Intraoperative Flow Measurement of Native Liver and Allograft During Orthotopic Liver Transplantation in Children

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doi:10.1016/j.transproceed.2007.07.042

Copyright © 2007 Elsevier Inc. All rights reserved.

Liver transplantation

J. Bueno, a, , A. Escartína, J. Balsellsa and C. Margarit†, a aLiver Transplant Unit and Pediatric Surgery Department, Hospital Valle de Hebron, Barcelona, Spain. Abstract

Hepatic hemodynamic changes during liver transplantation (OLT) in children have not yet been studied. We measured intraoperative portal vein flow (PVF) and hepatic arterial flow (HAF) (mL/min) in 53 children and 58 grafts during OLT. Flows were measured in the native organ and in the allograft. In the native liver, PVF and HAF are similar; after transplantation they return to the physiological situation. No flow differences were seen between whole and partial grafts. Among the 8 (14%) portal vein thromboses, PVF was lower in both the native liver and the graft than in the no thrombosis group (P < .05). PVF <5 mL/min/kg was a risk factor to develop PV thrombosis. No graft loss occurred in 3 cases without PVF at the time of OLTs despite the observation that repermeabilization was not possible. In 4 patients with PVF <5 mL/min/kg, after tying a spontaneous spleno-renal shunt (n = 3) or performing a porto-renal vein anastomosis (n = 1), PVF reached >20 mL/min/kg, avoiding thrombosis. In conclusion, PVF and HAF measurements during pediatric OLT may predict patients at high risk for development of PV thrombosis.

Address reprint requests to Dr Bueno, Unidad de Trasplante Hepático Infantil, Hospital Universitario Valle de Hebron, Paseo Valle de Hebron 119-129, Barcelona, Spain 08035.† Deceased.

Transplantation Proceedings Volume 39, Issue 7, September 2007, Pages 2278-2279