Hepatic microvascular changes in rat abdominal compartment syndrome

Monitoring intra‐abdominal pressure after liver transplantation in children

“…A direct effect of elevated IAP on graft viability cannot be excluded, given that microvascular perfusion was not tested in this study. 11 In response to patch reduction, patients with TAC in our study had significantly reduced portal venous inflow in association with a slight increase in IAP (Table 3). Our observations of significantly increased hepatic artery flow velocities during IAH episodes, compared to periods with normal IAP, suggest that high IAP may impact graft perfusion, even in a heterogeneous population of children.…”

“…In contrast to that adult series, we did not detect a significant effect of IAH on diuresis, fluid balance, or kidney function, perhaps due to the substantially higher percentage of patients with IAH in the adult study. A direct effect of elevated IAP on graft viability cannot be excluded, given that microvascular perfusion was not tested in this study . In response to patch reduction, patients with TAC in our study had significantly reduced portal venous inflow in association with a slight increase in IAP (Table ).…”

“…Avoiding elevated IAP is considered to be a critical element in the successful surgical management of pediatric liver transplant recipient care. Additionally, graft volume should be well‐matched to the recipient's abdomen size to prevent impairment of blood supply and graft dysfunction associated with abdominal compartment syndrome . Surgeons perform TAC with patch enlargement of the abdominal cavity when split adult‐liver grafts are too large to fit within the abdominal cavity of small patients without leading to pressurization of the organ .…”

“…A size mismatch between a small abdominal cavity and a relatively large split organ in small children can lead to traction and insufficient compliance of the abdominal wall, a circumstance that has the potential to produce high IAP. Impaired arterial and portal blood flow due to an elevated IAP can lead to graft dysfunction . Therefore, a TAC with a patch is often used to enlarge the abdominal cavity in small children receiving a liver transplant .…”

“…Impaired arterial and portal blood flow due to an elevated IAP can lead to graft dysfunction. [6][7][8][9][10][11] Therefore, a TAC with a patch is often used to enlarge the abdominal cavity in small children receiving a liver transplant. [3][4][5] Vascular flow assessment with Doppler US is the goldstandard method for monitoring graft perfusion though it does not detect IAP directly.…”