title: Direct pressure measurement in the hepatic artery during liver transplantation: can it prevent the "steal" syndrome?
abstract: Splenic artery "steal" syndrome after orthotopic liver transplantation (OLT) is an important cause of graft dysfunction. Direct pressure measurement in the hepatic (HA) and radial artery (RA) may identify patients at risk allowing its prevention. This observational study compared radial and hepatic mean arterial pressures (MAP) measured during 100 OLTs performed in 99 recipients, in whom the HA was considered suitable for the anastomosis. A difference of ≥5 mmHg between the radial and hepatic MAP was arbitrarily chosen as the criterion for inflow modulation. Seven patients fulfilled this criterion showing a MAP gradient that was significantly different compared to the others (-10.8±3.3 vs. 2.6±5.0; p<0.0001). They underwent splenic artery ligation (n=5), arcuate ligament division (n=1) and aortohepatic bypass grafting (n=1) that all resulted in immediate normalization of the arterial inflow pressure to the graft. The splenic artery "steal" syndrome occurred in one patient (day 2 after OLT) in whom the mean HA pressure normalized during OLT following arcuate ligament division, suggesting pathology within the graft as the most likely etiology. Our results indicate that radial MAP can reflect the hepatic MAP during OLT. If a substantial pressure gradient is found, it can be corrected by intraoperative splenic artery ligation or arcuate ligament division.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Marie Curie Hospital, Szczecin, Poland. drmwojcicki@wp.pl
authors.forename: Maciej
authors.initials: M
authors.lastname: Wojcicki
authors.forename: Monika
authors.initials: M
authors.lastname: Pakosz-Golanowska
authors.forename: Jerzy
authors.initials: J
authors.lastname: Lubikowski
authors.forename: Mariola
authors.initials: M
authors.lastname: Post
authors.forename: Konrad
authors.initials: K
authors.lastname: Jarosz
authors.forename: Piotr
authors.initials: P
authors.lastname: Milkiewicz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D005260:Female; D006499:Hepatic Artery / Q000502:physiology* / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008026:Ligation; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000209:etiology; D017534:Radial Artery / Q000502:physiology; D013157:Splenic Artery / Q000601:surgery; D013577:Syndrome; D055815:Young Adult