Intraoperative portal vein blood flow predicts allograft and patient survival following liver transplantation.
BACKGROUND
We hypothesized that operative variables might predict survival following liver transplantation.


METHODS
We examined perioperative variables from 469 liver transplants carried out at the University of Washington during 2003-2006. Logistic regression determined the variables' contributions to survival at 30, 90 and 365 days.


RESULTS
Portal vein blood flow (>1 l/min) was significant to patient survival at 30, 90 and 365 days. Complete reperfusion was only a significant predictor of survival at 30 days. This provided model receiver operating characteristic (ROC) area under the curve (AUC) statistics of 0.93 and 0.87 for 30 and 90 days, respectively. At 365 days, hepatic artery blood flow (>250 ml/min) combined with portal vein blood flow was significantly predictive of survival, with an AUC of 0.74. A subset analysis of 110 transplants demonstrated improved 1-year survival with more aggressive vascular revisions.


CONCLUSIONS
Portal vein blood flow is a significant predictor of survival after liver transplantation. Initially, the liver's survival is based on portal vein blood flow; however, subsequent biliary problems and patient demise result from both poor portal vein and inadequate hepatic artery blood flow.
Spitzer
Austin L
AL
Division of Transplantation, Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA. spitz@u.washington.edu
Dick
Andre A S
AA
Bakthavatsalam
Ramasamy
R
Halldorson
Jeffrey B
JB
Salvalaggio
Paolo R
PR
Reyes
Jorge D
JD
Perkins
James D
JD
D001783:Blood Flow Velocity; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D007432:Intraoperative Period; D008102:Liver Circulation; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D012372:ROC Curve; D015424:Reperfusion; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous