Modulation of portal graft inflow: a necessity in adult living-donor liver transplantation?
OBJECTIVE
To evaluate the clinical significance of modulating the recipient portal inflow (rPVF) through perioperative ligation of the splenic artery in adult living-donor liver transplantation (ALDLTx) by focusing on vascular complications, intractable ascites production, and the prevention of small-for-size syndrome (SFSS).


BACKGROUND
In ALDLTx, portal graft flow is enhanced to at least twice the donor value, raising the total liver inflow. Recipient hepatic arterial flow (rHAF) is lower than expected. Portal hyperperfusion of small grafts in larger recipients is thought to be one of the main causes of posttransplant graft dysfunction/SFSS.


METHODS
Seventeen ALDLTx were reviewed for a minimum of 2 months. Patients were divided retrospectively into two groups: G1 (n = 7), without modulation of rPVF, and G2 (n = 10), with splenic artery ligation to decrease rPVF perioperatively. Donor and recipient hepatic hemodynamics were evaluated against graft function and outcome, including correlations between rPVF, graft weight, graft:recipient body weight ratio, and recipient weight.


RESULTS
Following portal and arterial reperfusion, mean rPVF and rPVF/graft weight were much higher than in the donors, whereas mean rHAF and rHAF/graft weight were much lower. No differences were found between groups, except for rPVF and rHAF, which were much more higher and lower, respectively, before splenic artery ligation. In G1 patients, SFSS was seen in two patients and vascular complications occurred in two others. In G2 patients, splenic artery ligation permitted a significant decrease in rPVF, an improvement in rHAF, and the resolution of refractory ascites. Neither SFSS nor vascular complications were seen in G2 patients.


CONCLUSIONS
When a suboptimal graft:recipient body weight ratio is accompanied by high rPVF in ALDLTx, the portal flow should be modulated perioperatively; splenic artery ligation is a simple and safe method that is sufficient to allow this modulation in most patients.
Troisi
Roberto
R
Department of General Surgery, Division of Hepato-Biliary and Liver Transplantation Surgery, Ghent University Hospital, Belgium. roberto.troisi@rug.ac.be
Cammu
Guy
G
Militerno
Giuseppe
G
De Baerdemaeker
Luc
L
Decruyenaere
Johan
J
Hoste
Eric
E
Smeets
Peter
P
Colle
Isabelle
I
Van Vlierberghe
Hans
H
Petrovic
Mirko
M
Voet
Dirk
D
Mortier
Eric
E
Hesse
Uwe J
UJ
de Hemptinne
Bernard
B
D000328:Adult; D001783:Blood Flow Velocity; D001835:Body Weight; D005260:Female; D006499:Hepatic Artery / Q000502:physiology; D006801:Humans; D008026:Ligation; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011169:Portal Vein / Q000502:physiology / Q000637:transplantation*; D012189:Retrospective Studies; D013157:Splenic Artery / Q000601:surgery*