Premium
Reversal of portal flow after acute rejection in living‐donor liver transplantation
Author(s) -
Sugimoto Hiroyuki,
Kaneko Tetsuya,
Marui Yuji,
Inoue Soichiro,
Seo Takahiko,
Hatsuno Tsuyoshi,
Ando Hisami,
Nakao Akimasa
Publication year - 2001
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340100028
Subject(s) - medicine , liver transplantation , centrilobular necrosis , transplantation , pulsatile flow , surgery , liver biopsy , portal vein thrombosis , fibrous capsule of glisson , portal venous pressure , cirrhosis , radiology , biopsy , thrombosis , portal hypertension , necrosis
Portal hepatofugal flow is rare after liver transplantation. We experienced a case in which hepatofugal portal flow was observed in acute rejection. A 6‐year‐old boy with glycogen storage disease type Ia underwent living‐donor liver transplantation. On postoperative day 7, portal venous peak velocity was markedly decreased without portal thrombosis and obstruction of the hepatic vein, and hepatic arterial peak velocity increased reciprocally. Based on a diagnosis of acute rejection, made on postoperative day 8, we initiated steroid pulse therapy. Despite the employment of this therapy, continuous hepatofugal portal flow was observed in the entire liver on postoperative day 8. On day 12, as the liver disorder progressed, the Doppler waveform in the portal vein changed from continuous to pulsatile hepatofugal flow. The patient died of liver failure on day 14. The histological findings of a biopsy specimen on day 9 showed centrilobular necrosis, while total hepatocellular necrosis was seen at autopsy. Hepatofugal flow after liver transplantation is considered to be an ominous sign caused by several factors, and its appearance indicates a fatal condition.