{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:40:51Z","timestamp":1787316051414,"version":"build-2736575974"},"reference-count":36,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The dual vascular inflow of liver grafts in liver transplantation (LT) is increasingly recognized as crucial to achieving adequate graft function in deceased donor LT (DDLT). Portal hyperperfusion is the most common, leading to decreased intrahepatic adenosine and arterial vasoconstriction via the hepatic artery buffer response. Splanchnic vasodilators, splenic artery embolization, or splenectomy are all recognized among other treatments. However, the management of portal hypoperfusion is less well described, with only isolated case reports describing the augmentation of portal venous (PV) inflow. This is the largest series describing PV arterialization as a strategy to save liver grafts by bolstering portal inflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients at a single transplant center (Cleveland Clinic Abu Dhabi, UAE) were included (2018\u20132024). Intra\u2010operative portal vein and hepatic artery flows are measured in all cases using a MediStim vascular flow device, and liver\u2010vascular ultrasounds are obtained routinely post\u2010transplant. Surgical PV arterialization is used as a short\u2010term measure when adequate portal vein flow cannot be achieved using conventional techniques. Cases were performed using end\u2010to\u2010side anastomosis of a cadaveric iliac artery graft from the recipient infra\u2010renal aorta (\n                      <jats:italic>n<\/jats:italic>\n                      = 3) to the recipient PV as an additional inflow in Y\u2010configuration or using a conduit from the donor splenic artery to the donor PV (end\u2010to\u2010side) with the standard PV\u2010anastomosis also functioning.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four patients were deemed to have inadequate portal flow in the early post\u2010LT (range POD1\u20107,\n                      <jats:italic>n<\/jats:italic>\n                      = 3) or intra\u2010operative (\n                      <jats:italic>n<\/jats:italic>\n                      = 1) periods. All patients had laboratory and\/or visual evidence of inadequate liver function secondary to portal hypoperfusion at the time of the decision to pursue arterialization. PV flows before arterialization were 500\u2013590\u00a0mL\/min [31\u201339\u00a0mL\/min\/100\u00a0g] and 1.4\u20132\u00a0L\/min [93\u2013133\u00a0mL\/min\/100\u00a0g] after arterialization. Arterialization grafts (\n                      <jats:italic>n<\/jats:italic>\n                      = 3) were ligated on post\u2010arterialization days 2\u20137. At the conclusion of modulation, PV flows were 1.1\u20102.3\u00a0L\/min [73\u2013147\u00a0mL\/min\/100\u00a0g] with maintained HA flows 120\u2013495\u00a0mL\/min, highlighting the relative adaptability of liver graft and PV compliance after augmentation.\n                    <\/jats:p>\n                    <jats:p>\n                      All four patients are symptom\u2010free with intact liver graft function at a range of 6\u201318 months post\u2010LT. Graft survival of 100% compares favorably to all\u2010comers after LT in the same setting (1\u2010year GS = 96%, log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      = 0.874).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Arterialization of the portal vein is a viable and graft\u2010saving strategy for PV hypoperfusion in LT. Surgeons may pursue this approach in the scenario of inadequate portal vein perfusion without other identifiable causes, such as PV thrombus or port\u2010systemic shunts, with a plan for arterial shunt reversal 1\u20137 days after placement based on flow assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70351","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T18:20:56Z","timestamp":1761070856000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Arterialization of the Portal Vein: A Potentially Graft\u2010Saving Strategy to Optimize Veno\u2010Arterial Inflow in Liver Transplantation"],"prefix":"10.1111","volume":"39","author":[{"given":"Teresa Diago","family":"Uso","sequence":"first","affiliation":[{"name":"Transplant Enterprise Cleveland Clinic Abu Dhabi  Abu Dhabi 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