Surgery 1990 Apr;107(4):417-27

Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: interest for early complications and nutrition

Payen DM, Fratacci MD, Dupuy P, Gatecel C, Vigouroux C, Ozier Y, Houssin D,
Chapuis Y
Department of Anesthesiology and Intensive Care, Lariboisiere University
Hospital, Paris, France 
Abstract
Hepatic artery thrombosis and early acute rejection are severe complications of
orthotopic liver transplantation (OLT). Their rapid detection is most desirable.
The purpose of this study was to assess the usefulness of monitoring hepatic
artery (HABF) and portal vein (PVBF) blood flows during the first week after
OLT. At the end of operation, microprobes were sutured to the vessels, and their
connecting tubes were externalized and connected to a pulsed Doppler flowmeter
operating at 8 MHz. In 10 patients (ages ranged from 2 to 54 years) of 106,
measurements of HABF and PVBF were done during alternative clamping of both
vessels and before and after abdominal closure, every 12 hours during 7 days,
and at day 7, before and after a 150 gm carbohydrate meal. At day 7 the probes
were pulled out by gentle traction without complication, and all patients were
allowed to go home. Reciprocal increase of flow during selective clamping was
only observed for HABF (+45.8% +/- 47.6%; p less than 0.01). Abdominal closure
decreased both HABF and PVBF by 13.8%, p less than 0.01, and 26%, p less than
0.05, respectively. In seven cases no significant variation of HABF and PVBF was
observed during 7 days. In two patients with histologically confirmed early
acute rejection, a marked decrease of diastolic HABF, without modification in
PVBF, was the first manifestation and was rapidly corrected by boluses of
steroids. In one patient disappearance of systolic and diastolic HABF led us to
diagnose an arterial obliteration caused by a plicature, which was successfully
surgically treated in the emergency department. In all patients, after oral
ingestion of the carbohydrate meal, and only after this type of diet, a
significant and deep decrease (-87%, p less than 0.001) of HABF was observed
between 7 and 120 minutes without any change in PVBF. Such an effect was not
observed in control patients. We conclude that this Doppler flowmetric technique
with implantable microprobes is useful for rapid diagnosis of and strategy in
treating early complications and is a new tool for pathophysiologic study of OLT
consequences