Use of intra-arterial papaverine in the management of hepatic artery vasospasm post liver transplant

Hepatic artery vasospasm, albeit a well-known and recognized phenomenon post liver transplant, is a less understood sequelae and many have postulated it’s pathophysiology. Literature has cited a 2-5% incidence of hepatic artery thrombosis post liver transplant[ 1 ], but the data for hepatic artery vasospasm still lacks due to inadequate studies and reports to this phenomenon. It is imperative for clinicians in the transplant team to diagnose and manage early post operative reduced hepatic artery flow as this can be a major cause for allograft failure. This case report transcribed the use of intra-arterial papaverine infusion in a 59 year old gentleman with liver cirrhosis and hepatocellular carcinoma who underwent cadaveric liver transplant subsequently complicated with hepatic artery vasospasm post operative. It was noted during post operative day 3 that patient had significantly reduced hepatic arterial flow and resistive index (RI). Diagnosis was made with a CT hepatic angiogram and monitoring with serial doppler ultrasounds of the hepatic artery flow was done. Treatment was first initiated with systemic nitrates, intra-arterial isosorbide-dinitrate and intra-arterial papaverine infusion. The final method of intervention proved successful in resolving the spasmodic segment involving the hepatic artery. This report documented the implication of using intra-arterial papaverine and its success in treating hepatic artery vasospasm post liver transplant.