Illustration of transplant surgery procedure

Transplant Surgery Resource Hub

Resources illustrating how MiraQ is used in transplant surgery to get enhanced surgical insight.


Transplantation surgery today, while advanced, relies on separate tools for visualizing anatomy and measuring blood flow, leaving room for uncertainty. Imagine an instrument that integrates Transit Time Flow Measurement (TTFM) with high-frequency imaging, transforming transplant surgeries with precision and real-time insights, guiding you to perform surgery with best possible patient outcomes.

The MiraQ is the only device combining Transit Time Flow Measurement (TTFM) and high-resolution imaging. It empowers transplantation surgeons with precision and real-time insights, elevating patient outcomes in one innovative solution. Perform imaging, measure blood flow and receive immediate feedback on how well a graft is functioning.

Quality assessment with blood flow measurement and high-frequency imaging during transplant surgery protects the patient from graft failure and minimizes the risk for reinterventions. Graft patency is the predominant predictor of long-term survival after transplantation surgery.

“From our experience with intraoperative measurement of absolute flow in the graft vessels, we believe that the causes of technically imperfect perfusion of the graft can be identified and instantly corrected so that primary graft dysfunction or graft infarction can be avoided.”

Rasmussen et al. (1997)
"Intraoperative measurement of graft blood flow - a necessity in liver transplantation"

Liver Transplant Surgery

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. 

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 Hyperperfusion

• 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)

  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).
Registry for Quality Assessment with Ultrasound Imaging and TTFM in Cardiac Surgery

Renal Transplant Surgery

Transit time flow measurement can be successfully used to evaluate renal transplant anastomoses. Accurate intraoperative measurements provide a rapid and objective assessment of renal graft patency.

EAU Guidelines on Renal Transplantation

Arterial thrombosis 

Transplant renal artery thrombosis is a rare complication (prevalence 0.5-3.5%). Usually, it is a consequence of a technical error during the anastomosis. 

Venous thrombosis 

Transplant renal vein thrombosis is an early complication (prevalence 0.5-4%) and one of the most important causes of graft loss during the first postoperative month. The aetiology includes technical errors and/or difficulties during surgery and the hypercoagulative state of the recipient.

Transplant renal artery stenosis 

The incidence of transplant renal artery stenosis is 1-25%. Risk factors include small caliber and atherosclerosis of the donor artery, trauma to the donor artery at procurement, absence of an arterial patch, suturing technique (interrupted vs. continuous), and damage to the iliac artery during transplantation. It is more common at the site of the anastomosis.

Breda A, K. Budde K, Figueiredo KA, Lledó García E, Olsburgh J, Regele H. European Association of Urology 2021

Illustration of transplant surgery procedure

Case Studies

Enhance your surgical techniques and knowledge with Case Studies, showcasing real-world applications of MiraQ for improved patient outcomes and surgical efficiency.


Enhance your surgical techniques and knowledge with webinars from leading surgeons presenting their experience with the Medistim technology.​


Dive into publications implementing the Medistim technology to document improved patient outcomes and surgical efficiency.


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