Revista do Colégio Brasileiro de Cirurgiões
https://app.periodikos.com.br/journal/rcbc/article/doi/10.1590/0100-6991e-20260010
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

Diagnóstico, Tratamento e Desfechos da Trombose da Artéria Hepática Após Transplante Hepático

Diagnosis, treatment, and outcomes of hepatic artery thrombosis after liver transplantation

Vivian Laís Sasaki; Júlio Cezar Uili Coelho; Henrique de Aguiar Wiederkehr; Marco Aurélio Raeder da Costa; Diancarlos Andrade; João Paulo Barros Sanches; Julio Cesar Wiederkehr; Eduardo Brommelstroet Ramos; Alcindo Pissaia Junior

http://dx.doi.org/10.1590/0100-6991e-20260010 RCBC, vol.53, e20260010, 2026
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Resumo

Racional: A trombose da artéria hepática (TAH) é a complicação vascular mais comum e grave em pacientes submetidos ao transplante hepático (TH), com incidência entre 2% e 9% e mortalidade variando de 11% a 60%. Apesar de sua relevância clínica, as publicações brasileiras sobre o tema ainda são escassas.

Objetivos: Avaliar o diagnóstico, o tratamento e os desfechos da TAH em pacientes submetidos a TH em três hospitais brasileiros (Hospital Santa Isabel, Blumenau, Santa Catarina; Hospital das Clínicas, Curitiba, Paraná; e Hospital Nossa Senhora das Graças, Curitiba, Paraná).

Métodos: Estudo observacional, longitudinal e retrospectivo, que incluiu pacientes com diagnóstico de TAH após transplante hepático entre setembro de 1991 e dezembro de 2023, em três centros médicos de grande porte no Brasil. Os dados foram obtidos por meio da revisão de prontuários eletrônicos e protocolos institucionais.

Resultados: Entre os 1.362 transplantes realizados, 35 pacientes apresentaram TAH, correspondendo a uma incidência de 2,6%. Em 43,8% dos casos, o diagnóstico foi feito nas primeiras 48 horas por meio do Doppler. A avaliação intraoperatória do pulso arterial isoladamente não se associou à mortalidade (p = 0,16). Pacientes submetidos a retransplante apresentaram tendência à menor mortalidade (p = 0,076).

Conclusões: O retransplante está relacionado à redução da mortalidade nos casos de TAH, sendo considerado o tratamento padrão-ouro. O uso do Doppler intra-operatório deve ser considerado não apenas como ferramenta de triagem, mas também como auxílio na tomada de decisões cirúrgicas.

Palavras-chave

Transplante de Fígado; Trombose da Artéria Hepática; Retransplante

Abstract

Rationale: Hepatic Artery Thrombosis (HAT) is the most common and severe vascular complication in patients undergoing Liver Transplantation (LT), with an incidence ranging from 2% to 9% and mortality between 11% and 60%. Despite its clinical relevance, Brazilian publications on the topic remain limited.

Objectives: To evaluate the diagnosis, treatment, and outcomes of HAT in patients undergoing LT at three Brazilian hospitals (Hospital Santa Isabel, Blumenau, Santa Catarina; Hospital das Clínicas, Curitiba, Paraná; and Hospital Nossa Senhora das Graças, Curitiba, Paraná).

Methods: This was a longitudinal, observational, retrospective study including patients diagnosed with HAT after LT between September 1991 and December 2023 at three major Brazilian medical centers. Data were obtained from electronic medical records and institutional protocols.

Results: Among 1,362 transplants performed, 35 patients developed HAT, corresponding to an incidence of 2.6%. Doppler ultrasound detected the condition within the first 48 hours in 43.8% of cases. Intraoperative assessment of arterial pulse alone was not associated with mortality (p = 0.16). Patients who underwent retransplantation showed a trend toward lower mortality (p = 0.076).

Conclusion: Retransplantation is associated with reduced mortality in HAT cases and is considered the gold-standard treatment. Intraoperative Doppler ultrasound should be considered not only as a screening tool but also as an aid in surgical decision-making.

Keywords

Liver Transplantation; Hepatic Artery Thrombosis; Retransplantation

Referências

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Submetido em:
01/08/2025

Aceito em:
23/10/2025

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