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Hepatic hemodynamic changes during orthotopic liver transplantation (OLT) in children have not yet been studied. We measured intraoperative portal vein flow (PVF) and hepatic arterial flow (HAF) (mL/min) in 53 children and 58 grafts during OLT.
Flows were measured in the native organ and in the allograft. In the native liver, PVF and HAF are similar; after transplantation they return to the physiological situation.
No flow differences were seen between whole and partial grafts. Among the 8 (14%) portal vein thromboses, PVF was lower in both the native liver and the graft than in the no thrombosis group (P < 0.05). PVF < 5mL/min/kg was a risk factor to develop PV thrombosis.
No graft loss occurred in 3 cases without PVF at the time of OLTs despite the observation that repermeabilization was not possible.
In 4 patients with PVF < 5 mL/min/kg, after tying a spontaneous spleno-renal shunt (n=3) or performing a porto-renal vein anastomosis (n=1), PVF reached > 20 mL/min/kg, avoiding thrombosis.
In conclusion, PVF and HAF measurements during pediatric OLT may predict patients at high risk for development of PV thrombosis.
