title: Risk factors for intraoperative portal vein thrombosis in pediatric living donor liver transplantation.
abstract: 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.
authors.affiliation: Department of Diagnostic Radiology, Chang Gung, University, Chang Gung Memorial Hospital, Kaohsiumg Medical Center, Koahsiung, Taiwan. cheng.yufen@msa.hinet.net
authors.forename: Yu Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Chao Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Tung Liang
authors.initials: TL
authors.lastname: Huang
authors.forename: Tai Yi
authors.initials: TY
authors.lastname: Chen
authors.forename: Yaw Sen
authors.initials: YS
authors.lastname: Chen
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.forename: Chih Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: King Wah
authors.initials: KW
authors.lastname: Chiu
authors.forename: Leo Leung-chit
authors.initials: LL
authors.lastname: Tsang
authors.forename: Po Lin
authors.initials: PL
authors.lastname: Sun
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
mesh_terms: 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