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Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats
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Intra-operative portal hemodynamics in pediatric LDLT: Doppler ultrasound surveillance

Lihong Gu1, Hua Fang1, Shijun Zhang1

  • 1Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Pediatric Transplantation
|April 27, 2018
PubMed

Insights

Doppler ultrasonography effectively monitors portal vein (PV) flow during living donor liver transplantation (LDLT) in children. Prompt interventions for insufficient PV flow significantly improve hepatic hemodynamics, ensuring successful outcomes.

Area of Science:

  • Hepatology
  • Pediatric Surgery
  • Vascular Surgery

Background:

  • Living donor liver transplantation (LDLT) is a critical procedure for pediatric patients with end-stage liver disease.
  • Monitoring portal vein (PV) flow is essential for graft success in LDLT.
  • Intra-operative complications, such as insufficient PV flow, can negatively impact outcomes.

Purpose of the Study:

  • To evaluate the utility of Doppler ultrasonography in monitoring intra-operative portal vein (PV) flow during pediatric LDLT.
  • To assess the effectiveness of various interventions for managing insufficient intra-operative PV flow.
  • To identify key indicators for intervention in pediatric LDLT.

Main Methods:

  • Retrospective cohort study of 550 pediatric recipients (<18 years) undergoing LDLT.
  • Utilized Doppler ultrasonography to assess intra-operative PV flow.
  • Analyzed interventions for 33 recipients (6%) with insufficient PV flow, including stent placement, anticoagulation, and surgical revisions.

Main Results:

  • Insufficient intra-operative PV flow occurred in 6% of pediatric LDLT recipients.
  • Interventions significantly improved peak PV velocity, hepatic artery pulsatility (HAPSV), hepatic artery resistance index (HARI), and hepatic vein (HV) velocity (P<.01).
  • Insufficient PV flow and decreased HARI were key indicators for intervention.

Conclusions:

  • Doppler ultrasonography is a valuable tool for real-time monitoring of PV flow during pediatric LDLT.
  • Prompt intra-operative management of insufficient PV flow leads to significant hemodynamic improvements.
  • Immediate resolution of PV flow is achievable, enhancing the feasibility of pediatric LDLT.

Keywords:
Doppler ultrasoundhemodynamicliving donor liver transplantationpediatricportal vein

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