Lack of a correlation between portal vein flow and pressure: Toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation

Sainz-Barriga, Mauricio; Scudeller, Luigia; Costa, M. G.; Hemptinne, Bernard de; Troisi, Roberto

doi:10.1002/lt.22295

Cited by 82 publications

(81 citation statements)

References 48 publications

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“…In such cases, even grafts with a GRWR <0.6 can be transplanted successfully (11,13,14). In case of portal hypertension, different surgical techniques are available to reduce or eliminate the rate of postoperative complications related to the small-forsize syndrome (SFSS) (12,16). The signs of SFSS observed in our patients with hyperbilirubinemia could obviously be related to a small graft volume.…”

Section: Discussionmentioning

confidence: 85%

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Pure Laparoscopic Full-Left Living Donor Hepatectomy for Calculated Small-for-Size LDLT in Adults: Proof of Concept

Troisi

Wójcicki

Tomassini

et al. 2013

American Journal of Transplantation

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Adult-to-adult living donor liver transplantation (A2ALDLT) is an accepted mode of treatment for endstage liver disease. Right-lobe grafts have usually been preferred in view of the higher graft volume, which lowers the risk of a small-for-size syndrome. However, donor left hepatectomy is associated with less morbidity than when it is compared to right hepatectomy. Laparoscopic donor hepatectomy (LDH) has been considered almost exclusively in pediatric transplantation. The results of laparoscopic left-liver graft procurement for calculated small-for-size A2ALDLT in four donors are presented. The graft-to-recipient body weight ratio was <0.8 in all recipients. The mean portal vein flow and the pressure and hepatic artery flows were measured at 190 AE 56 mL/min/100 g, 13 AE 1.4 mm/Hg and 109 AE 19 mL/min, respectively. No early postoperative donor complications were recorded. One graft was lost due to intrahepatic abscesses. Asymptomatic stenosis of a right posterior duct was treated with a Roux-en-Y loop 4 months later in one donor. We show that LDH of the full-left lobe is feasible. LDH is a very demanding operation, potentially decreasing donor morbidity. Standardization of this procedure, making it accessible to the growing number of experienced laparoscopic liver surgeons, could help renewing the interest for A2ALDLT in the Western world.

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Section: Discussionmentioning

confidence: 85%

“…This means that a real GRWR of <0.8 should be anticipated. We know that important parameters other than graft volume can potentially influence the outcome (12,14). In such cases, even grafts with a GRWR <0.6 can be transplanted successfully (11,13,14).…”

Section: Discussionmentioning

confidence: 99%

Pure Laparoscopic Full-Left Living Donor Hepatectomy for Calculated Small-for-Size LDLT in Adults: Proof of Concept

Troisi

Wójcicki

Tomassini

et al. 2013

American Journal of Transplantation

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“…The latter, however, does not allow for continuous monitoring, and portal pressure can vary with central venous pressure, which in turn can vary with the positions of the patient and the catheter tip. 11 Sainz-Barriga and associates 12 found no correlation between postreperfusion portal pressure and portal flow. They suggested the need for portal flow modulation does not require elevation of both.…”

Section: Discussionmentioning

confidence: 96%

Untitled

2014

Exp Clin Transplant

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“…12 In living-donor liver transplant, high morbidity in the donor of a right lobe graft has been reported, but successful living-donor liver transplant with a small-for-size graft may be anticipated with technical modifications such as the portal pressure modulation. 13 In addition, increased use of deceaseddonor liver transplant may minimize the need for living donors, especially for adolescent recipients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Graft Size Matching on Pediatric Living-donor Liver Transplantation in Japan

Kasahara¹,

Sakamoto²,

Umeshita³

et al. 2014

Exp Clin Transplant

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Objectives: The Japanese Liver Transplantation Society is a cooperative research consortium, established in 1980 to characterize and follow trends in patient and graft survival in all liver transplants in Japan. This study evaluated the effect of graft size matching on survival in pediatric recipients of livingdonor liver transplant. Materials and Methods: Between November 1989 and December 2010, there were 2224 patients aged < 18 years who received living-donor liver transplant in Japan. Survival was evaluated according to graft size matching. Results: There were 998 male and 1226 female donors (median age, 35.2 y). There was no donor mortality associated with surgery. The median age of recipients was 4.0 years (range, 13 d to 17.9 y) and body weight was 16.6 kg (range, 2.6 to 90 kg). The survival of living-donor liver transplant recipients was greater for pediatric than adult recipients at 1 year (adult, 81%; pediatric, 88%), 5 years (adult, 72%; pediatric, 85%), 10 years (adult, 66%; pediatric, 83%), and 15 years (adult, 57%; pediatric, 80%) after transplant (difference between adult and pediatric recipients: P ≤ .0001). In the 2224 recipients aged < 18 years, the graft types included left lateral segment in 1549 recipients (70%), left lobe in 500 recipients (23%), reduced left lateral segment in 96 recipients (4%), right lobe in 76 recipients (3%), and posterior segment in 3 recipients (0.1%). There was no significant difference in survival between recipients that had different graft types. However, recipients aged < 1 year (296 recipients) who received grafts with graft-to-recipient body weight ratio > 4.0% had significantly worse patient survival because of problems associated with large-for-size grafts. Conclusions: Living-donor liver transplant had greater survival in children than adult recipients. Graft-to-recipient body weight ratio was a significant prognostic factor in recipients aged < 1 year.

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Lack of a correlation between portal vein flow and pressure: Toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation

Cited by 82 publications

References 48 publications

Pure Laparoscopic Full-Left Living Donor Hepatectomy for Calculated Small-for-Size LDLT in Adults: Proof of Concept

Pure Laparoscopic Full-Left Living Donor Hepatectomy for Calculated Small-for-Size LDLT in Adults: Proof of Concept

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Effect of Graft Size Matching on Pediatric Living-donor Liver Transplantation in Japan

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