TY - JOUR
T1 - How transplant surgeons can overcome the inevitable insufficiency of allograft size during adult living-donor liver transplantation
T2 - Strategy for donor safety with a smaller-size graft and excellent recipient results
AU - Hori, Tomohide
AU - Ogura, Yasuhiro
AU - Ogawa, Kohei
AU - Kaido, Toshimi
AU - Segawa, Hajime
AU - Okajima, Hideaki
AU - Kogure, Takayuki
AU - Uemoto, Shinji
PY - 2012/5
Y1 - 2012/5
N2 - 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.
AB - 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.
KW - Graft/recipient weight ratio
KW - Liver transplantation
KW - Portal hypertension
KW - Portal pressure
KW - Shear stress
KW - Small-for-size
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U2 - 10.1111/j.1399-0012.2012.01664.x
DO - 10.1111/j.1399-0012.2012.01664.x
M3 - Article
C2 - 22686957
AN - SCOPUS:84862256598
VL - 26
SP - E324-E334
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 3
ER -