Venous hemodynamics in living donor right lobe liver transplantation.
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.
The Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY 10029, USA. gabriel.gondolesi@mountsinai.org
Gabriel E
GE
Gondolesi
Sander
S
Florman
Cal
C
Matsumoto
Ruoqing
R
Huang
Thomas M
TM
Fishbein
Patricia A
PA
Sheiner
Myron E
ME
Schwartz
Sukru
S
Emre
Swan
S
Thung
Robert
R
Shapiro
Charles M
CM
Miller
D000328:Adult; D001663:Bilirubin / Q000097:blood; D001783:Blood Flow Velocity; D005260:Female; D006439:Hemodynamics; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D018608:Ultrasonography, Doppler
D001663:Bilirubin