Intra operative hepatic blood flow in pediatric split liver transplantation, correlation with the outcome

الملخص EN

Introduction : Little is known so far on the relationship between liver blood flow and graft function in the specific setting of pediatric liver transplantation with cadaveric split grafts.

We prospectively evaluated intra-operative variations of arterial and portal flow in pediatric recipients of left-lateral segment grafts from in situ split and impacts of the total flow on early graft function.

Methods : 30 children were studied.

Portal vein(PV) and hepatic artery(HA) flows were measured in the native liver after dissection and after HA ligation, and in the graft after PV anastomosis, after HA anastomosis and at the end of the operation.

Patient and graft weight were recorded, as well as INR after decamping.

Postoperatively, Ultrasond / Doppler (US / Doppler ) and liver function tests (bilirubin, INR, AST, ALT, alkaline phosphatase and GGT) were recorded at days 1, 2, 3, 4, 5, 6, 7, 14, and 30.

The correlation between flow/graft weight ratio (FGW) and graft function was analyzed.

Results : The mean patient weight was 13.19 kg (SD9.39) and GR / WR was 3.19(SD 1.58).

The mean total liver flow was 516 ml / min (SD 304).

The mean total flow / graft weight ratio was 175 ml / min / 100g (SD 100).

A Significant functional impairment of the graft was observed for low and high FGW, with cutoffs at 100 and 300 ml / min / 100g respectively.

These situations were correlated with significantly higher intra operative INR and post operative INR, AST ALT and GGT.

Delayed graft function, vascular complication, and retransplantation rates were significantly higher in patients with high and low FGW.

Particularly, delayed graft function was observed in all the three children with high FGW(420 ,420, and 392ml / min / 100gm respectively) we defined this situation as a “small for flow syndrome".

Conclusion : Low and High FGW seem to be independent determinants of post-transplant delayed function and an effort should be done to maintain FGW between 100 and 300ml / min / 100mg graft weight.