Risk factors for intraoperative portal vein thrombosis in pediatric living donor liver transplantation.
Pathologic changes of the recipient native portal venous system may cause thrombosis of the portal vein, especially in pediatric living donor liver transplantation (LDLT). This study assessed the utility of Doppler ultrasound (US) for the detection of intraoperative portal vein occlusion and identification of predisposing risk factors in the recipients. Seventy-three pediatric recipients who underwent LDLT at Chang Gung Memorial Hospital, Taiwan, from 1994 to 2002 were included. Preoperative and intraoperative Doppler US evaluation of the portal vein was performed. Age, body weight, native liver disease, type of graft, graft recipient weight ratio (GRWR), type of portal anastomosis, portal velocity, portal venous size and presence of portosystemic shunt were analyzed for statistical significance of predisposing risk factors. Eight episodes of intraoperative portal vein thrombosis, with typical findings of absent Doppler flow in portal vein and prominent hepatic artery with a resistant index lower than 0.5 (p < 0.001), were detected during transplantation, which was then corrected by thrombectomy and re-anastomosis. Children age < or =1 yr (p = 0.025), weight < or =10 kg (p = 0.024), low portal flow < or =7 cm/s (p = 0.021), portal venous size < or =4 mm (p = 0.001), and GRWR >3 (p < 0.017) were all risk factors for intraoperative portal vein thrombosis. Doppler US is essential in the preoperative evaluation, early detection and monitoring of outcome of the portal vein in liver transplant.
Cheng
Yu Fan
YF
Department of Diagnostic Radiology, Chang Gung, University, Chang Gung Memorial Hospital, Kaohsiumg Medical Center, Koahsiung, Taiwan. cheng.yufen@msa.hinet.net
Chen
Chao Long
CL
Huang
Tung Liang
TL
Chen
Tai Yi
TY
Chen
Yaw Sen
YS
Takatsuki
Mitsuhisa
M
Wang
Chih Chi
CC
Chiu
King Wah
KW
Tsang
Leo Leung-chit
LL
Sun
Po Lin
PL
Jawan
Bruno
B
D000293:Adolescent; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D011169:Portal Vein; D012307:Risk Factors; D017131:Thrombectomy; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery