S2620 Percutaneous Transluminal Angioplasty vs Stenting for Hepatic Artery Stenosis After Liver Transplantation in Adults

Introduction: Hepatic artery stenosis (HAS) is a serious complication of liver transplantation (LT), with no established guidelines for choosing between percutaneous transluminal Angioplasty (PTA) and stent. This study compared their outcomes to inform clinical practice. Methods: We searched PubMed, SCOPUS, Cochrane library, and Web of Science for studies comparing PTA and stenting in HAS patients after liver transplantation. The primary outcome was primary patency rate at 6 months, 12 months, and the end of follow-up. Secondary outcomes included technical success, major complications, Hepatic artery thrombosis (HAT) incidence, reintervention rates, and time to recurrent HAS. We also conducted a subgroup analysis based on major complication types, specifically artery dissection and rupture. Study quality was assessed using the Newcastle–Ottawa scale, and data analysis was performed using REVMAN 5.4.1. Results: Nine observational studies, including 325 patients with HAS after LT, were analyzed, with 140 treated with PTA alone and 197 with stents. No significant differences were found between stenting and PTA in primary patency rates at 6 months, 12 months, and the end of follow-up, as well as in technical success, major complications, artery dissection, artery rupture, and HAT incidence. However, stenting was significantly associated with a lower reintervention rate (RR = 0.57, 95% CI [0.36, 0.89], P = 0.01) and a longer time to recurrent HAS compared to PTA (MD = 36.42, 95% CI [14.14, 58.70], P = 0.001). Conclusion: Both PTA and stenting demonstrate comparable primary patency rates and safety outcomes, making them viable options for HAS treatment after liver transplantation. However, stenting was associated with a lower reintervention rate and a longer time to recurrent HAS, suggesting potential long-term benefits. Treatment selection should be individualized, considering anatomical factors, stenosis morphology, and operator expertise.