DOES INTRAOPERATIVE HEPATIC-ARTERY FLOW PREDICT ARTERIAL COMPLICATIONS AFTER LIVER-TRANSPLANTATION

Background. Lit-tie is known about the value of intraoperative hepatic artery (HA) flow measurement on the development of HA complications i n orthotopic liver transplantation (OLT). We undertook this study to s ee whether assessing HA flow at the OLT helps predict posttransplant H A complications (HA thrombosis or stenosis). Methods. Four hundred and eleven consecutive OLT in 367 adult patients who received grafts betw een November 1992 and August 1995 were reviewed. Of these, 259 grafts in 255 patients with at least 1 year of follow-up and with complete da ta were studied. HA flow, portal vein flow, percentage of cardiac inde x going to HA (HA/CI), HA flow per 100 g of liver tissue, mean arteria l pressure, central venous pressure, and CI were analyzed. Preservatio n injury was assessed by posttransplant alanine aminotransferase and a spartate aminotransferase levels. Results, Thirty-four patients with 3 5 grafts developed HA thrombosis or stenosis during a median follow-up time of 29 months. HA complications occurring within the first 100 da ys of OLT were classified as early complications. HA now at the time o f surgery and percentage of CI going to the Liver were found to be sig nificant variables in early HA complications. Hepatic hemodynamics wer e not different in the late HA complication group compared to the cont rol. Systemic hemodynamics and posttransplant alanine aminotransferase and aspartate aminotransferase levels were similar in all three group s. Logistic regression analysis showed that patients with HA flows les s than 400 ml/min were more than 5 times as likely to develop HA compl ications (risk ratio 5.1). Conclusions. HA flow measurement should be obtained at the time of OLT and may help to predict early but not late posttransplant HA complications. Patients with HA flows less than 400 ml/min or HA/CI values of less than 7% may carry a higher risk for HA stenosis or thrombosis and may need close surveillance to detect such problems.