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. Living Donor Liver Transplantation in Adults
Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow
Living Donor Liver Transplantation in Adults
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

3. The Segmental Liver Graft: Anatomical Considerations
Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow
The Segmental Liver Graft: Anatomical Considerations
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

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

5. The Segmental Liver Graft: Hemodynamic Properties
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;7012:

6. Different Methods of Hemodynamic Assessment: Pros and Cons
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. Preconditions for Assessing Flow Volume
Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow
Preconditions for Assessing Flow Volume
correct acquisition of the Doppler signal
precisely corrected angle of flow direction
exact determination of vessels‘ diameters

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

9. 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 donor‘s right lobe (=graft)
Donor Procedure, Living Donor Liver Transplantation
Doppler ultra-sound of the recipient‘s graft within the first 24 h following reperfusion
Doppler ultra-sound of the recipient‘s graft within the first 48 h following reperfusion
Doppler ultra-sound of the recipient‘s graft within the first 72 h following reperfusion

10. Living Donor Liver Transplantation in Adults
Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow
Living Donor Liver Transplantation in Adults
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)

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

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

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

14. Clinical Implications
Doppler Ultrasound in Living Donor Liver Transplantation: Role of Portal Venous Flow
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.)
Clinical Implications

15. Summarizing the Results
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. 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