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Intraoperative measurement of graft blood flow — a necessity in liver transplantation

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Transplant International

Abstract

Portal venous and hepatic arterial flow was measured intraoperatively in the 70 most recent patients undergoing liver transplantation in our institution. Impaired graft flow due to vascular abnormalities was detected in six patients. One patient suffered from arterial steal due to stenosis of the recipient celiac trunk with blood shunting from the hepatic to the splenic artery. Ligation of the recipient hepatic artery restored the arterial graft flow. In two patients we found reduced portal venous flow due to large portosystemic collaterals. The collaterals accountable for the impaired portal flow were identified and ligated, which restored portal venous graft flow. Excessive sensitivity of the portal venous flow to the position of the graft was found in a 6-month-old boy. Portal venous flow varied considerably, depending upon the position of the graft, and intraoperative flow measurement allowed the best position of the graft to be identified. Two patients developed arterial thrombosis in the early postoperative course. Immediate laparatomy with thrombectomy resulted in good, palpable pulsation in the graft artery in both patients. Intraoperative flow measurement demonstrated satisfactory arterial flow in one patient, whereas there was no net flow in the other patient's graft artery. Pulsation in this patient was caused by blood oscillating in and out of the liver. In conclusion, we find that causes of primary graft dysfunction due to technically flawed reperfusion of the graft can be identified and alleviated by intraoperative measurement of the flow in the graft vessels.

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References

  1. De Carlis L, Favero ED, Rondinara G, Belli LS, Sansalone CV, Zani B, Cazzulani A, Brambilla G, Rampoldi A, Belli L (1992) The role of spontaneous portosystemic shunts in the course of orthotopic liver transplantation. Transpl Int 5: 9–14

    PubMed  Google Scholar 

  2. Doppmann JR, Dunnik NR, Girton M, Fanci AS, Popovsky MA (1979) Bile cysts secondary to liver infarcts: report on case and experimental production of small vessel hepatic artery occlusion. Radiology 130: 1–5

    PubMed  Google Scholar 

  3. Henderson JM, Gilmore GT, Mackay GJ, Galloway JR, Dodson TF, Kuntner MH (1993) Hemodynamics during liver transplantation: the interactions between cardiac output and portal venous and hepatic arterial flows. Hepatology 16:715–718

    Google Scholar 

  4. Jurim O, Shaked A, Kiai K, Millis JM, Colquhoun SD, Busuttil RW (1993) Celiac compression syndrome and liver transplantation. Ann Surg 218: 10–12

    PubMed  Google Scholar 

  5. Lautt WW (1985) Mechanism and role of intrinsic regulation of hepatic arterial flow: hepatic arterial buffer response. Am J Physiol 249: 549–556

    Google Scholar 

  6. Manner M, Otto G, Senninger N, Kraus T, Goerich J, Herfarth C (1991) Arterial steal: an unusual cause for hepatic hypoperfusion after liver transplantation. Transpl Int 4: 122–124

    PubMed  Google Scholar 

  7. Merion RM, Burtch GD, Ham JM, Turcotte JG, Campbell DA (1989) The hepatic artery in liver transplantation. Transplantation 48: 438–443

    PubMed  Google Scholar 

  8. Paulsen AW, Klintmalm GBG (1992) Direct measurement of hepatic blood flow in native and transplanted organs, with accompanying systemic hemodynamics. Hepatology 16: 100–111

    PubMed  Google Scholar 

  9. Payen DM, Fracatacci MD, Dupuy P, Gatacel C, Vigouroux C, Ozier Y, Houssin D (1990) Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: interest for early complications and nutrition. Surgery 107: 417–427

    PubMed  Google Scholar 

  10. Ploeg RJ, D'Alessandro AM, Knechtle SJ (1993) Risk factors for primary dysfunction after liver transplantation — a multivariate analysis. Transplantation 55:807–813

    PubMed  Google Scholar 

  11. Starzl TE, Demetris AJ (1990) (ed) Early graft function. Liver transplantation, 1st edn. Yearbook Medical, Chicago, pp 43–56

    Google Scholar 

  12. Starzl TE, Demetris AJ, Van Thiel D (1989) Liver transplantation. N Engl J Med 321: 1014–1022

    PubMed  Google Scholar 

  13. Todo S, Demetris AJ, Makowka L (1989) Primary nonfunction of hepatic allografts with preexisting fatty infiltration. Transplantation 47: 903–905

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Transplantation V, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark

    Allan Rasmussen, Allan Hjortrup & Preben Kirkegaard

Authors
  1. Allan Rasmussen
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  2. Allan Hjortrup
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  3. Preben Kirkegaard
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Rasmussen, A., Hjortrup, A. & Kirkegaard, P. Intraoperative measurement of graft blood flow — a necessity in liver transplantation. Transplant Int 10, 74–77 (1996). https://doi.org/10.1007/BF02044347

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  • DOI: https://doi.org/10.1007/BF02044347

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