Satoshi Ogiso1, Masanori Nakamura2, Takashi Tanaka2, Kenji Komiya3, Hideya Kamei1, Yasuharu Onishi1, Kanta Jobara1, Nobuhiko Kurata1, Keiichi Itatani4, Yasuhiro Ogura5. 1. Division of Transplant Surgery, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8550, Japan. 2. Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Aichi, 466-8555, Japan. 3. Department of Modern Mechanical Engineering, Waseda University, Shinjuku City, Tokyo, 169-8050, Japan. 4. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 5. Division of Transplant Surgery, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8550, Japan. oguchan@med.nagoya-u.ac.jp.
Abstract
BACKGROUND: Portal vein stenosis develops in 3.4-14% of split liver transplantation1-3 and its early detection and treatment are essential to achieve long-term graft survival,2-5 although the diagnostic capability of conventional modalities such as Doppler ultrasound and computed tomography is limited.1,4,5 METHODS: This study used computational fluid dynamics to analyze portal vein hemodynamics in the management of post-transplant portal vein stenosis. To perform computational fluid dynamics analyses, three-dimensional portal vein model was created using computed tomographic DICOM data. The inlet flow condition was set according the flow velocity measured on Doppler ultrasonography. Finally, portal vein flow was simulated on a fluid analysis software (Software Cradle, Japan). RESULTS: An 18-month-old girl underwent liver transplantation using a left lateral graft for biliary atresia. At the post-transplant 1-week evaluation, the computational fluid dynamics streamline analysis visualized vortices and an accelerated flow with a velocity ratio < 2 around the anastomotic site. The wall shear stress analysis revealed a high wall shear stress area within the post-anastomotic portal vein. At the post-transplant 6-month evaluation, the streamline analysis illustrated the increased vortices and worsening flow acceleration to reach the proposed diagnostic criteria (velocity ratio > 3:1).3,5 The pressure analysis revealed a positive pressure gradient of 3.8 mmHg across the stenotic site. Based on the findings, the patient underwent percutaneous transhepatic portal venoplasty with balloon dilation. The post-treatment analyses confirmed the improvement of a jet flow, vortices, a high wall shear stress, and a pressure gradient. DISCUSSION: The computational fluid dynamics analyses are useful for prediction, early detection, and follow-up of post-transplant portal vein stenosis and would be a promising technology in post-transplant management.
BACKGROUND: Portal vein stenosis develops in 3.4-14% of split liver transplantation1-3 and its early detection and treatment are essential to achieve long-term graft survival,2-5 although the diagnostic capability of conventional modalities such as Doppler ultrasound and computed tomography is limited.1,4,5 METHODS: This study used computational fluid dynamics to analyze portal vein hemodynamics in the management of post-transplant portal vein stenosis. To perform computational fluid dynamics analyses, three-dimensional portal vein model was created using computed tomographic DICOM data. The inlet flow condition was set according the flow velocity measured on Doppler ultrasonography. Finally, portal vein flow was simulated on a fluid analysis software (Software Cradle, Japan). RESULTS: An 18-month-old girl underwent liver transplantation using a left lateral graft for biliary atresia. At the post-transplant 1-week evaluation, the computational fluid dynamics streamline analysis visualized vortices and an accelerated flow with a velocity ratio < 2 around the anastomotic site. The wall shear stress analysis revealed a high wall shear stress area within the post-anastomotic portal vein. At the post-transplant 6-month evaluation, the streamline analysis illustrated the increased vortices and worsening flow acceleration to reach the proposed diagnostic criteria (velocity ratio > 3:1).3,5 The pressure analysis revealed a positive pressure gradient of 3.8 mmHg across the stenotic site. Based on the findings, the patient underwent percutaneous transhepatic portal venoplasty with balloon dilation. The post-treatment analyses confirmed the improvement of a jet flow, vortices, a high wall shear stress, and a pressure gradient. DISCUSSION: The computational fluid dynamics analyses are useful for prediction, early detection, and follow-up of post-transplant portal vein stenosis and would be a promising technology in post-transplant management.
Authors: Joseph F Buell; Brian Funaki; David C Cronin; Atsushi Yoshida; Meryl K Perlman; Jonathan Lorenz; Sue Kelly; Lynda Brady; Jeffrey A Leef; J Michael Millis Journal: Ann Surg Date: 2002-11 Impact factor: 12.969
Authors: T L Huang; Y F Cheng; T Y Chen; L L Tsang; H Y Ou; C Y Yu; C C Wang; S H Wang; C L Lin; H K Cheung; H L Eng; B Jawan; A M Concejero; C L Chen Journal: Transplant Proc Date: 2010-04 Impact factor: 1.066
Authors: Preeti Kanikarla Marie; Natalie W Fowlkes; Vahid Afshar-Kharghan; Stephanie L Martch; Alexey Sorokin; John Paul Shen; Van K Morris; Arvind Dasari; Nancy You; Anil K Sood; Michael J Overman; Scott Kopetz; David George Menter Journal: Front Oncol Date: 2021-07-21 Impact factor: 6.244