Annabel Blasi, Joan Beltran, Victor Molina, Rocio Garcia, Pilar Taura and Juan Carlos Garcia Valdecasas
The incidence of portal vein thrombosis (PVT) after liver transplantation (LT) is considered to be relatively an uncommon complication (1-3%) in comparison to hepatic artery thrombosis, however it can significantly reduce graft and patient survival. Delayed PVT, defined as those appeared one month after LT, does not necessarily lead to graft failure and the main consequences are related to portal hypertension. To the contrary, early PVT potentially resulted in re-transplantation [1-3]. Virchow describes three broad categories of factors that are thought to contribute to thrombosis: hypercoagulability, hemodynamic changes and endothelial injury. In low pressure systems (as it is venous circulation) the hemodynamic factor (blood flow) is considered to play an important role in the development of thrombotic events. For this reason, intraoperative flow measurements (arterial and portal flows) are performed in majority of centers in all patients before bile duct anastomosis during LT. However, these flows are subjected to hemodynamic patient conditions (especially cardiac index and vascular resistances) which are highly variable during and immediately after liver transplantation [4]. Otherwise, some groups suggest the importance of the temporary porto-caval shunt performed during the anhepatic phase to know the conditions before reperfusion and determine whether they will be favorable or not [5]. Although as to be one of the main factors, the role of intraoperative portal flow after graft reperfusion as a contributor to PVT after liver transplantation has not be assessed yet. Our aim is to investigate the correlation between the intraoperative portal flows after graft reperfusion with the appearance of early portal vein thrombosis after LT. Secondarily; we investigate the correlation between the temporary porto-caval shunt and the portal flow, also between the cardiac output and the temporary porto-caval shunt and arterial and portal flows after graft reperfusion, during LT.
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