Horizons in TransplantationLiver transplantationExploring Portal Vein Hemodynamic Velocities as a Promising, Attractive Horizon for Small-for-Size Syndrome Prediction After Living-Donor Liver Transplantation: An Egyptian Center Study

- SFSS can increase risk of mortality after LT.
- PVV has good sensitivity and specificity in SFSS prediction; PO PVV appears to be a significant hemodynamic factor that influences the functional status of the transplanted liver.
- Although portal velocity may appear to be less accurate than the calculated flow, it may be a less sophisticated method for SFSS prediction with acceptable sensitivity and specificity, and it could be used as an adjunctive to other parameters such as portal pressure to increase the precision of SFSS prediction.
- In the presence of high IO PVV, surgeons may adopt additional maneuvers to adjust marked portal over-perfusion by graft inflow modifications such as splenectomy.

BackgroundLiver transplantation is the only definite treatment for patients with irreversible liver failure. This explored the impact of portal vein hemodynamic velocities on graft functions to determine the mean portal vein velocities that may increase small-for-size syndrome (SFSS) risk.MethodsThe study was conducted with 123 cirrhotic patients who underwent living-donor liver transplantation (LDLT) at Kasr Alainy Hospital, Cairo, Egypt. Patients were submitted to full history, examination, pre-transplantation labs, and imaging. Intra-operative Doppler studies were performed after graft reperfusion. Post-operative (PO) Doppler was performed once a day over the first 2 weeks. Complete graft functions were obtained daily for patients.ResultsPVV (portal vein velocities) declined gradually but significantly after LT (intra-operative), and PO PVV were significantly higher in the SFSS group. The best cut-off values for prediction of SFSS with the use of intra-operative (before, during, and after) post-anastomotic PVV were 55.5, 106, and 126.5 cm/s, respectively, and, for PO before and after anastomotic PVV, 48.6 and 71.1 cm/s, respectively. There was a significant positive correlation between PO mean PVV and mean alanine transferase, total bilirubin, and international normalized ratio.ConclusionsPVV is a significant hemodynamic factor that influences graft functions. SFSS, which has a negative impact after LDLT, could be predicted by cut-off values for PVV, and therefore preventive measures such as splenectomy may be considered for its prevention.