title: Correlation between intraoperative blood flows and hepatic artery strictures in liver transplantation.
abstract: Hepatic artery strictures (HASs) may be a source of morbidity and mortality in liver transplant recipients. This study evaluated the potential correlation between intraoperative arterial and venous blood flows measured after implantation of the liver allograft and the occurrence of postoperative HASs requiring repair. Prospectively collected data from 1,038 patients with complete data sets who underwent initial orthotopic liver transplantations between December 1984 and December 1999 were used. Electromagnetic flow measurements were routinely obtained in these cases. Hepatic artery and portal vein patency were reassessed routinely according to our protocol in the first postoperative day by Doppler ultrasound. When considered hemodynamically significant, strictures were corrected. There was a 6.2% incidence (n = 64) of hepatic artery stenosis in our transplant population. When considered as a whole, the hepatic artery stenosis group had lower intraoperative flow volumes than transplant recipients who did not develop strictures (mean flows, 452 v 518 mL/min, respectively; P =.025). The hepatic artery stenosis group also had lower intraoperative portal vein flows compared with the group without hepatic artery stenosis (1.80 v 2.11 L/min, respectively; P =.0043). Strictures were less frequent among transplant recipients with cryptogenic cirrhosis. We did not observe differences among the groups for retransplantation or patient and graft survival. In our series, there was a 6.2% incidence of postoperative HASs. We observed a significant association between intraoperative hepatic artery and portal vein flows and postoperative HASs.
authors.affiliation: Transplantation Services, Baylor University Medical Center, Dallas, TX 75246, USA.
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Marlon F
authors.initials: MF
authors.lastname: Levy
authors.forename: Hebe
authors.initials: H
authors.lastname: Molmenti
authors.forename: Donna
authors.initials: D
authors.lastname: Casey
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Fasola
authors.forename: W Mark
authors.initials: WM
authors.lastname: Hamilton
authors.forename: Ghapjoong
authors.initials: G
authors.lastname: Jung
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Brian M
authors.initials: BM
authors.lastname: Gogel
authors.forename: Robert M
authors.initials: RM
authors.lastname: Goldstein
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gonwa
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
mesh_terms: D001157:Arterial Occlusive Diseases / Q000453:epidemiology*; D001783:Blood Flow Velocity; D006499:Hepatic Artery; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000502:physiology; D016343:Monitoring, Intraoperative; D011169:Portal Vein; D012189:Retrospective Studies