PRIMARY SHUNT PERFUSION DETECTED BY COLOR-FLOW DOPPLER IMAGING AND ITS IMPACT ON LIVER ALLOGRAFT SURVIVAL

Primary dysfunction (PDF) and eventual primary nonfunction (PNF) of li ver allografts have been characterized by various clinical and laborat ory parameters reflecting,graft function, cellular integrity and extra hepatic influence following orthotopic liver transplantation (OLT). Du ring the past 6 yr we have been able to demonstrate that this potentia lly devastating condition is routinely accompanied by a pathological i nitial perfusion pattern detected by colour flow doppler imaging (CFDI ) within hours following OLT. In the majority of PDF cases (n=30) CFDI revealed increased vascular resistance in regard to arterial blood fl ow to the malfunctioning graft, with a resulting 1-yr graft survival r ate of 80% following the institution of early prostaglandin therapy in this group of patients. A completely different perfusion pattern was noticed by CFDI in a total of 13 cases with grossly decreased arterial resistance, resulting in an apparently supranormal arterial blood sup ply together with a reduced portal inflow in comparison to primarily f unctioning grafts. The presence of this pathologic graft perfusion was explained by the formation of arterio-portal shunts within the graft during conservation and reperfusion, leading to a 1-yr graft survival of merely 46.1%.