Early modulation of portal graft inflow in adult living donor liver transplant recipients with high portal inflow detected by intraoperative color doppler ultrasound

Splenic flow clearly contributes to portal hyperperfusion in end-stage liver disease patients with hypersplenism. Early modulation of portal graft inflow can relieve the partial graft from the deleterious effects of this portal overflow. Color Doppler ultrasound may play an important role in the intraoperative detection of patients with high recipient portal inflow. Among 138 cases, portal inflow increased after liver transplantation, namely recipient portal inflow (rPVF) of 60 to 554 mL/min/100 g graft weight (mean = 156 mL/min/100 g). There were eight cases in which the rPVF was >250 mL/min/100 g graft weight. In the early period of this study, there were two patients with high portal inflow (rPVF > 250 mL/min/100 g graft) who did not undergo modulation of the portal flow. Small-for-size syndrome occurred in two patients. Later in the series, six patients underwent intraoperative splenic arterial ligation or splenectomy; only one of them displayed prolonged hyperbilirubinemia. The incidence of small-for-size syndrome between these two groups was significant (P =.048). No complication occurred related to the splenic artery ligation or the splenectomy. In conclusion, early modulation of portal graft inflow can protect the graft from portal overflow damage. Intraoperative Doppler ultrasound measurement is an optimal modality for detection of high rPVF.