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Venous hemodynamics in living donor right lobe liver transplantation
Author(s) -
Gondolesi Gabriel E.,
Florman Sander,
Matsumoto Cal,
Huang Ruoqing,
Fishbein Thomas M.,
Sheiner Patricia A.,
Schwartz Myron E.,
Emre Sukru,
Thung Swan,
Shapiro Robert,
Miller Charles M.
Publication year - 2002
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2002.33690
Subject(s) - medicine , hemodynamics , liver transplantation , bilirubin , portal venous pressure , portal vein , transplantation , surgery , portal hypertension , cardiology , urology , cirrhosis
We evaluated the influence of portal and hepatic venous hemodynamics on the immediate and 3‐month postoperative function of living donor right lobe grafts. Portal velocity was measured prospectively by ultrasound in 14 consecutive donor/recipient pairs. Velocity was converted to flow with the Moriyasu formula. Measurements were taken in donors in the operating room and in recipients at 1 hour after reperfusion and 3 months after transplant. Recipient liver function tests were measured postoperatively. Prereperfusion and postreperfusion liver biopsies were evaluated and correlated with the hemodynamic and biochemical results. There were 11 male (78.6%) and 3 female donors (mean age, 38.9 ± 9.8 years) for 10 male (71.4%) and 4 female recipients (mean age, 49.3 ± 14 years). The mean graft/recipient weight ratio was 1.22 ± 0.3. The mean right portal vein pressure was 8 ± 1.8 mm Hg in donors versus 13 ± 4.7 mm Hg in recipients ( P < .05). The mean peak flow velocity (Vmax) in the portal vein in donors was 47.6 ± 12.8 cm/sec (normal, 44 cm/sec). One hour after graft reperfusion in the recipient, the mean portal Vmax was significantly higher at 94.7 ± 28.4 cm/sec ( P = .004), but by 3 months follow‐up, mean portal Vmax had fallen to 58.8 ± 37.8 ( P = .01). Recipient portal vein Vmax highly correlated with portal flow ( r = 0.7, P = .01). Increased recipient total bilirubin on postoperative day 2 correlated highly with higher recipient portal flow one hour after transplant ( r = 0.6; P = .03). Portal vein velocity/flow dramatically increases after reperfusion, returning to baseline about 3 months after transplant. Evaluation of hepatic and portal venous flow is a relatively easy skill to acquire. Intraoperative ultrasound may enable the surgeon to predict graft dysfunction and possibly, may be used to implement pre‐emptive therapies.