Portal hemodynamics in living-related liver transplantation: quantitative measurement by Doppler ultrasound

Huang, Tung‐Liang; Cheng, Yu; Chen, T.Y; Lee, T.Y.C; Lee, T.Y; Chen, Y.S; Chiang, Yuan‐Cheng; Liu, P.P; Eng, Hock‐Liew; Chen, C.L

doi:10.1016/s0041-1345(98)00987-7

Cited by 17 publications

(9 citation statements)

References 7 publications

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“…Hyperdynamic circulation with increased systemic and portal flow is known to persist initially after liver transplantation, especially in case of advanced post-necrotic liver cirrhosis with high portal hypertension and major splenomegaly (22)(23)(24). In this setting, post-operative US values of the PVF reach mean values of >70 cm/s (25,26). The use of HPCS results in a significant and persisting reduction of the portal inflow to more than 50% of the initial values.…”

Section: Discussionmentioning

confidence: 99%

Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation

Troisi

Ricciardi

Smeets

et al. 2005

American Journal of Transplantation

243

251

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Graft hyperperfusion in small-for-size grafts (SFSG) is considered the main causal factor of small-for-size syndrome (SFSS). We compared SFSG with a graft-torecipient body ratio ≤0.8, with and without graft inflow modulation (GIM) by means of a hemi-portocaval shunt (HPCS). Thirteen patients underwent adult-toadult living donor liver transplantation (AALDLT): G1, n = 5 [4 right livers (RL) and 1 left liver (LL)] without GIM, and G2, n = 8 (4 RL and 4 LL) with GIM. In G2 patients, portal vein flow (PVF) was significantly reduced by HPCS: 190 ± 70 mL/min/100 g liver in G2 vs. 401 ± 225 ml/min in G1 (p = 0.002). One-and 6-month post-transplantation graft volume/standard liver volume (GV/SLV) ratio was of 72% and 79.5% in G1; 80% and 101% in G2 (p = ns). SFSS was observed in three G1 recipients (who were retransplanted), but in none of the G2 patients. At 1-year, patient and graft survival was respectively of 40% and 20% in G1, 87.5% and 75% in G2 (p = 0.024 and 0.03).It is concluded that drastic reduction of PVF by means of HPCS improves overall patient and graft survival by averting the occurrence of SFSS. Graft inflow modulation through HPCS reduces the risk of complications when transplanting SFSG in adult recipients.

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Section: Discussionmentioning

confidence: 99%

Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation

Troisi

Ricciardi

Smeets

et al. 2005

American Journal of Transplantation

243

251

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“…One report suggested that the mean flow velocity range of the portal vein is 25-60 cm/ second (mean, 41 cm/second) and that portal blood flow volume is 15-33 ml/minute/kg (mean, 24 ml/minute/kg) in noncomplicated cases after vascular reconstruction. 19 High-flow velocities in these recipients may be caused by a combination of splanchnic hyperdynamic circulation and portal venous narrowing. In our study, the mean velocity of the portal vein in noncomplicated cases was 67.61 6 39.69 cm/second, which was not significantly different from that of patients with portal vein stenosis (70.54 6 37.71 cm/second).…”

Section: Discussionmentioning

confidence: 99%

Routine intraoperative Doppler sonography in the evaluation of complications after living‐related donor liver transplantation

Choi

Lee

et al. 2007

J of Clinical Ultrasound

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“…Although hemodynamic changes after orthotopic liver transplantation with whole-liver grafts have been studied; reports on hemodynamics after partial-liver transplantation are rare. 11,13,14 Recently, the difference in portal flow after liver transplantation with regard to liver disease was reported, which found high portal flow in transplant recipients with LC and normal portal flow in transplant recipients with FHF. 12 In the present study, we analyzed the relationship between changes in PV velocity and size of a liver allograft.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Because a persistent PV hyperdynamic state after orthotopic liver transplantation has been reported in patients with liver cirrhosis, we hypothesized that this should affect a partial-liver allograft more than a wholeliver allograft. [10][11][12] The purpose of this study is to evaluate the relationship between PV velocity and degree of liver regeneration in human living donor liver transplantation (LDLT). First, PV flow to a partial-liver graft after transplantation was quantified in patients grouped by disease.…”

mentioning

confidence: 99%

Relationship between portal venous flow and liver regeneration in patients after living donor right-lobe liver transplantation

Eguchi¹

2003

Liver Transplantation

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The purpose of this study is to evaluate the relationship between portal venous (PV) velocity and degree of liver regeneration in humans after living donor liver transplantation (LDLT). Between July 1997 and September 2002, a total of 15 adult-to-adult LDLTs with right-lobe grafts were performed, and 13 of these patients were enrolled in this study. Postoperative PV dynamics differed according to the primary liver disease; therefore, patients were divided into two groups: a fulminant hepatic failure (FHF) group (n ‫؍‬ 4) and a liver cirrhosis (LC) group (n ‫؍‬ 9). Right-lobe donors (n ‫؍‬ 13; D group) were used as controls. Doppler ultrasound was used to measured changes in PV velocity preoperatively; postoperative days (PODs) 1, 3, 7, 14, and 28; and 3 months after LDLT. To assess hepatic regeneration, the increase in liver volume ratio (postoperative liver volume to standard liver volume [SLV]) was measured. PV velocity after LDLT in the LC group increased sharply until POD 7, whereas those in the FHF and D groups were constant. In the first 3 months after LDLT, mean PV velocity was greater in the LC group than the other groups, reflecting the persistent hyperdynamic state in chronic end-stage liver disease. Liver regeneration also was more rapid in the LC group than the FHF and D groups and reached 100% as early as 2 weeks posttransplantation, whereas both the FHF and D livers reached approximately 80% of SLV at 3 months. PV velocity POD 7 correlated significantly with regeneration of the partial-liver allograft at 1 month (r ‫؍‬ 0.84; P ‫؍‬ .0091). In conclusion, the PV persistent hyperdynamic state in the LC group could directly trigger early liver regeneration in partial-liver allografts after LDLT. (Liver Transpl 2003;9:547-551.) D espite recent advances in molecular biology and cell physiology, the precise mechanism of liver regeneration after partial hepatectomy remains to be elucidated. Initiation of liver regeneration by increased shear stress in the portal venous (PV) wall, i.e., the shear-stress theory, has been shown in rats. 1-3 PV hypertension after partial liver resection in rats induces the expression and upregulation of many regeneration-related genes in the liver, followed by DNA synthesis and mitosis. 4 However, few attempts have been made to determine whether such a theory is applicable to liver regeneration in humans.Because of the shortage of brain-dead donors, partial-liver transplantation from living related donors has gained popularity worldwide. 5 In contrast to wholeliver transplantation, a partial-liver allograft regenerates to adjust to the recipient's environment. 6 Thus, partialliver transplantation provides a unique opportunity to investigate the unresolved mechanism of liver regeneration and determine the liver volume required to sustain life in humans. [7][8][9] Because a persistent PV hyperdynamic state after orthotopic liver transplantation has been reported in patients with liver cirrhosis, we hypothesized that this should affect a partial-liver allograft more than a wholel...

show abstract

Portal hemodynamics in living-related liver transplantation: quantitative measurement by Doppler ultrasound

Cited by 17 publications

References 7 publications

Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation

Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation

Routine intraoperative Doppler sonography in the evaluation of complications after living‐related donor liver transplantation

Relationship between portal venous flow and liver regeneration in patients after living donor right-lobe liver transplantation

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