Percutaneous transluminal angioplasty vs. stenting for hepatic artery stenosis after liver transplantation in adults: a systematic review and meta-analysis.

Purpose: 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.

Materials and methods: We searched PubMed, SCOPUS, Cochrane library, and Web of Science for studies comparing PTA and stenting in HAS patients after LT. The primary outcome was primary patency rate. 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.

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 show similar primary patency and safety for HAS after LT. However, stenting offers lower reintervention rates and longer recurrence-free intervals, suggesting better long-term outcomes. Treatment selection should be individualized, considering anatomical factors, stenosis morphology, and operator expertise.