Lf. Donnelly et al., REDUCED-SIZE HEPATIC ALLOGRAFT VASCULAR COMPRESSION IN CHILDREN - DETECTION WITH COLOR DOPPLER SONOGRAPHY, American journal of roentgenology, 165(3), 1995, pp. 655-657
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.