How transplant surgeons can overcome the inevitable insufficiency of allograft size during adult living-donor liver transplantation: Strategy for donor safety with a smaller-size graft and excellent recipient results

Tomohide Hori, Yasuhiro Ogura, Kohei Ogawa, Toshimi Kaido, Hajime Segawa, Hideaki Okajima, Takayuki Kogure, Shinji Uemoto

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)

Abstract

Small-for-size grafts are an issue in liver transplantation. Portal venous pressure (PVP) was monitored and intentionally controlled during living-donor liver transplantation (LDLT) in 155 adult recipients. The indocyanine green elimination rate (kICG) was simultaneously measured in 16 recipients and divided by the graft weight (g) to reflect portal venous flow (PVF). The target PVP was <20 mmHg. Patients were divided by the final PVP (mmHg): Group A, PVP < 12; Group B, 12 ≤ PVP < 15; Group C, 15 ≤ PVP < 20; and Group D, PVP ≥ 20. With intentional PVP control, we performed splenectomy and collateral ligation in 80 cases, splenectomy in 39 cases, and splenectomy, collateral ligation, and additional creation in five cases. Thirty-one cases received no modulation. Groups A and B showed good LDLT results, while Groups C and D did not. Final PVP was the most important factor for the LDLT results, and the PVP cutoffs for good outcomes and clinical courses were both 15.5 mmHg. The respective kICG/graft weight cutoffs were 3.5580 × 10-4/g and 4.0015 × 10-4/g. Intentional PVP modulation at <15 mmHg is a sure surgical strategy for small-for-size grafts, to establish greater donor safety with good LDLT results. The kICG/graft weight value may have potential as a parameter for optimal PVF and a predictor for LDLT results.

Original languageEnglish
Pages (from-to)E324-E334
JournalClinical Transplantation
Volume26
Issue number3
DOIs
Publication statusPublished - 2012 May

Keywords

  • Graft/recipient weight ratio
  • Liver transplantation
  • Portal hypertension
  • Portal pressure
  • Shear stress
  • Small-for-size

ASJC Scopus subject areas

  • Transplantation

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