Abstract
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.
| Original language | English |
|---|---|
| Journal | Hepatology Research |
| DOIs | |
| Publication status | Accepted/In press - 2016 |
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Keywords
- Intrahepatic arterioportal fistula
- Liver transplantation
- Portal hypertension
ASJC Scopus subject areas
- Hepatology
- Infectious Diseases
Cite this
A successful case of deceased donor liver transplantation for a patient with intrahepatic arterioportal fistula. / Takagi, Kosei; Yagi, Takahito; Yoshida, Ryuichi; Shinoura, Susumu; Umeda, Yuzo; Nobuoka, Daisuke; Watanabe, Nobuyuki; Kuise, Takashi; Sui, Kenta; Hirose, Akira; Tsuboi, Makiko; Ogasawara, Mitsunari; Iwasaki, Shinji; Saibara, Toshiji; Fujiwara, Toshiyoshi.
In: Hepatology Research, 2016.Research output: Contribution to journal › Article
}
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
PY - 2016
Y1 - 2016
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
UR - http://www.scopus.com/inward/record.url?scp=84971554646&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84971554646&partnerID=8YFLogxK
U2 - 10.1111/hepr.12701
DO - 10.1111/hepr.12701
M3 - Article
JO - Hepatology Research
JF - Hepatology Research
SN - 1386-6346
ER -