CELIAC COMPRESSION SYNDROME AND LIVER-TRANSPLANTATION

Objective The authors assessed the prevalence and clinical significanc e of the celiac compression syndrome in liver transplantation patients . Summary Background Data Compression of the celiac axis by the median arcuate ligament of the diaphragm, causes a decrease in celiac artery blood flow which may lead to hepatic artery thrombosis in patients un dergoing orthotopic liver transplantation. Methods From July 1991 to J uly 1992, 17 (10%) cases of celiac compression syndrome were identifie d among 164 consecutive adult patients who underwent liver transplanta tion. The diagnosis was confirmed by blood flow recording demonstratin g a typical pattern of accentuated decrease in celiac blood flow durin g expiration. Results Surgical transection of the median arcuate ligam ent resulted in normalization of the hepatic artery blood flow. In two cases (11.7%), an interposition iliac graft from the recipient supra- celiac aorta was used for the arterial reconstruction. During the foll ow-up period of up to 15 months, there was no incidence of hepatic art ery thrombosis. Conclusions The clinical significance of the celiac co mpression syndrome is evident in liver transplantation in which the co llateral circulation to the liver is compromised and the celiac artery remains the only source of arterial blood. It is imperative to identi fy and remove the obstruction of the celiac axis to prevent severe com plications and potential graft loss.