Hepatofugal portal flow after living donor liver transplantation

Background/Aims: Reversed portal flow following liver transplantation is life-threatening complication. There are few reports, however, regarding reversed portal flow after liver transplantation. Methodology: We performed 180 living donor liver transplantations (LDLTs) over 8 years. Portal vein flow was routinely measured postoperatively two or three times a day during the first 2 weeks after LDLT. Surgical correction of reversed portal flow was attempted as soon as possible. Results: Five patients (2%) were complicated by postoperative hepatofugal portal flow. The reversed portal flow was corrected surgically in all the patients by splenectomy and/or ligation of the residual collateral veins. The revision operation was repeated in two patients. In three patients, the shunts responsible for hepatofugal flow were not detected in preoperative imaging, which must be approached under the guidance of intraoperative ultrasound or radiologic examination. All five patients survived the operation. Conclusions: Hepatofugal flow causes ischemic damage to the graft, which will not normalize spontaneously. Prompt treatment of the reversed portal flow salvaged the graft.