Is Treatment of Hepatic Osteodystrophy With Bisphosphonate Possible

Hepatic artery thrombosis (HAT) is a serious complication after liver transplantation (LT) which often resulted in biliary complication, early graft loss and patient death. According to the time course, HAT within 30 days is defined as early HAT, while HAT occurs more than 30 days after LT is defined as late HAT. In a large review of 21,822 patients underwent LT, the overall incidence of early HAT is 4.4%, with higher incidence in children than in adult (8.3 vs 2.9%), and a median time of diagnosis on POD7. Early HAT resulted in an overall re-transplantation rate of 53.1% (children higher than adult, 62 vs. 50%) and an overall mortality rate of 33.3% (adult higher than children, 34.3 vs 25%). It is generally thought that early HAT without urgent re-vascularization or re-transplantation almost always leads to mortality, especially those occuring within a few days of posttransplant. Here we presented 3 cases of early HAT after living donor LT, in which the attempts of arterial revascularization failed through surgical or endovascular intervention. Unexpectedly, these 3 patients survive well with acceptable graft function and followed up for 32 months, 11 months, and 4 months, respectively. Possible explanations from anatomical aspect were reviewed and discussed. Our experience showed that early HAT occuring within one week postoperatively, without successful re-vascularization or urgent re-transplantation, may not always lead to mortality, and re-transplantation may be preserved for selective patients who had irreversible liver failure. Prevalence of Hypothyroidism in Nonalcoholic Fatty Liver Disease in