Effect of Portal Venous Pressure on Liver Function of Donors in Living Donor Liver Transplantation

Abstract

Background We assessed the alterations in portal hemodynamics associated with donor right hepatectomy and its effects on functional regeneration of the remnant liver. Material/Methods This prospective study included 30 adult living donors who underwent right hepatectomy in the Liver Transplantation Unit, Faculty of Medicine, Cairo University from June 2015 to October 2016. During donor surgery, portal venous pressure (PVP) was measured using an antithrombotic catheter inserted into the main portal vein, and was measured before and after clamping of the right portal vein. Postoperatively, liver function tests were done daily until normalization. The outcome measures were the time to normalization of liver function tests and effect of residual volume and steatosis on PVP. Results All donors had normal PVP before clamping and changed significantly after clamping (p<0.001). After clamping, 25 donors (83%) had a PVP above 12 mmHg; i.e. had high portal pressure. The median percentage of change was 55%. There were obvious increases in liver enzymes and bilirubin after surgery, but albumin and international normalized ratio showed progressive decreases postoperatively. The percent change in PVP was positively correlated with the levels of liver enzymes, time to normalization of liver enzymes, albumin, and bilirubin, and with the degree of steatosis, bit it was negatively correlated with residual liver volume. Conclusions During living donor liver transplantation, PVP increases by over 50% after clamping of the right portal vein of the donor’s liver. This increase is associated with temporary delay of normalization of liver function of the donors.

C‐C motif chemokine ligand 5 confines liver regeneration by down‐regulating reparative macrophage‐derived hepatocyte growth factor in a forkhead box O 3a–dependent manner

“…[ 5 ] Unfortunately, morbidity and mortality rates are 10%–21% and 0.18%–0.50%, respectively, partly attributable to insufficient remnant functional liver volume. [ 6 , 7 , 8 ] Recovery of patients following a hepatectomy relies on the remarkable regenerative capacity of the liver, which is one of the few organs with this property. [ 9 ] Therefore, an improved understanding of the molecular and cellular mechanisms underlying liver regeneration (LR) after PHx is urgently required.…”

Splenic Artery Ligation: An Ontable Bail-Out Strategy for Small-for-Size Remnants after Major Hepatectomy: A Retrospective Study

“…The syndrome has been extensively evaluated in clinical and experimental studies to elucidate all the implicated causative factors that may be valuable in formulating an algorithmic profile of hemodynamic variables that could be modified accordingly, to ensure safe cut off values of PVP, PVF, and HAF at a given small-for-size liver graft or liver remnant after right liver donation or extended liver resection [ 5 , 8 , 11 , 17 , 18 , 19 , 20 ]. Therefore, the importance of the early evaluation of PVP after hepatectomy has emerged as an independent predictor of postoperative outcome and various strategies have been proposed aiming at modulating portal overflow, which appears to be the main contributor to the SFSS.…”

“…Modulations of Portal Venous Pressure (PVP) and Portal Venous Flow (PVF) are practical and effective measures to readjust the portal flow to the diminished microvascular milieu after extensive liver resections [ 5 , 8 , 11 , 17 , 18 , 19 , 20 ].…”

Comprehensive Approach to Assessment of Liver Viability During Normothermic Machine Perfusion

“…10 Furthermore, increased vascular resistance is associated with impaired liver function. 32,33 For example, severe macrosteatosis may result in sinusoidal stenosis and reduced perfusion. 34 Some studies have found that the perfusion blood flow was higher than the standard and remained stable, which does not indicate homogenous hepatic perfusion.…”