Hemodynamics of hepatic artery in infant recipients at early postoperative stage after DCD liver transplantation

Abstract

Objective To summarize the hemodynamics of hepatic artery in infant recipients at early postoperative stage after DCD liver transplantation, and to explore the possible factors associated with early postoperative hepatic artery occlusion (HAO). Method Clinical data of all infant recipients of DCD liver transplantation performed by a single surgical team in our hospital from January 2014 to July 2015 were retrospectively analyzed by reviewing medical charts, with emphasis on Doppler ultrasonic results of graft liver at early postoperative stage. Clinical characteristics of graft hepatic artery hemodynamics were exactly described, and factors possibly associated with early postoperative HAO were recorded and analyzed statistically. Result The incidence of early postoperative HAO in infant recipients after DCD liver transplantation was 26.1%(6/23). HAO initially appeared as no detection of flow? signals in intrahepatic arterial branches in most cases, which further progressed to the occlusion of main hepatic artery. And all cases produced compensatory collateral blood flows on 14.7±2.9 days after HAO. Grouped by hepatic artery occlusion, recipients in HAO group showed significantly higher incidence of graft-size mismatch than those in non-HAO group, and the incidence was 83.3%(5/6)、23.5%(4/17), respectively(P=0.018). Grouped by the graft size, the portal vein flow (PVF) showed statistically significant differences among three groups, they were 316.91±114.96 ml/min, 158.20±66.10 ml/min, and 110.09±33.46 ml/min in the small-sized graft group, the size-matched graft group and the large-sized graft group, respectively(P<0.01). Conclusion The incidence of early postoperative HAO was significantly higher in the size-mismatched infant recipients after DCD liver transplantation, compared with the size-matched recipients. The ability of the hepatic artery to produce compensatory flow changes in response to changes in portal venous flow, termed as hepatic arterial buffer response (HABR), might explain the potential mechanism of HAO in the small-sized graft recipients. However, the mechanism of HAO in the large-sized graft recipients is still unclear. Key words: Organ donation; Child; Liver transplantation; Infant; Hemodynamic phenomena; Arterial occlusive diseases