WOFAPS 2025 8th World Congress of Pediatric Surgery

Alejandro Madurga, Maria Victoria Lopez-Canelada, César Oterino, Alba Sanchez Galan, Javier Serradilla, Francisco Hernandez-Oliveros, Ane Andres

Hospital Universitario La Paz

Introduction: Vascular complications are more common in pediatric liver transplantation (PLT). We present our pilot experience with flow measurements (FM) in pediatric recipients and compare the results with adult standards.

Methods: We analyzed recent FM data (2023-2025) in PLT. We compared these values with those established for adults and examined their association with intraoperative ultrasound (US), recipient data, transplant characteristics, and vascular complications. We measured the maximum portal velocity (Vmax), peak systolic velocity (PSV), arterial resistance index (ARI), pre/post-anastomosis portal flow, and post-anastomosis arterial flow.

Results: We collected FM and US data from 41 PLT recipients. The median age was 66.6 months (range: 1.4-171), transplant weight was 20 kg (4.4-62), and the average graft weight was 480g (mean GWGR 3.4%). Graft types included 5 whole grafts, 11 reduced, 14 split, and 6 living donor grafts. Mean portal flow pre/post-anastomosis and arterial flow were lower than the adult standard (54.3/88.5 ml/min/100g vs. 100-250 ml/min/100g) and (50 vs. 100 ml/min), respectively. We found 3 arterial complications and 1 portal stenosis, all of which were resolved through surgery/interventional radiology. No differences were observed based on graft type or size. The US values of Vmax, PSV, and average ARI were 52.2 cm/s, 63.5 cm/s, and 0.6, respectively (no association with FM). In 9 cases, the splenic artery was ligated.

Conclusion: FM in PLT is a useful and simple tool, complementary to US. Acceptable values are lower than those described for adults, and multicenter studies are needed to validate these findings