Hepatofugal portal flow after living donor liver transplantation.
OBJECTIVE
Reversed portal flow following liver transplantation is life-threatening complication. There are few reports, however, regarding reversed portal flow after liver transplantation.


METHODS
We performed 180 living donor liver transplantations (LDLTs) over 8 years. Portal vein flow was routinely measured postoperatively two or three times a day during the first 2 weeks after LDLT. Surgical correction of reversed portal flow was attempted as soon as possible.


RESULTS
Five patients (2%) were complicated by postoperative hepatofugal portal flow. The reversed portal flow was corrected surgically in all the patients by splenectomy and/or ligation of the residual collateral veins. The revision operation was repeated in two patients. In three patients, the shunts responsible for hepatofugal flow were not detected in preoperative imaging, which must be approached under the guidance of intraoperative ultrasound or radiologic examination. All five patients survived the operation.


CONCLUSIONS
Hepatofugal flow causes ischemic damage to the graft, which will not normalize spontaneously. Prompt treatment of the reversed portal flow salvaged the graft.
Kyoden
Yusuke
Y
Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Sugawara
Yasuhiko
Y
Kaneko
Junichi
J
Kishi
Yoji
Y
Akamatsu
Nobuhisa
N
Makuuchi
Masatoshi
M
D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology*; D011183:Postoperative Complications / Q000601:surgery*; D013156:Splenectomy; D016896:Treatment Outcome