VASCULAR COMPLICATIONS IN LIVING-RELATED LIVER-TRANSPLANTATION DETECTED WITH INTRAOPERATIVE AND POSTOPERATIVE DOPPLER US

Background/Aims: The purpose of this study was to clarify changes in t he graft hemodynamics induced by vascular complications in living rela ted liver transplantation. Methods: This study included 46 pediatric r ecipients who underwent partial liver transplantation from living rela ted donors. The blood flow was evaluated in the portal system, the hep atic artery and the hepatic vein with serial intra- and post-operative Doppler ultrasound (US). Results: In 12 patients, intraoperative Dopp ler US showed a decrease in portal venous inflow (<9 ml . min(-1). kg( -1)) toward the liver graft and could act as a guide for ligation of c ollaterals in seven patients, portal re-construction in two, thrombect omy in one and relief of hepatic venous outflow obstruction in two for increasing the portal venous inflow. In five patients, intraoperative Doppler US showed poor arterial inflow i.e. dampened arterial wavefor ms which involved both low pulsatility index (<0.90) and low peak-syst olic velocity (<31 cm/s), In three of them, the waveform was more puls atile after re-anastomosis or relief from stretching of the hepatic ar tery. The remaining two patients developed hepatic artery thrombosis. Most of the hepatic venous outflow obstruction (four of five patients) had bat waveforms, low flow velocity (<10 cm/s) of the hepatic vein, and poor portal inflow (flow velocity <14 cm/s). Postoperative Doppler US showed hepatic venous outflow obstruction in three patients, hepat ic artery thrombosis in three (twice in one patient), portal vein sten osis in two and portal vein thrombosis in one. These complications wer e successfully managed with surgical procedures in three patients, tra nshepatic angioplasty in three and conservative treatments in four. Si x patients died of nonvascular complications. Conclusions: Serial intr a- and post-operative Doppler US was a useful technique for making an early diagnosis of abnormal hemodynamics of the graft circulation, Fur thermore, intraoperative Doppler US could assess reconstructed vessels objectively and would reduce the incidence of vascular complications following transplantation.