Optimal Portal Venous Circulation for Liver Graft Function after Living-Donor Liver Transplantation

Yagi, Shintaro; Iida, Takuya; Hori, Tomohide; Taniguchi, Koki; Yamamoto, Chiyo; Yamagiwa, Kentaro; Üemoto, Shinji

doi:10.1097/01.tp.0000198122.15235.a7

Cited by 99 publications

(90 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Detailed surgical procedures for intentional modulation of PVP have been described elsewhere [40,41] . Paradoxically, the acceptable minimum GRWR of < 0.7 is possible at graft selection [40] because intentional PVP modulation during LDLT will prevent small-for-size syndrome after LDLT [38][39][40][41][42] . Although intentional PVP control seems to overcome an GRWR of < 0.7, these grafts still cause critical problems when evaluated retrospectively [40] .…”

Section: Intentional Modulation Of Pvp During Ldltmentioning

confidence: 99%

“…ICG kinetics reflect the functional hepatocytes (cell volume) and effective PVF (clearance) [31,[49][50][51][52] , and PVF is a major determinant of kICG in the normal liver [32,34,49,51,53] . The PVF has a large influence on liver regeneration after LT [32,43] , and reversible damage to hepatocytes begins immediately after graft recirculation [32,38,39,43] . Some researchers have focused on ICG kinetics as a liver function test after LT [31,32] , and kICG values can predict clinical outcomes in the early postoperative period after LDLT by closely reflecting the influence of systemic dynamics on the splanchnic circulation [32] .…”

Section: Strategic Value Of Icg Kinetics During Ltmentioning

confidence: 99%

“…Intentional modulation of the PVP to ≤ 15 mmHg is a simple and sure strategy during LDLT [38][39][40][41][42] . Detailed surgical procedures for intentional modulation of PVP have been described elsewhere [40,41] .…”

Section: Intentional Modulation Of Pvp During Ldltmentioning

confidence: 99%

See 2 more Smart Citations

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Hori

Ogura

Onishi

et al. 2016

WJH

Self Cite

View full text Add to dashboard Cite

Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation (LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow (PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green (ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination Hori T et al . Peculiar hemodynamics in advanced cirrhosis constant (k ICG) in the well-preserved allograft. The k ICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.

show abstract

Section: Intentional Modulation Of Pvp During Ldltmentioning

confidence: 99%

Section: Strategic Value Of Icg Kinetics During Ltmentioning

confidence: 99%

See 1 more Smart Citation

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Hori

Ogura

Onishi

et al. 2016

WJH

Self Cite

View full text Add to dashboard Cite

show abstract

“…T herefore, indications for concomitant splenectomy should be decided carefully. Although we perform splenectomy concurrently with LDLT to modulate portal venous pressure, especially when the portal venous pressure is over 20 mmHg after reflowing [15] , we do not perform concomitant splenectomy for introduction of IFN therapy routinely at present. Sohara et al [11] have reported the efficacy of PSE on overcoming IFN-related thrombocytopenia after liver transplantation.…”

Section: Recurrent Hepatitis T/momentioning

confidence: 99%

Successful laparoscopic splenectomy after living-donor liver transplantation for thrombocytopenia caused by antiviral therapy

Kato

Usui²,

Azumi³

et al. 2008

WJG

View full text Add to dashboard Cite

A l t h o u g h i n t e r f e r o n ( I F N ) b a s e d t h e r a p y f o r recurrent hepatitis C virus (HCV) infection after liver transplantation has been widely accepted, it induces various adverse effects such as thrombocytopenia, resulting in its interruption. Recently, concomitant s p l e n e c t o m y a t t h e t i m e o f l i v i n g d o n o r l i v e r transplantation (LDLT) has been tried to overcome this problem, but this procedure leads to several complications such as excessive intraoperative bleeding and serious infection. A 60-year-old female received LDLT using a left lobe graft from her second son for liver failure caused by hepatitis C-related cirrhosis. Six months after LDLT, she was diagnosed as recurrent HCV infection by liver biopsy. IFN monotherapy was started from 7 mo after LDLT and her platelet count decreased to less than 50 000/μL, which thus made it necessary to discontinue the treatment. We decided to attempt laparoscopic splenectomy (LS) under general anesthesia. Since intra-abdominal findings did not show any adhesion formations around the spleen, LS could be successfully performed. After LS, since her platelet count immediately increased to 225 000/μL 14 d after operation, IFN therapy was restarted and we could convert the combination therapy of IFN and ribavirin, resulting in no detectable viral marker. In conclusion, LS can be performed safely even after LDLT, and LS after LDLT is a feasible and less invasive modality for thrombocytopenia caused by antiviral therapy.

show abstract

“…However, there is little information about the outcome of LDLT with prior spontaneous portasystemic shunts. It has been generally accepted that adequate PVF is essential for postoperative hepatic regeneration after hepatectomy and partial liver transplantation [18][19][20]. Preserved portasystemic shunt is reported to cause excessive decrease in graft PVF, leading…”

Section: Introductionmentioning

confidence: 99%

The outcome of living donor liver transplantation with prior spontaneous large portasystemic shunts

et al. 2007

View full text Add to dashboard Cite

Optimal Portal Venous Circulation for Liver Graft Function after Living-Donor Liver Transplantation

Abstract: Liver graft function was better when PVF and graft compliance were higher and PVP was maintained under 20 mmHg.

Cited by 99 publications

References 22 publications

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Successful laparoscopic splenectomy after living-donor liver transplantation for thrombocytopenia caused by antiviral therapy

The outcome of living donor liver transplantation with prior spontaneous large portasystemic shunts

Contact Info

Product

Resources

About