Insufficient Portal Vein Inflow in Children without Major Shunt Vessels During Living Donor Liver Transplantation
Toshiharu Matsuura, Koichiro Yoshimaru, Yusuke Yanagi, Genshiro Esumi, Makoto Hayashida, Tomoaki Taguchi
Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Ann Transplant 2016; 21:373-379
Available online: 2016-06-16
Liver cirrhosis is frequently accompanied by insufficient portal vein inflow (IPVF) with large portosystemic shunts. However, pediatric cases often manifested IPVF without any apparent major portosystemic shunts. Although IPVF is a very critical issue, the intraoperative assessment has not been well established. In this study, we reviewed the intraoperative approach and the outcome of the IPVF cases at our department.
MATERIAL AND METHODS: Eighty-three living donor liver transplantations (LDLT) were performed from 1996 to 2014. The IPVF occurred in 5 cases and necessitated some additional assessments and intraoperative PV flow modulations. We retrospectively reviewed the operative records and analyzed the risk factors and the outcome of the IPVF.
RESULTS: All 5 IPVF cases were biliary atresia and the mean age at LDLT was 0.74±0.19 years old. The mean recipient PV diameter was 4.3±0.8 mm and the donor IMV patch grafts were applied. To increase the PV inflow, the collaterals around the spleen were ligated in all cases. Intraoperative portal venography was performed in 1 case for selective shunt vessel ligation. In 1 case, the graft was removed and returned to the back table to prevent graft loss during the IPVF. As a result, the final PVF/GV increased to 66.4±20.0 ml/min/100 g.
CONCLUSIONS: IPVF is a very critical problem. Intraoperative portal venography is helpful and collateral veins ligation is crucial. In some cases, returning the graft to the back table during the PV inflow modulation can prevent graft loss.
Keywords: Blood Flow Velocity, Liver Transplantation, Portal Vein