Significance of measured intraoperative portal vein flows after thrombendvenectomy in deceased donor liver transplantations with portal vein thrombosis

• Published in: Liver transplantation Vol. 23; no. 8; pp. 1032 - 1039
• Main Authors: Draoua, Mark, Titze, Nicole, Gupta, Amar, Fernandez, Hoylan T., Ramsay, Michael, Saracino, Giovanna, McKenna, Gregory, Testa, Giuliano, Klintmalm, Goran B., Kim, Peter T. W.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.08.2017
• Subjects: Cholestasis - epidemiology; Cholestasis - physiopathology; End Stage Liver Disease - surgery; Female; Graft Survival; Hepatic artery; Hepatic Artery - pathology; Humans; Incidence; Intraoperative Period; Kaplan-Meier Estimate; Liver; Liver - blood supply; Liver - surgery; Liver Transplantation; Liver transplants; Magnetic Resonance Angiography; Male; Middle Aged; Portal vein; Portal Vein - physiopathology; Postoperative Complications - epidemiology; Regional Blood Flow; Stricture; Survival; Thrombectomy; Thrombosis; Tissue Donors; Ultrasonography, Doppler; Veins & arteries; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - epidemiology; Venous Thrombosis - physiopathology; Venous Thrombosis - surgery
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.24779

Adequate portal vein (PV) flow in liver transplantation is essential for a good outcome, and it may be compromised in patients with portal vein thrombosis (PVT). This study evaluated the impact of intraoperatively measured PV flow after PV thrombendvenectomy on outcomes after deceased donor liver transplantation (DDLT). The study included 77 patients over a 16‐year period who underwent PV thrombendvenectomy with complete flow data. Patients were classified into 2 groups: high PV flow (>1300 mL/minute; n = 55) and low PV flow (≤1300 mL/minute; n = 22). Postoperative complications and graft survival were analyzed according to the PV flow. The 2 groups were similar in demographic characteristics. Low PV flow was associated with higher cumulative rates of biliary strictures (P = 0.02) and lower 1‐, 2‐, and 5‐year graft survival (89%, 85%, and 68% versus 64%, 55%, and 38%, respectively; P = 0.002). There was no difference in the incidence of postoperative PVT between the groups (1.8% versus 9.1%; P = 0.19). No biliary leaks or hepatic artery thromboses were reported in either group. By multivariate analyses, age >60 years (hazard ratio [HR], 3.04, 95% confidence interval [CI], 1.36‐6.82; P = 0.007) and low portal flow (HR, 2.31; 95% CI, 1.15‐4.65; P = 0.02) were associated with worse survival. In conclusion, PV flow <1300 mL/minute after PV thrombendvenectomy for PVT during DDLT was associated with higher rates of biliary strictures and worse graft survival. Consideration should be given to identifying reasons for low flow and performing maneuvers to increase PV flow when intraoperative PV flows are <1300 mL/minute. Liver Transplantation 23 1032–1039 2017 AASLD.