Transplant Surgery Resource Hub

Combine flow and pressure measurements with intraoperative ultrasound to ensure adequate hemodynamics and patent anastomoses during liver transplantation. 

Adequate graft perfusion is essential for successful liver transplantations. Intraoperative Transit Time Flow Measurement (TTFM) with Medistim’s MiraQ™ systems provides surgical guidance to assess anastomosis quality, allowing the surgeon to adjust any imbalance in the hepatic portal and arterial flow and pressure. In addition, the MiraQ systems can be equipped with High-frequency Ultrasound (HFUS) that is useful in assessing anastomotic morphology and detecting thromboses. 

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Avoid graft dysfunction by using TTFM, HFUS & pressure measurements to¹¹: 

• Detect technical anastomotic imperfections such as intimal flaps or misplaced stitches³

• Detect Hepatic Artery Thrombosis (HAT) and/or stenosis (HAS)^{9, 10}

• Assess Hepatic Artery Buffer Response (HABR) and reduce the risk of Portal Hyperperfusion⁷ 

• Prevent and guide treatment of SFSS (Small for Size Syndrome) ^{1, 4, 5}

• Quantify hemodynamic imbalances and tailor graft inflow modulation (GIM): ^{2, 4, 5, 6}

 – Management of Spontaneous Porto-Systemic Shunts (SPSS) 

 – Splenic Artery Ligation (SAL)/Splenectomy (SPL) 

 – Hemi-Portacaval Shunt (HPCS)

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References

1. Clinical Relevance of Adapting Portal Vein Flow in Living Donor Liver Transplantation in Adult Patients. Troisi RI & de Hemptinne B. Liver Transplantation, Vol 9, No 9, Suppl 1, 2003: pp S36-S41.
2. Prospective evaluation of intraoperative hemodynamics in liver transplantation with whole, partial and DCD grafts. Sainz-Barriga M, Reyntjens K,Costa MG, Scudeller L,Rogiers X, Wouters P, de Hemptinne B,Troisi RI. American Journal of Transplantation 2010; 10: 1850–1860. 
3. Arterial Blood Flow Predicts Graft Survival in Liver Transplant Patients. Pratschke S, Meimarakis G, Mayr S, Graeb C, Rentsch M, Zachoval R, Bruns CJ, Kleespies A, Jauch K-W, Loehe F, Angele MK. Liver Transpl17:436-445, 2011. 
4. The International Liver Transplantation Society (ILTS) Living Donor Liver Transplant Recipient Guideline. Miller CM, Quintini C, Dhawan A, Durand F, Heimbach JK, Kim Schl uger HL, Kyrana E, Lee S-G, Lerut J, Lo C-M, Pomfret EA. Transplantation 2017;101: 938–944. 
5. Modulation of portal graft inflow: A necessity in adult living donor liver transplantation. Troisi RI, Cammu G, Militerno G, De Baerdemaeker L, Decruyenaere J, Hoste E, Smeets P, Colle I, Van Vlierberghe H, Petrovic M, Voet D, Mortier E, Hesse UJ, de Hemptinne B. Ann Surg 2003, 237(3):429-436. 
6. Effects of hemi-portocaval shunts for inflow modulation on the outcome of small for-size grafts in living donor liver transplantation. Troisi RI, Ricciardi S, Colle I, Van Vlierberge H, Smeets P, Petrovic M, de Hemptinne B. Am J Transpl 2005, 5: 1397-1404. 
7. Lack of a correlation between portal vein flow and pressure: Toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation. Sainz-Barriga M, Scudeller L, Costa MG, de Hemptinne B, Troisi RI. Liver Transplantation 17:836–848, 2011. 
8. Liver Transplantation at Cleveland Clinic. Hashimoto K, Aucejo F, Quintini C, El-Gazzaz G, Hodgkinson P, Fujiki M, Diago T, Kelly D, Winans C, Vogt D, Eghtesad B, Fung J, Miller C. Clinical Transplants 2010, Kap. 18, 195-206. 
9. Probability, management, and long-term outcomes of biliary complications after hepatic artery thrombosis in liver transplant recipients. Fujiki M, Hashimoto K, Palaios E, Quintini C, Aucejo FN, Uso TD, Miller CM. Surgery 2017;162:1101-11. 
10. Too Much, Too Little, or Just Right? The Importance of Allograft Portal Flow in Deceased Donor Liver Transplantation. Matsushima H, Sasaki K, Fujiki M, Uso TD, Aucejo F, Kwon CHD, Eghtesad B, Miller C, Quintini C, Hashimoto K. Transplantation, April 2020, Volume 104, Number 4.
11. Medistim Guidebook-Transplantation (Version GBTXINen0.0.0 pg 5).