Splanchnic hyperemia after liver transplantation in patients with end-stage liver disease

Álvarez, Daniel; Gerona, Solange; Waisburg, Zulema; Ciardullo, M; Santibañés, Eduardo de; Mastaï, Ricardo

doi:10.1002/lt.500040403

Cited by 15 publications

(21 citation statements)

References 23 publications

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“…Stenosis of the graft artery may augment the shift of blood flow into the splenic or gastroduodenal artery. 2,8,9 Furthermore, profound changes in perfusion patterns in the splanchnic region after OLT, with increased portal blood flow and subsequently decreased hepatic arterial blood flow, may support the development of ASSs. 4,8,10,11 ASSs involving the splenic or gastroduodenal artery occur not only after OLT, but also in patients with end-stage liver disease before OLT.…”

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“…2,8,9 Furthermore, profound changes in perfusion patterns in the splanchnic region after OLT, with increased portal blood flow and subsequently decreased hepatic arterial blood flow, may support the development of ASSs. 4,8,10,11 ASSs involving the splenic or gastroduodenal artery occur not only after OLT, but also in patients with end-stage liver disease before OLT. 4,6,7 These patients may present with splenomegaly and hypersplenism, rather than with clinical symptoms of hepatic malperfusion, and the steal syndrome may remain undetected.…”

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confidence: 99%

“…It is important to note that the majority of patients with end-stage liver disease who present with an enlarged spleen and hypersplenism do not have an ASS. 8,9 However, splanchnic hyperemia and hyperperfusion of the spleen associated with hypersplenism may facilitate the development of ASSs in these patients. 11 Angiographic findings, such as an enlarged splenic artery and early perfusion of the splenic artery, have been reported to be indicative for ASSs 6 ; however, reliable criteria for the diagnosis of steal syndromes have not been defined to date.…”

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confidence: 99%

“…This can be achieved by either splenectomy, ligation, or coil embolization of the splenic artery. 4,7,8 However, these procedures are associated with considerable mortality and morbidity in transplant recipients.…”

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Diagnosis and treatment of arterial steal syndromes in liver transplant recipients

Nüssler

Settmacher

Haase

et al. 2003

Liver Transplantation

127

139

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Arterial steal syndromes (ASSs) after orthotopic liver transplantation (OLT) are characterized by arterial hypoperfusion of the graft caused by shifting of blood flow into the splenic or gastroduodenal artery. Despite their potentially devastating consequences, such as ischemic biliary tract destruction or graft failure, ASSs have received little attention to date. We report the incidence, diagnosis, and treatment of ASS among 1,250 consecutive OLTs. ASS was observed in 69 patients (5.9%). All these patients presented with elevated liver enzyme levels, impaired graft function, or cholestasis. Treatment consisted of splenectomy (n ‫؍‬ 18), coil embolization of the splenic or gastroduodenal artery (n ‫؍‬ 29), or reduction in splenic artery blood flow through administration of an artificial stenosis (banding; n ‫؍‬ 9). Mild symptoms of ASS did not warrant treatment in 13 patients. However, 3 of these patients developed ischemic biliary destruction requiring re-OLT. Serious complications also were observed after splenectomy and coil embolization, requiring re-OLT in 18%. Conversely, no complications were observed after banding the splenic artery. Prophylactic banding of the splenic artery was performed in 97 patients and was associated with a complication rate of 4%. In summary, the incidence of ASS is similar to that of other vascular complications. Untreated ASSs may lead to serious complications in more than 30% of patients. Of a variety of treatment options, banding the splenic artery was associated with the lowest complication rate. Banding also may be performed prophylactically in selected patients to prevent the development of ASS after OLT. (Liver Transpl 2003;9: 596-602.)

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confidence: 99%

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Diagnosis and treatment of arterial steal syndromes in liver transplant recipients

Nüssler

Settmacher

Haase

et al. 2003

Liver Transplantation

127

139

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“…Эффективной альтернативой спленэктомии мо-жет являться эмболизация селезеночной артерии (ЭСА) [4][5][6]. Результаты ЭСА при различных по-казаниях хорошо изучены [7][8][9], однако данные об ее эффективности у пациентов, перенесших ОТП, недостаточны и требуют дальнейшего изучения [10,11].…”

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Splenic Artery Embolization in Patients Undergoing Orthotopic Liver Transplantation

Гранов

Таразов

Поликарпов

et al. 2016

RJTAO

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ФГБУ «Российский научный центр радиологии и хирургических технологий» Минздрава РФ, Санкт-Петербург, Российская Федерация Цель: анализ результатов эмболизации селезеночной артерии у пяти пациентов после ортотопической трансплантации печени. Материалы и методы. Эмболизация селезеночной артерии выполнялась 6 раз пятерым (3,2%) пациентам из 158, перенесших ортотопическую трансплантацию печени, в сроки от 2 мес. до 10 лет после операции. Показаниями к эмболизации в 3 случаях послужили проявления синдрома ги-перспленизма, в других 3 -синдром обкрадывания селезеночной артерией. Результаты. Из 3 случаев эмболизации селезеночной артерии, выполненной в связи с проявлениями гиперспленизма, в 2 -рецидив заболевания, в 1 -инфаркт селезенки. Во всех этих случаях потребовалась спленэктомия. В 3 случаях, когда эмболизация выполнялась в связи с проявлением синдрома обкрадывания селезеночной артерией, достигнута ремиссия, спленэктомия не потребовалась. Заключение. Эмболизация селезеночной артерии может рассматриваться как способ лечения больных с проявлением синдромов обкрадывания и гипер-спленизма в посттрансплантационном периоде, при этом наиболее выраженный эффект достигается у пациентов с преобладанием явлений синдрома обкрадывания. Aim: to analyze the results of embolization of the splenic artery in fi ve patients after orthotopic liver transplantation. Materials and methods. Embolization of the splenic artery was performed 6 times in fi ve (3.2%) of 158 patients who underwent orthotopic liver transplantation in terms from 2 months up to 10 years after surgery. The indications for embolization in 3 cases were the manifestations of hypersplenism syndrome, in 3 others -splenic artery steal syndrome. Results. In 3 cases of splenic artery embolization, performed in connection with the manifestations of hypersplenism: 2 -recurrent disease, 1 -splenic infarction. In all these cases a splenectomy was required. In 3 cases when embolization was performed in connection with the display of the splenic artery steal syndrome remission was achieved, splenectomy was not required. Conclusion. Splenic artery embolization can be considered as a method of treating patients with manifestations of steal syndrome and hypersplenism after orthotopic liver transplantation. The most pronounced effect was achieved in patients with a predominance of manifestations of steal syndrome.

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Vasopressin decreases portal vein pressure and flow in the native liver during liver transplantation

et al. 2008

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Vasodilation due to impaired vascular tone is common in liver failure. Vasoconstrictor drugs are almost always required during the anhepatic phase of a liver transplant to maintain blood pressure unless venovenous bypass is employed. Argininevasopressin can be used as a vasoconstrictor instead of or in addition to norepinephrine for this purpose, but the effect of vasopressin on the portal vein pressure and flow in this setting is unknown. Portal vein pressure, portal vein blood flow, hemodynamic variables, and plasma vasopressin levels were measured in 16 patients during liver transplantation after ligation of the hepatic artery before and after a vasopressin infusion of 3.8 Ϯ 1.1 units/hour. Measurements were performed on the native liver prior to caval clamping. After vasopressin infusion, the portal vein pressure decreased significantly from 24.0 Ϯ 6.5 to 21.5 Ϯ 7.4 mm Hg [mean Ϯ standard deviation (SD), P ϭ 0.006]. The portal vein blood flow also decreased (from 1.01 Ϯ 0.53 to 0.76 Ϯ 0.53 L/minute, mean Ϯ SD, P Ͻ 0.0001), as did the portal vein blood flow to cardiac output ratio (from 0.14 Ϯ 0.06 to 0.10 Ϯ 0.07, mean Ϯ SD, P Ͻ 0.0001). In conclusion, vasopressin significantly decreased portal vein pressure and flow of the native liver without decreasing cardiac output or intestinal perfusion in patients undergoing liver transplantations. Liver Transpl 14: [1664][1665][1666][1667][1668][1669][1670] 2008 Patients in hepatic failure who require a liver transplant often exhibit profound vasodilatation and are able to maintain adequate perfusion pressure only by increasing cardiac output.1 Without the use of portocaval bypass or preservation of the recipient vena cava (the piggyback technique), cardiac preload decreases significantly upon clamping of the inferior vena cava, and decreased cardiac output and arterial blood pressure follow.Sympathomimetic drugs such as norepinephrine and epinephrine are used to maintain an adequate arterial blood pressure during the anhepatic phase. We have observed that a low-dose infusion of arginine-vasopressin (AVP), either alone or in combination with norepinephrine, is also potentially effective for this purpose, but we did not know if vasopressin had a beneficial effect on portal blood flow and pressure in patients undergoing liver transplantations. Vasopressin is a potent vasoconstrictor in vasodilatory septic shock, [2][3][4] and vasopressin analogues such as ornipressin and terlipressin have been used successfully to treat hepatorenal syndrome. 5,6 Vasopressin causes splanchnic Abbreviations: ABG, arterial blood gas; AVP, arginine-vasopressin; CO, cardiac output; CVP, central venous pressure; DBP, diastolic blood pressure; DPAP, diastolic pulmonary artery pressure; FFP, fresh frozen plasma used intraoperatively; g-a, gastric/arterial; LOS, length of stay; LRLT, living related liver transplantation; MAP, mean arterial pressure; MELD, Model for End-Stage Liver Disease; MPAP, mean pulmonary artery pressure; NAFLD, nonalcoholic fatty liver disease; OLT, orthotopic liver trans...

show abstract

Splanchnic hyperemia after liver transplantation in patients with end-stage liver disease

Cited by 15 publications

References 23 publications

Diagnosis and treatment of arterial steal syndromes in liver transplant recipients

Diagnosis and treatment of arterial steal syndromes in liver transplant recipients

Splenic Artery Embolization in Patients Undergoing Orthotopic Liver Transplantation

Vasopressin decreases portal vein pressure and flow in the native liver during liver transplantation

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