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A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva
Published on: January 12, 2019
Intraoperative measurement of graft blood flow--a necessity in liver transplantation
A Rasmussen1, A Hjortrup, P Kirkegaard
1Department of Transplantation V, Rigshospitalet, University of Copenhagen, Denmark.
Insights
Intraoperative flow measurement in liver transplantation identifies and resolves graft dysfunction caused by vascular issues. This technique ensures optimal blood flow, improving transplant outcomes.
Area of Science:
- Transplantation Surgery
- Vascular Surgery
- Hepatobiliary Surgery
Background:
- Liver transplantation requires precise graft reperfusion to prevent primary graft dysfunction.
- Vascular complications can significantly impair graft function and patient outcomes.
Observation:
- Intraoperative flow measurements of portal venous and hepatic arterial flow were performed in 70 liver transplant patients.
- Six patients exhibited impaired graft flow attributed to vascular abnormalities, including arterial steal, portosystemic collaterals, and graft positioning sensitivity.
- Early postoperative arterial thrombosis was observed in two patients.
Findings:
- Stenosis of the recipient celiac trunk led to arterial steal, resolved by hepatic artery ligation.
- Large portosystemic collaterals caused reduced portal venous flow, corrected by collateral ligation.
- Optimal graft positioning was determined using flow measurements in a pediatric patient with positional flow sensitivity.
- Thrombectomy successfully restored graft artery pulsation in two patients with early postoperative thrombosis.
Implications:
- Intraoperative flow measurement is crucial for identifying and managing technically flawed graft reperfusion in liver transplantation.
- This technique allows for timely intervention, potentially preventing primary graft dysfunction and improving graft survival rates.
- The study highlights the utility of flow assessment in diverse vascular scenarios encountered during liver transplantation.
Abstract:
Portal venous and hepatic arterial flow was measured intraoperatively in the 70 most recent patients undergoing liver transplantation in our institution. Impaired graft flow due to vascular abnormalities was detected in six patients. One patient suffered from arterial steal due to stenosis of the recipient celiac trunk with blood shunting from the hepatic to the splenic artery. Ligation of the recipient hepatic artery restored the arterial graft flow. In two patients we found reduced portal venous flow due to large portosystemic collaterals. The collaterals accountable for the impaired portal flow were identified and ligated, which restored portal venous graft flow. Excessive sensitivity of the portal venous flow to the position of the graft was found in a 6-month-old boy. Portal venous flow varied considerably, depending upon the position of the graft, and intraoperative flow measurement allowed the best position of the graft to be identified. Two patients developed arterial thrombosis in the early postoperative course. Immediate laparatomy with thrombectomy resulted in good, palpable pulsation in the graft artery in both patients. Intraoperative flow measurement demonstrated satisfactory arterial flow in one patient, whereas there was no net flow in the other patient's graft artery. Pulsation in this patient was caused by blood oscillating in and out of the liver. In conclusion, we find that causes of primary graft dysfunction due to technically flawed reperfusion of the graft can be identified and alleviated by intraoperative measurement of the flow in the graft vessels.
