Improving hepatic and portal venous flows using tissue expander and Foley catheter in liver transplantation.
OBJECTIVE
Vascular reconstruction is important in liver transplantation because its obstruction causes graft failure and eventual loss. Vascular outflow obstruction may be due to graft malposition. We describe our experience with liver allograft repositioning using tissue expander and Foley catheter to improve hepatic and portal venous outflows.


METHODS
A total of seven patients who received liver transplantation at our institution developed hepatic and/or portal venous obstruction during final graft positioning detected by Doppler ultrasonography (hepatic vein flow <10 cm/s; portal vein flow <12 cm/s). Chart and operative records of these patients were reviewed. Technique of operation, donor-recipient characteristics, use of tissue expander or Foley catheter to improve venous outflow, complications, and outcome were analyzed.


RESULTS
Hepatic and/or portal venous obstruction were detected after portal reperfusion. We used commercially available tissue expander used in plastic surgery and Foley catheter to reposition the graft. Tissue expanders were used in three recipients (age: 27-46 yr). Foley catheters were used in four recipients (age: 7 months-53 yr). One recipient used both tissue expander and Foley catheter. Expanders were filled with 300-770 mL saline and placed into the right subphrenic space. Foley catheters were filled with 15-75 mL saline. Significant improvements in hepatic and/or portal venous outflow were detected by Doppler ultrasonography post-graft repositioning. Aspiration of expander and Foley catheter contents was started from 6th to 27th postoperative day under sonographic guidance. All expanders and catheters were removed by the 19th-56th postoperative day (mean: 38 d). Complications included chylous ascites (1/7), bile leak (1/7), tube drain infection (2/7), septicemia (2/7). All complications were successfully managed by non-operative interventions. There was no outflow obstruction detected by ultrasonography before and after removal of expanders and catheters. One- and two-year graft and patient survivals were both 100%.


CONCLUSIONS
The use of tissue expanders and Foley catheters to improve hepatic and portal venous outflow in malposed liver allografts is a simple and safe method after liver transplantation.
Liver Transplantation Program, Department of Surgery, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Kaohsiung, Taiwan.
Chih-Chi
CC
Wang
Allan M
AM
Concejero
Chee-Chien
CC
Yong
Yaw-Sen
YS
Chen
Shih-Ho
SH
Wang
Chih-Che
CC
Lin
Yueh-Wei
YW
Liu
Chin-Hsiang
CH
Yang
Tsan-Shiun
TS
Lin
Kuo-Chen
KC
Hung
Bruno
B
Jawan
Yu-Fan
YF
Cheng
Salleh
S
Ibrahim
Chao-Long
CL
Chen
D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002404:Catheterization; D005260:Female; D006801:Humans; D007223:Infant; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging; D016031:Liver Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000502:physiology*; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D012039:Regional Blood Flow; D015625:Tissue Expansion Devices; D018608:Ultrasonography, Doppler; D014652:Vascular Diseases / Q000517:prevention & control