Journal of Hepatology and Gastrointestinal disorders
Open Access

Abstract

Importance of Hepatic Flows in Liver Transplantation

Kim PTW and Klintmalm GB

Establishing appropriate dual blood supply in liver transplant is important to ensure optimal graft survival and post-operative outcomes. The hemodynamic changes in cirrhotic patients render the patients with hyperdynamic circulation and this environment raises the portal venous flow through the graft immediately after transplant. In deceased donor liver transplantation, lower hepatic flows are associated with detrimental outcomes. Lower measured hepatic artery flow has been associated with lower graft survival and higher rate of arterial complications. Lower portal venous flow of less than 1-1.3 L/min has been associated with lower graft survival. Lower hepatic artery flow is associated with increased rate of biliary complications after deceased donor transplantation. In live donor liver transplantation, portal hyperperfusion is implicated in small for size syndrome. Maneuvers to decrease portal venous flow such as splenic artery ligation, splenectomy or portacaval shunt have been associated with improved outcomes after live donor liver transplantation. It appears that relationship between higher portal flows and poor outcomes is not yet firmly established in that the live donor liver graft may tolerate higher PV flows when the outflow of the graft is well established and if the higher PV flow is not accompanied by portal hypertension. The importance of blood flow in liver transplantation is undeniable. Further studies are required to establish the relationship between the portal and hepatic arterial flows to biliary and arterial complications after liver transplantation.