Hepatic vein flow index during orthotopic liver transplantation as predictive factor for postoperative early allograft dysfunction

Study of Early Postoperative Doppler Changes Post Living Donor Liver Transplantation and Their Impact on Early Mortality and Small-for-Size Syndrome: A Retrospective Study

BACKGROUND

Adult-to-adult living donor liver transplantation (LDLT) has been a common practice because of the deficiency of deceased donor liver transplants. Liver hemodynamics differ substantially between cases with end-stage liver disease undergoing LT because of various degrees of hepatic affection, nature of implicated causative factors, and pathogenesis of the hepatic disorder. The present retrospective study primarily aimed to study the early postoperative doppler changes after adult to adult LDLT. The secondary aim was to assess these hemodynamics' impact on early in-hospital deaths and small for size syndrome (SFSS) development.

METHODS

This retrospective work was done on 123 adult cases with end-stage liver disease for whom adult LDLT was performed after exclusion of pediatric patients and those with vascular complications.

RESULTS

Postoperative (PO) mean portal vein velocity (PVV), hepatic artery (HA) peak systolic velocity (PSV), and HA resistivity index (RI) declined gradually but significantly post adult LDLT. Phasicity of hepatic veins changes towards the triphasic waveform gradually in the early PO period. There is a notable negative relationship between PO mean PVV with PO mean HA PSV. Higher PO HA RI affected PO mortality, while higher PO PVV and lower HA PSV increased the incidence of SFSS.

CONCLUSION

Early postoperative Doppler changes post-LDLT (PO PVV, HA RI, and HA PSV) can affect both mortality and SFSS development.

Hepatic Vein Flow Index During Orthotopic Liver Transplantation as a Predictive Factor for Postoperative Early Allograft Dysfunction

OBJECTIVES

The authors devised a hepatic vein flow index (HVFi), using intraoperative transesophageal echocardiography and graft weight, and investigated its predictive value for postoperative graft function in orthotopic liver transplant.

DESIGN

Prospective clinical trial.

SETTING,

Single-center tertiary academic hospital.

PARTICIPANTS

Ninety-seven patients who had orthotopic liver transplant with the piggy-back technique between February 2018 and December 2019.

MEASUREMENTS AND MAIN RESULTS

HVFi was defined with HV flow/graft weight. Patients who developed early graft dysfunction (EAD) had low HVFi in systole (HVFi sys, 1.23 v 2.19 L/min/kg, p < 0.01), low HVFi in diastole (HVFi dia, 0.87 v 1.54 L/min/kg, p < 0.01), low hepatic vein flow (HVF) in systole (HVF sys, 2.04 v 3.95 L/min, p < 0.01), and low HVF in diastole (HVF dia, 1.44 v 2.63 L/min, p < 0.01). More cardiac death, more vasopressors at the time of measurement, more acute rejection, longer time to normalize total bilirubin (TIME t-bil), longer surgery time, longer neohepatic time, and more packed red blood cell transfusion were observed in the EAD patients. All HVF parameters were negatively correlated with TIME t-bil (HVFi sys R = -0.406, p < 0.01; HFVi dia R = -0.442, p < 0.01; HVF sys R = -0.44, p < 0.01; HVF dia R = -0.467, p < 0.01). The receiver operating characteristic curve analysis determined the best cut-off levels of HVFi to predict occurrence of EAD (HVFi sys <1.608, HVFi dia <0.784 L/min/kg), acute rejection (HVFi sys <1.388, HVFi dia <1.077 L/min/kg), and prolonged high total bilirubin (HVFi sys <1.471, HVFi dia <1.087 L/min/kg).

CONCLUSIONS

The authors' devised HVFi has the potential to predict the postoperative graft function.