of the esophageal varices became more frequent, hepatic encephalopathy worsened. After repeated, uncontrollable attacks of hepatic coma, the patient was referred to our facility for further treatment. Surgical approaches to IAPF other than liver transplantation were challenging because of diffuse collateralization; therefore, we placed the patient on the national waiting list for DDLT. Although her Model for End-Stage Liver Disease score was relatively low, she received a DDLT 2 months after the waiting period. The postoperative course was uneventful, and the patient was discharged 44 days after her transplant. Liver transplantation may be a valid treatment option for uncontrollable IAPF with severe portal hypertension.
AB - Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension that is often difficult to treat with interventional radiology or surgery. Liver transplantation for IAPF is extremely rare. We report a case of bilateral diffuse IAPF with severe portal hypertension requiring deceased donor liver transplantation (DDLT). A 51-year-old woman with no past medical history was admitted to another hospital complaining of abdominal distension and marasmus. A computed tomography scan and digital subtraction angiography indicated a massive pleural effusion, ascites, and a very large IAPF. Several attempts of interventional embolization of the feeding artery failed to ameliorate arterioportal shunt flow. As ruptures of the esophageal varices became more frequent, hepatic encephalopathy worsened. After repeated, uncontrollable attacks of hepatic coma, the patient was referred to our facility for further treatment. Surgical approaches to IAPF other than liver transplantation were challenging because of diffuse collateralization; therefore, we placed the patient on the national waiting list for DDLT. Although her Model for End-Stage Liver Disease score was relatively low, she received a DDLT 2 months after the waiting period. The postoperative course was uneventful, and the patient was discharged 44 days after her transplant. Liver transplantation may be a valid treatment option for uncontrollable IAPF with severe portal hypertension.
KW - intrahepatic arterioportal fistula
KW - liver transplantation
KW - portal hypertension
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U2 - 10.1111/hepr.12701
DO - 10.1111/hepr.12701
M3 - Article
AN - SCOPUS:84971554646
VL - 46
SP - 1409
EP - 1415
JO - Hepatology Research
JF - Hepatology Research
SN - 1386-6346
IS - 13
ER -