Hepatofugal portal flow associated with acute rejection in living-donor auxiliary partial orthotopic liver transplantation: A report of one case and literature review

Abstract

We report a case of reversible hepatofugal portal flow after auxiliary partial orthotopic liver transplantation (APOLT) from a living donor in this study. On postoperative day 6, continuous hepatofugal portal flow was observed in the grafted liver without portal thrombosis and obstruction of the hepatic vein. Based on histological findings, acute rejection was the suspected cause. The normal portal venous flow was restored after steroid pulse and antithymocyte globulin (ATG) therapies. The patient was discharged on the 30th postoperative day. It was concluded that hepatofugal flow after liver transplantation is a sign of serious acute rejection, and can be successfully treated by anti-rejection therapy.

Keywords

hepatofugal flow / auxiliary partial orthotopic liver transplantation / living-donor liver transplantation / acute rejection

References

[1] IkegamiT., KawasakiS., OhnoY., et al.. Temporary auxiliary liver transplantation from a living donor to an adult recipient with familial amyloid polyneuropathy. Transplantation, 2002, 73(4): 628-630

[2] ParkY.K., KimB.W., WangH.J., et al.. Auxiliary partial orthotopic living donor liver transplantation in a patient with Wilson’s disease: a case report. Transplant Proc, 2008, 40(10): 3808-3809

[3] SomedaH., MoriyasuF., FujimotoM., et al.. Vascular complications in living related liver transplantation detected with intraoperative and postoperative Doppler US. J Hepatol, 1995, 22(6): 623-632

[4] SugimotoH., KanekoT., MaruiY., et al.. Reversal of portal flow after acute rejection in living-donor liver transplantation. J Hepatobiliary Pancreat Surg, 2001, 8(6): 573-576

[5] KyodenY., SugawaraY., MatsuiY., et al.. Hepatofugal portal flow due to acute cellular rejection. Abdom Imaging, 2005, 30(3): 303-305

[6] KasaharaM., TakadaY., EgawaH., et al.. Auxiliary partial orthotopic living donor liver transplantation: Kyoto University experience. Am J Transplant, 2005, 5(3): 558-565

[7] YabeS., EgawaH., InomataY., et al.. Auxiliary partial orthotopic liver transplantation from living donors: significance of portal blood flow. Transplantation, 1998, 66(4): 484-488

[8] KasaharaM., TakadaY., KozakiK., et al.. Functional portal flow competition after auxiliary partial orthotopic living donor liver transplantation in noncirrhotic metabolic liver disease. J Pediatr Surg, 2004, 39(7): 1138-1141

[9] JonesV.S., McCallJ.L., ThomasG., et al.. Reverse portal flow after liver transplantation-ominous or acceptable?. Pediatr Transplant, 2010, 14(4): E34-E37