Portal Venous Flow Volume Measurements May Aid Intraoperative Management of Large Portosystemic Shunts During Pediatric Liver Transplantation.
1Transplant Surgery, Univ of Colorado, Aurora, CO
2Transplant Surgery, Children's Hospital Colorado, Aurora, CO.
Meeting: 2016 American Transplant Congress
Abstract number: D207
Keywords: Pediatric
Session Information
Date: Tuesday, June 14, 2016
Session Name: Poster Session D: Pediatric Liver Transplantation
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
PURPOSE: In pediatric patients undergoing liver transplantation, portal hypoperfusion can result in irreversible portal vein thrombosis and early graft loss. Intraoperative hepatic hemodynamic studies have been well described in living donor liver transplantation. We present our experience with intraoperative PV Flow (PVF) measurements in the management of large portosystemic shunts.
METHODS: Retrospective chart review of 27 patients who underwent a solid organ liver transplantation from Jan 2013 to Nov 2015. Patients without clear documentation of intraoperative PVF measurements were excluded. PVF measurements were obtained after anastamosis of PV and HA using a Medistim VeriQ system.
RESULTS: 3 patients met inclusion criteria and characteristics are in table 1. Patient 1 had a known large splenorenal shunt on preoperative imaging. After reperfusion, temporary ligation of the left renal vein (LRV) worsened the portal flow so it was left intact. Patient 2 had a large coronary vein that was ligated after demonstration of increased portal flow with temporary occlusion. Patient 3 had an unknown large splenorenal shunt that was discovered after initial poor portal flow. The left renal vein was temporary ligated and portal flow drastically improved so the LRV was permanently ligated.
CONCLUSIONS: Our series suggests that portal vein flow volume measurements at the time of liver transplantation may aid in the decision to perform a shunt modulation procedure at the time of transplant.
| Patient 1 | Patient 2 | Patient 3 | |
| Age | 1 yr 4 mo | 5 y 1 mo | 0 yr 7 mo |
| Diagnosis | Biliary Atresia | Idiopathich PV Thrombosis | Biliary Atresia |
| Donor Type | Brain Death | Brain Death | Brain Death |
| Graft Size | 250 gm | 300 gm | 150 gm |
| Graft Type | Whole | Whole | Whole |
| Cold Ischemia | 7 h 45 m | 10 h 57 min | 9 h 15 min |
| Caval Anastamosis | Non-piggyback | Non-piggyback | Non-piggyback |
| Portal Anastamosis | SMV/Splenic | SMV/Splenic | SMV/Splenic |
| Perfusion Quality | Good | Fair | Fair |
| Initial PVF Volume | 263 mL/min | 50 mL/min | 93 mL/min |
| Vessel Temporarily Ligated | Left renal vein | Coronary Vein | Left renal vein |
| PVF After Shunt Modulation | 108 mL/min | 189 mL/min | 216 mL/min |
| Outcome | No modulation. Normal Graft Function. |
Coronary vein ligated. Normal Graft Function. |
Left enal vein ligated. Normal Graft Function. |
CITATION INFORMATION: Pshak T, Roach J, Karrer F, Wachs M. Portal Venous Flow Volume Measurements May Aid Intraoperative Management of Large Portosystemic Shunts During Pediatric Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Pshak T, Roach J, Karrer F, Wachs M. Portal Venous Flow Volume Measurements May Aid Intraoperative Management of Large Portosystemic Shunts During Pediatric Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/portal-venous-flow-volume-measurements-may-aid-intraoperative-management-of-large-portosystemic-shunts-during-pediatric-liver-transplantation/. Accessed September 27, 2020.« Back to 2016 American Transplant Congress