title: Intra-operative management of low portal vein flow in pediatric living donor liver transplantation.
abstract: For pediatric living donor liver transplantation, portal vein complications cause significant morbidity and graft failure. Routine intra-operative Doppler ultrasound is performed after graft reperfusion to evaluate the flow of portal vein. This retrospective study reviewed 65 children who had undergone living donor liver transplantation. Seven patients were detected with suboptimal portal vein flow velocity following vascular reconstruction and abdominal closure. They underwent immediate on-table interventions to improve the portal vein flow. Both surgical and endovascular modalities were employed, namely, graft re-positioning, collateral shunt ligation, thrombectomy, revision of anastomosis, inferior mesenteric vein cannulation, and endovascular stenting. The ultrasonographic follow-up assessment for all seven patients demonstrated patent portal vein and satisfactory flow. We reviewed our experience on the different modalities and proposed an approach for our future intra-operative management to improve portal vein flow at the time of liver transplantation.
authors.affiliation: Liver Transplantation Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ting-Lung
authors.initials: TL
authors.lastname: Lin
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Chiang
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Shih-Hor
authors.initials: SH
authors.lastname: Wang
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Yueh-Wei
authors.initials: YW
authors.lastname: Liu
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.forename: Tsan-Shiun
authors.initials: TS
authors.lastname: Lin
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Li
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Tai-Yi
authors.initials: TY
authors.lastname: Chen
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
mesh_terms: D001783:Blood Flow Velocity; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler