Applying Intraoperative Portal Venography in Liver Transplantation Vascular Surgery

Area of Science:

• Hepatobiliary Surgery
• Transplant Surgery
• Vascular Surgery

Background:

• Adequate portal inflow is critical for liver graft regeneration after transplantation.
• Intraoperative portal venography (IOPV) assesses portal vein patency, stenosis, thrombus, and collaterals in real-time.
• Portal vein pressure gradient measurement complements imaging during IOPV.

Purpose of the Study:

• To evaluate the impact of IOPV on surgical decision-making in liver transplantation.
• To determine the effect of IOPV on post-transplant outcomes.
• To establish criteria for patient selection based on IOPV findings.

Main Methods:

• 34 liver transplant patients with portal inflow issues underwent IOPV.
• Preoperative CT and US assessed portal vein status; IOPV guided interventions.
• Postoperative US and CT monitored portal flow and graft regeneration.

Main Results:

• IOPV influenced surgical planning in all cases, leading to interventions that improved portal vein flow velocity (6.3 to 30.8 cm/s, p < 0.001).
• Adequate inflow was achieved in 32 patients; 2 experienced persistent low or occluded flow.
• Liver graft regeneration ranged from 104% to 255% within one year.

Conclusions:

• IOPV is a valuable tool for optimizing surgical strategies and portal inflow in liver transplantation.
• Early integration of IOPV into practice may enhance graft outcomes.
• Further research is needed to refine patient selection and assess long-term benefits.