Intra-operative management of low portal vein flow in pediatric living donor liver transplantation |
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Authors: | Lin Ting-Lung Chiang Li-Wei Chen Chao-Long Wang Shih-Hor Lin Chih-Che Liu Yueh-Wei Yong Chee-Chien Lin Tsan-Shiun Li Wei-Feng Jawan Bruno Cheng Yu-Fan Chen Tai-Yi Concejero Allan M Wang Chih-Chi |
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Institution: | Liver Transplantation Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. |
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Abstract: | For pediatric living donor liver transplantation, portal vein complications cause significant morbidity and graft failure. Routine intra-operative Doppler ultrasound is performed after graft reperfusion to evaluate the flow of portal vein. This retrospective study reviewed 65 children who had undergone living donor liver transplantation. Seven patients were detected with suboptimal portal vein flow velocity following vascular reconstruction and abdominal closure. They underwent immediate on-table interventions to improve the portal vein flow. Both surgical and endovascular modalities were employed, namely, graft re-positioning, collateral shunt ligation, thrombectomy, revision of anastomosis, inferior mesenteric vein cannulation, and endovascular stenting. The ultrasonographic follow-up assessment for all seven patients demonstrated patent portal vein and satisfactory flow. We reviewed our experience on the different modalities and proposed an approach for our future intra-operative management to improve portal vein flow at the time of liver transplantation. |
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Keywords: | inferior mesenteric vein cannulation living donor liver transplantation portal vein complication stent |
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