Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications.
BACKGROUND
Although living-donor liver transplantation (LDLT) has been accepted for adult populations, the occurrence and pathogenesis of small-for-size syndrome remain highly controversial.


METHODS
Portal venous pressure (PVP) was measured in 79 cases of LDLT from anhepatic phase to day 14. PVP was monitored through a catheter inserted via the inferior mesenteric vein. In a separate series of seven cases of adult LDLT, the splenic artery was ligated following arterial reperfusion.


RESULTS
For days 2 to 4 and 9 to 11, recipients of small-for-size graft (<0.8% of body weight) displayed significantly higher PVP than recipients of larger grafts. The 13 patients with elevated mean PVP (>or=20 mm Hg) early in the first week (days 0-4) demonstrated significantly worse survival (84.5% vs. 38.5% at 6 months; P < 0.01), but this was not applicable to elevated mean PVP late in the first week (days 5-7). Elevated PVP early in the first week was also associated with higher incidence of bacteremia, cholestasis, prolonged prothrombin time, and ascites. Splenic artery ligation (SAL) immediately reduced PVP from 10 to 20 mm Hg (median, 16 mm Hg) to 9 to 13 mm Hg (median, 11 mm Hg; P = 0.02). Posttransplant PVP was significantly lower in SAL patients than in non-SAL patients from days 2 to 7 despite small graft size. Early PVP in SAL patients was consistently below 20 mm Hg, and survival was significantly better than in non-SAL patients with high early PVP (P < 0.01).


CONCLUSIONS
Elevated PVP in the early phase is strongly associated with poor patient survival attributable, at least in part, to small-for-size graft. Further elucidation of the pathogenesis behind this phenomenon and efforts to modify PVP will be key to improving results.
Ito
Takashi
T
Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan. itotaka@kuhp.kyoto-u.ac.jp.
Kiuchi
Tetsuya
T
Yamamoto
Hidekazu
H
Oike
Fumitaka
F
Ogura
Yasuhiro
Y
Fujimoto
Yasuhiro
Y
Hirohashi
Kazuhiro
K
Tanaka
And Koichi
AK
D000328:Adult; D005260:Female; D006801:Humans; D008026:Ligation; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011184:Postoperative Period; D013157:Splenic Artery; D016019:Survival Analysis; D013997:Time Factors