Evaluation of Hepatic Vasculature by Transesophageal Echocardiography (TEE) in Patients Undergoing Living Donor Liver Transplantation: A Prospective Observational Study

Liver Transplantation is a major surgery associated with severe haemodynamic changes.   Transesophageal Echocardiography (TEE) helps in real-time evaluation of hemodynamics of the patient and can play a vital role in management of such patients. As of now, TEE has primarily been used for evaluation of cardiac structures and hemodynamics in patients undergoing liver transplantation. However, with the advancement of technology, the role of TEE has expanded beyond the cardiac evaluation of the patients. There are also some reports about the utility of TEE for portal vein and hepatic vein evaluation in patients undergoing liver transplantation.   Immediate evaluation of portal vein and hepatic vein after graft reperfusion is of utmost importance for the early detection and correction of vascular complications. Currently, an in-field intraoperative doppler sonography of the hepatic vasculature is a standard practice. But this practice has some limitations, like the requirement of a radiologist present in the OR, and interference with the surgical field and a possible breach in sterility. On the other hand, TEE can provide an immediate, quick and repeated assessment of hepatic vasculature without risking any breach in field sterility.   As per our literature search, assessment of hepatic vasculature after graft reperfusion using TEE is limited. Hence, this study aims to evaluate portal vein, hepatic vein and hepatic artery using TEE during liver transplantation.