REDUCED-SIZE HEPATIC ALLOGRAFT VASCULAR COMPRESSION IN CHILDREN - DETECTION WITH COLOR DOPPLER SONOGRAPHY

A major cause of death in children awaiting liver transplantation has been the lack of timely availability of small donor organs [1-3]. The development of surgical techniques to accomplish a reduction hepatecto my has allowed the successful preparation of reduced-sized liver allog rafts [1-3], making available a wider spectrum of donor organs for sma ll children. This development has improved but not alleviated the seve re organ shortage for these patients [2]. Several problems unique to r educed-size liver transplantation complicate the closure of the abdome n after transplantation. The volume of the transplanted allograft ofte n exceeds the preoperative volume of the native liver when severe pare nchymal volume loss has accompanied cirrhosis. In addition, operative factors, such as the formation of intestinal and mesenteric edema [1-3 ], significant intraoperative fluid needs, and allograft swelling, fur ther complicate abdominal closure [1-3]. Great care must be exercised to prevent excessive intraabdominal pressure from distorting or occlud ing the hepatic artery or portal vein, The lateral displacement of the hepatic hilar structures and the often circuitous route that these bl ood vessels take after reduced-size liver transplantation [2, 4] predi spose these vessels to extrinsic compression in the presence of increa sed intraabdominal pressure. We report two patients in whom Doppler so nography was used to identify vascular compromise at the time that dec isions regarding abdominal closure were made.