Portal pressure &lt;15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before

Ogura, Yasuhiro; Hori, Tomohide; Moghazy, Walid M. El; Yoshizawa, Atsushi; Oike, Fumitaka; Mori, Akira; Kaido, Toshimi; Takada, Yasutsugu; Üemoto, Shinji

doi:10.1002/lt.22059

Cited by 212 publications

(263 citation statements)

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Section: Intentional Modulation Of Pvp During Ldltmentioning

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] . 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] .…”

Section: Intentional Modulation Of Pvp During Ldltmentioning

confidence: 99%

“…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%

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

Hori

Ogura

Onishi

et al. 2016

WJH

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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.

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Section: Intentional Modulation Of Pvp During Ldltmentioning

confidence: 99%

Section: Intentional Modulation Of Pvp During Ldltmentioning

confidence: 99%

Section: Intentional Modulation Of Pvp During Ldltmentioning

confidence: 99%

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

Hori

Ogura

Onishi

et al. 2016

WJH

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“…Az SFSS megjelenése nem csupán a graft volumenével, hanem annak keringésével is összefüggésben van. A graftok életképességét meghatározza a beülte-tett májrészeket érintő moderált nyomású (<15 Hgmm) portalis keringés és kifogástalan vénás elfolyás [17].…”

Section: Eredeti Közleményunclassified

Special considerations of living liver donor transplantation

et al. 2013

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Bevezetés: A felnőtt élődonoros májtranszplantáció a cadaver donorok hiánya miatt a transzplantáció, a szervnyerés egyik alternatív útja. Élődonorok kapcsán a recipiensnek adott kellő volumenű, súlyú graft mellett a donor biztonsága, szövődménymentes gyógyulása a fő cél. A középső vena hepatica, a speciális anatómiai helyzetéből fakadóan, jelentős dilemmát okoz. Az anatómiai jobb májlebenyek transzplantációjakor felmerül a középső vena hepatica S5 és S8-hoz futó ágainak rekonstrukciója. Célkitűzés: A szerzők célja a középső vena hepatica rekonstrukciós igényének anatómiai alapokon történő vizsgálata, illetve a portalis és vénás be-, kiáramlási fenomének leírása volt. Módszer: 130 élődonoros transzplantációban részt vett donor májanatómiai sajátosságait elemezték a MeVis szoftver segítségé-vel. Bevezetésre került az úgynevezett portohepaticus aránytalanságot jelző szám (shift). Eredmények: Az esetek 64,6%-ában jobb vena hepatica dominancia volt jellemző, a bal vena hepatica sohasem volt domináns. A V5 és V8 területe közösen a jobb májlebeny 33,2±8,9%-a volt. A portalis territórium és vénás lefedettség korrelációi a kö-vetkezők voltak: bal lebenyben R 2 = 0,7811, a középső vena hepaticához tartozó területen: R² = 0,5463 és a jobb vena hepaticához tartozó területen: R² = 0,5843. A shift átlagos értéke 28,2% volt. Következtetések: A vena portae és vena hepatica be-és kiáramlási mintázatában látható különbségek befolyással lehetnek a középső vena hepatica rekonstrukciójának kérdésére. Orv. Hetil., 2013, 154, 1417-1425. Kulcsszavak: élődonor, májtranszplantáció, volumetria, MeVis Special considerations of living liver donor transplantationIntroduction: Due to the limited number of cadaver donors, adult living liver donor transplantation became an alternative for liver transplantation. During living liver donor transplantation, the safety and uncomplicated recovery of the donor are as important as the appropriate volume and weight of the donated graft. The middle hepatic vein causes a signifi cant dilemma, due to the special anatomical position. The reconstruction of the middle hepatic vein branches supplying S5, S8 is suggested when the anatomically right liver lobe is transplanted. Aim: The aim of the present study was to investigate the requirements of the reconstruction of middle hepatic vein and to give an accurate description about the discrepancy between the portal vein in-and outfl ow. Method: The authors analyzed the liver anatomic characteristics of 130 donors undergoing living liver donor transplantation with the use of MeVis software. The so-called porto-hepatic disparity index (shift) was introduced. Results: The right hepatic vein was dominant in 64.6% of all cases, while the left hepatic vein was never observed to be dominant. The territories of V5 and V8 were responsible for the 33.2±8.9% of the right hepatic lobe area. The correlation between portal venous territory and vein dominancy were as follows: R 2 = 0.7811 in the left liver lobe; R² = 0.5463 in the area of middle hepatic vein and R² = 0.5843 in...

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“…The minimum graft size requirement for successful LDLT has been set at 40 % for graft-weight-to-recipient-standard-liver-volume (GW/SLV) ratio [15] or 1 % for graft-to-recipient-weight ratio (GRWR) [16]. With more experience and a better understanding of the mechanism of graft injury in smallfor-size syndrome, there is evidence that this minimum graft size safety limit can be lowered and a higher proportion of LDLT using left liver graft could be performed [17]. We have previously estimated that, for every 5 % reduction in the minimum requirement for GW/SLV ratio, the proportion of adult LDLT using left liver graft would be doubled, while if the minimum GW/SLV ratio for successful LDLT could be reduced to 25 %, a left liver graft might be used in two-thirds of all adult LDLTs [18].…”

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confidence: 99%

Evaluating the living donor: expansion by innovation

2016

Hepatol Int

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Living donor liver transplantation (LDLT) provides an alternative for patients with end-stage liver disease to receive a life-saving transplant operation. As compared to deceased donor liver transplantation, LDLT is both surgically and ethically more challenging, as the operation involves taking a partial liver graft from a healthy living donor. The evaluation and selection of a living donor is a more complicated process which can be no less controversial than the donor operation itself. There are three main objectives. The first is to determine that a part of the donor's liver can be used reliably as a graft for the recipient. The second is to ensure the safety of the donor. The final objective is to assess the outcome of the recipient including the risks and benefits as compared to a deceased donor liver transplant. To ensure the safety of the operation, particularly for the donor, the pretransplant evaluation of a potential living donor according to a planned protocol and criteria is mandatory. There is extremely wide variation in the practice of donor evaluation among different transplant centers because of differences in the availability of deceased donor grafts, experience in LDLT, prevalence of various diseases, and socio-cultural factors.Metabolic syndrome, which includes a combination of obesity, diabetes, hypertension and dyslipidemia, represents a common risk factor for premature cardiovascular disease [1]. It is also closely but not causally related to nonalcoholic fatty liver disease (NAFLD) [2] which spans from steatosis to steatohepatitis. Hence, the presence of metabolic syndrome may potentially increase the operative risk of a living liver donor for both reasons. In this issue of the journal, Al-hamoudi et al. summarizes the outcome of 1065 potential donors who were evaluated for living liver donation at the King Faisal Hospital in Saudi Arabia [3], and identified elements of metabolic syndrome as the most common reasons for rejecting potential living liver donors. In potential donors for adults, the donation rate was only 13 %, with the most common reasons for rejection being a body mass index [28 in 28 % and diabetes in 19.2 %. Hepatic steatosis [10 % on radiologic imaging or liver biopsy was the reason for rejection in an additional 8 % of the donors. As a high volume center with an average of 40 LDLTs per year, which accounted for over 50 % of the annual case load of liver transplants, this experienced group from King Faisal Hospital has adopted a very cautious approach in donor selection with an upper age limit set at 45 years, a body mass index (BMI) under 28, and a policy of routine liver biopsy with the aim of accepting only donors with steatosis \10 %. The reasons as well as the consequences of such a cautious approach are obvious when considering the prevalence of metabolic syndrome in Saudi Arabia which is 10-15 % higher than in most developed countries [4].It is interesting to compare this experience from Saudi Arabia with the Hong Kong experience in a predominantly Chinese community...

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Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before

Cited by 212 publications

References 30 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

Special considerations of living liver donor transplantation

Evaluating the living donor: expansion by innovation

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