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Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Eisele RM, Schumacher G, Settmacher U, Neuhaus P Department of General,

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Presentation on theme: "Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Eisele RM, Schumacher G, Settmacher U, Neuhaus P Department of General,"— Presentation transcript:

1 Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Eisele RM, Schumacher G, Settmacher U, Neuhaus P Department of General, Visceral and Transplantation Surgery, Charitè Campus Virchow Klinikum, University of Berlin, Germany Department of General and Visceral Surgery, Friedrich-Schiller-University, Jena, Germany Disclosure of any financial interest or hazard is provided by the author on behalf of the study group

2 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Excellent results if selection of donor and recipient is proper and strict Scheduled procedure Donor is known previously and available for hemo- dynamic in house- examinations Living Donor Liver Transplantation in Adults

3 CAMPUS VIRCHOW KLINIKUM Right Liver Lobe (Segments V - VIII) One Hepatic Artery One Portal Venous Branch Right Hepatic Vein, occasionally with Reconstruction of the Middle or Inferior Right Hepatic Vein Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow The Segmental Liver Graft: Anatomical Considerations

4 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow The Segmental Liver Graft: Intraoperative View

5 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow The Segmental Liver Graft: Hemodynamic Properties Small for Size Graft Reduced Total Vascular Cross-Sectional Area Portal Hyperperfusion Unknown clinical impact Marcos A et al.: Transplantation 2000;70 12 :

6 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Different Methods of Hemodynamic Assessment: Pros and Cons Direct intraoperative way: Advantage: valid examination Disadvantage: invasive Indirectly using Doppler ultrasound: Disadvantage: many chances to fail Advantage: repeatedly appliable

7 CAMPUS VIRCHOW KLINIKUM correct acquisition of the Doppler signal precisely corrected angle of flow direction exact determination of vessels diameters Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Preconditions for Assessing Flow Volume

8 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Doppler Ultrasound and Hepatic Artery Flow

9 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Study Design Donor Recipient Donor ultrasound regarding portal venous and hepatic arterial branches supply- ing the donors right lobe (=graft) Donor Procedure, Living Donor Liver Transplantation Doppler ultra- sound of the recipients graft within the first 24 h following reperfusion Doppler ultra- sound of the recipients graft within the first 48 h following reperfusion Doppler ultra- sound of the recipients graft within the first 72 h following reperfusion

10 CAMPUS VIRCHOW KLINIKUM Treatment of end stage liver disease in 5 cases of ethyltoxic Cirrhosis 4 cases of Malignancy (2 CCC, 2 HCC) 3 cases of posthepatitic Cirrhosis (HCV) 2 cases of Primary Sclerosing Cholangitis 4 miscellaneous cases (Budd-Chiari-Syndrome, AIH, Polycystic Degeneration, Primary Biliary Cirrhosis) Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Living Donor Liver Transplantation in Adults

11 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Portal Venous Flow Pretx.Posttx. Maximum Mean Minimum p < (T-test)

12 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Hepatic Artery Flow Following Living Donor Liver Transplantation p < 0.01 (U-test) Intra- individual analysis: Inter- individual analysis: p < (T-test) p < (T-test) No signifi- cance in preopera- tive values

13 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow ml/min Timepoints HDF (n=8) LDF (n=6) p < 0.05 Wilcoxon for HDF p < 0.05 Friedman for HDF No signi- ficances in inter- individual analysis

14 CAMPUS VIRCHOW KLINIKUM No possible explanation in GBWR, immunosuppres- sion, or medical treatment with vasotropic agents No influence upon survival and outcome (2 deaths, 1 successful ReTx., 2 cases of ReTx. and subsequent death) vascular complications (1 HAT in a HDF pat.) other complications (ascitis, renal insufficiency, variceal bleeding in one HDF pat.) Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Clinical Implications

15 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Summarizing the Results Two subgroups could be distinguished in time course of hepatic arterial flow following living donor liver transplantation in adults Portal venous hyperperfusion - whereas common in both groups - obviously does not lead to the same hepatic arterial flow pattern in each patient.

16 CAMPUS VIRCHOW KLINIKUM Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow Conclusions Portal venous flow did not emerge to be a predictor of arterial flow following living donor liver transplantation in adults There seems to be a tendency towards a slower portal venous flow recovery in patients with typical hepatic arterial hypoperfusion following living donor liver transplantation


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