Using ultrasonography to monitor liver blood flow for liver transplant from donors supported on extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation (ECMO) has been used to support brain-dead donors for liver procurement. This study investigated the potential role of ultrasonographic monitoring of hepatic perfusion as an aid to improve the viability of liver transplants obtained from brain-dead donors who are supported on ECMO. A total of 40 brain-dead patients maintained on ECMO served as the study population. Hepatic blood flow was monitored using ultrasonography, and perioperative optimal perfusion was maintained by calibrating ECMO. Liver function tests were performed to assess the viability of the graft. The hepatic arterial blood flow was well maintained with no significant changes observed before and after ECMO (206 ± 32 versus 241 ± 45 mL/minute; P = 0.06). Similarly, the portal venous blood flow was also maintained throughout (451 ± 65 versus 482 ± 77 mL/minute; P = 0.09). No significant change in levels of total bilirubin, alanine transaminase, and lactic acid were reported during ECMO (P = 0.17, P = 0.08, and P = 0.09, respectively). Before the liver is procured, ultrasonographic monitoring of hepatic blood flow could be a valuable aid to improve the viability of a liver transplant by allowing for real-time calibration of ECMO perfusion in brain-dead liver donors. In our study, ultrasonographic monitoring helped prevent warm ischemic injury to the liver graft by avoiding both overperfusion and underperfusion of the liver.
Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China.
Xian-Sheng
XS
Zhu
Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China.
Sha-Sha
SS
Wang
Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China.
Qi
Q
Cheng
Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China.
Chuang-Wen
CW
Ye
The Center for Liver Disease and Transplantation, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China.
Feng
F
Huo
The Center for Liver Disease and Transplantation, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China.
Peng
P
Li
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000032:analysis / Q000097:blood; D001783:Blood Flow Velocity; D001926:Brain Death; D002138:Calibration; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011169:Portal Vein / Q000473:pathology; D013997:Time Factors; D014019:Tissue Donors; D014463:Ultrasonography; D055815:Young Adult
D019344:Lactic Acid; D000410:Alanine Transaminase; D001663:Bilirubin