Liver Graft-to-Recipient Spleen Size Ratio as a Novel Predictor of Portal Hyperperfusion Syndrome in Living Donor Liver Transplantation

Abstract

Portal hyperperfusion in a small-size liver graft is one cause of posttransplant graft dysfunction. We retrospectively analyzed the potential risk factors predicting the development of portal hyperperfusion in 43 adult living donor liver transplantation recipients. The following were evaluated: age, body weight, native liver disease, spleen size, graft size, graft-to-recipient weight ratio (GRWR), total portal flow, recipient portal venous flow per 100 g graft weight (RPVF), graft-torecipient spleen size ratio (GRSSR) and portosystemic shunting. Spleen size was directly proportional to the total portal flow (p = 0.001) and RPVF (p = 0.014). Graft hyperperfusion (RPVF flow >250 mL/min/ 100 g graft) was seen in eight recipients. If the GRSSR was <0.6, 5 of 11 cases were found to have graft hyperperfusion (p = 0.017). The presence of portosystemic shunting was significant in decreasing excessive RPVF (p = 0.059). A decrease in portal flow in the hyperperfused grafts was achieved by intraoperative splenic artery ligation or splenectomy. Spleen size is a major factor contributing to portal flow after transplant. The GRSSR is associated with posttransplant graft hyperperfusion at a ratio of <0.6.

A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation

“…Platelet count, which is generally affected by spleen size, had a negative correlation with spleen volume, but it had no correlation to PVP after reperfusion. Cheng et al 10 previously reported that the spleen volume was significantly associated with excessive portal venous flow and that a graft-to-recipient spleen size ratio of less than 0.6 might predict the development of posttransplant portal hyperperfusion. In their study, however, the definition of posttransplant portal hyperperfusion was more than 260 mL/min per 100 g graft liver weight measured by Doppler ultrasonography, which was associated with posttransplant hyperbilirubinemia and longer hospital stays, but was not a factor in patient survival.…”

“…These findings indicate that not only graft size but also hemodynamic status, especially spleen volume, should be considered in evaluating PVP after reperfusion. Recently, Cheng et al 10 revealed that the spleen volume was significantly associated with excessive portal venous flow measured by intraoperative Doppler ultrasonography just after reperfusion, emphasizing the graft-to-recipient spleen size ratio as a novel predictor of portal hyperperfusion syndrome in ALDLT.…”

Measurement of Donor Kidney Functional Renal Volume and Glomerular Filtration Rate to Predict Allograft Function during the Post-Transplantation Period

“…Moreover, as in the normal population and for donors with uninephrectomy, the concept of size matching can be applied to organ transplantation, such as renal allografts or liver transplants. Small-graft-for-large-size recipients may encounter some clinical problems and various degrees of graft dysfunction, and such recipients have been associated with poor renal graft and hepatic allograft survival [1, 10]. In this study, graft failure related to small-graft-for-large-size recipients did not develop during this study period.…”

Split-Liver Full-Left Full-Right: Proposal for an Operative Protocol

“…The recipients must satisfy the following criteria: the preoperatively calculated graft-to-recipient weight ratio should be 1% (the Urata formula [9] should be used to assess the graft weight); the preoperatively calculated graftto-recipient spleen size ratio should be 0.6 (according to the study by Cheng et al [10]). Recipient exclusion criteria are: United Network for Organ Sharing status 1 and 2A and previous transjugular intrahepatic portosystemic shunts.…”