L/I‐5 Hemodynamics in adult‐to‐adult living donor liver transplantation: personal experience

Abstract

Introduction: The interaction and modulation of inflow and outflow in adult living donor liver transplants (LDLTs) is very complex; small‐for‐size syndrome (SFSS) still represents the most dangerous complication in this regard.Methods: We measured the liver hemodynamics, in both donors and recipients, in 21 LDLTs.Measured parameters included hepatic artery flow (HAF) and portal vein flow (PVF) (ml/min/100 g ), PVF/HAF ratio (PAR) by means of transit time flowmeter, and portal vein pressure (PVP). For all recipients, we used a maximalized outflow with blanket technique (with MHV in 19). According to the results, in order to prevent SFSS, we performed either splenic artery ligation (SAL) or modified porto‐caval‐shunt (PCS) or intrarterial PGI2 + steroid infusion.Results: The median reference values in donors were as follows: HAF, 26.5 ml/min/100g; PVF, 78.5 ml/min/100g; and PAR, 2.5. At total of 5 patients underwent SAL because of GBWR ≤ 0.9; HAF decreased from 32% to 82% in 4; PVF increased from 300% to 400% in 3; PAR was > 20 in 2. None of these patients developed SFSS. Two patients underwent intraarterial infusion of PGI2 + steroids over 14 days because of a PVF increase ≥ 300%, HAF decrease of 82% in 1, PAR 66 and 22, PVP > 20 in 1, and impossibility of SAL. No SFSS was observed. One patient underwent a modified PCS because of PVF increase of 250%, HAF decrease of 70%, PAR 27. No complications occurred.Discusssion: Strength monitoring of liver hemodynamics at pre‐, intra‐, and posthepatic level allows specific management at the different levels in order to prevent SFSS and graft loss.