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Portal Venous Flow Volume Measurements May Aid Intraoperative Management of Large Portosystemic Shunts During Pediatric Liver Transplantation.

T. Pshak,1 J. Roach,2 F. Karrer,2 M. Wachs.2

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

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  • Pre-Transplant Portal Vein Recanalization-Transjugular Intrahepatic Portosystemic Shunt in Patients With Chronic Portal Vein Thrombosis
  • Interventional Treatment With Minimal Surgery Is an Effective Way for Acute Portal Vein Thrombosis After Pediatric Liver Transplantation: The Experience of Largest Pediatric Liver Transplantation Center in China

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).

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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 February 28, 2021.

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