Ultrasonography.  2016 Jan;35(1):78-82. 10.14366/usg.15012.

Portal venous perfusion steal causing graft dysfunction after orthotopic liver transplantation: serial imaging findings in a successfully treated patient

• Lee M
• Kim SK
• Chung YE
• Choi JY
• Park MS
• Lim JS
• Kim MJ
• Kim H

• KMID: 2382022
• DOI: http://doi.org/10.14366/usg.15012

Abstract

A 53-year-old male with hepatocellular carcinoma underwent orthotopic liver transplantation. Preoperative computed tomography revealed main portal vein luminal narrowing by flat thrombi and the development of cavernous transformation. On post-transplantation day 1, thrombotic portal venous occlusion occurred, and emergency thrombectomy was performed. Subsequent Doppler ultrasonography and contrast-enhanced ultrasonography confirmed the restoration of normal portal venous flow. The next day, however, decreased portal venous velocity was observed via Doppler ultrasonography, and serum liver enzymes and bilirubin levels remained persistently elevated. Direct portography identified massive perfusion steal through prominent splenorenal collateral veins. Stent insertion and balloon angioplasty of the portal vein were performed, and subsequent Doppler ultrasonography demonstrated normalized portal flow parameters. Afterwards, the serum liver enzymes and bilirubin levels rapidly normalized.

Keyword

Liver transplantation; Portosystemic shunt, surgical; Ultrasonography, Doppler; Perfusion

MeSH Terms

Angioplasty, Balloon
Bilirubin
Carcinoma, Hepatocellular
Emergencies
Humans
Liver Transplantation*
Liver*
Male
Middle Aged
Perfusion*
Phenobarbital
Portal Vein
Portasystemic Shunt, Surgical
Portography
Stents
Thrombectomy
Transplants*
Ultrasonography
Ultrasonography, Doppler
Veins
Bilirubin
Phenobarbital