Reversal of portal flow after acute rejection in living-donor liver transplantation |
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Authors: | Hiroyuki Sugimoto Tetsuya Kaneko Yuji Marui Soichiro Inoue Takahiko Seo Tsuyoshi Hatsuno Hisami Ando Akimasa Nakao |
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Affiliation: | Second Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan, JP Department of Pediatric Surgery, Nagoya University School of Medicine, Nagoya, Japan, JP
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Abstract: | Portal hepatofugal flow is rare after liver transplantation. We experienced a case in which hepatofugal portal flow was observed in acute rejection. A 6‐year‐old boy with glycogen storage disease type Ia underwent living‐donor liver transplantation. On postoperative day 7, portal venous peak velocity was markedly decreased without portal thrombosis and obstruction of the hepatic vein, and hepatic arterial peak velocity increased reciprocally. Based on a diagnosis of acute rejection, made on postoperative day 8, we initiated steroid pulse therapy. Despite the employment of this therapy, continuous hepatofugal portal flow was observed in the entire liver on postoperative day 8. On day 12, as the liver disorder progressed, the Doppler waveform in the portal vein changed from continuous to pulsatile hepatofugal flow. The patient died of liver failure on day 14. The histological findings of a biopsy specimen on day 9 showed centrilobular necrosis, while total hepatocellular necrosis was seen at autopsy. Hepatofugal flow after liver transplantation is considered to be an ominous sign caused by several factors, and its appearance indicates a fatal condition. |
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Keywords: | reversal of portal flow living‐donor liver transplantation acute rejection centrilobular necrosis glycogenosis type ia |
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