title: Impact of portal venous pressure on regeneration and graft damage after living-donor liver transplantation.
abstract: Several reports claim that portal hypertension after living-donor liver transplantation (LDLT) adversely affects graft function, but few have assessed the impact of portal venous pressure (PVP) on graft regeneration. We divided 32 adult LDLT recipients based on mean PVP during the 1st 3 days after LDLT into a group with a PVP > or = 20 mm of Hg (H Group; n = 17), and a group with a PVP < 20 mm of Hg (L Group; n = 15). Outcome in the H Group was poorer than in the L Group (58.8 vs. 92.9% at 1 year). Peak peripheral hepatocyte growth factor (HGF) during the 1st 2 weeks was higher in the H Group (L: 1,730 pg/mL, H: 3,696 pg/mL; P < .01), whereas peak portal vascular endothelial growth factor (VEGF) level during the 1st week was higher in the L Group (L: 433 pg/mL, H: 92 pg/mL; P < .05). Graft volume (GV) / standard liver volume (SLV) was higher in the H Group (L / H, at 2, 3, and 4 weeks, and at 3 months: 1.02 / 1.24, .916 / 1.16, .98 / 1.27, and .94 / 1.29, respectively; P < .05). Peak serum aspartate aminotransferase, bilirubin levels, and international normalized ratio after LDLT were significantly higher in the H Group, as was mean ascitic fluid volume. In conclusion, early postoperative PVP elevation to 20 mm of Hg or more was associated with rapid graft hypertrophy, higher peripheral blood HGF levels, and lower portal VEGF levels; and with a poor outcome, graft dysfunction with hyperbilirubinemia, coagulopathy, and severe ascites. Adequate liver regeneration requires an adequate increase in portal venous pressure and flow reflected by clearance of HGF and elevated VEGF levels.
authors.affiliation: First Department of Surgery, Mie University School of Medicine, 2-174, Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan. shintaro@clin.medic.mie-u.ac.jp
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.forename: Taku
authors.initials: T
authors.lastname: Iida
authors.forename: Kentaro
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.forename: Takashi
authors.initials: T
authors.lastname: Hamada
authors.forename: Koji
authors.initials: K
authors.lastname: Fujii
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology*; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery; D008115:Liver Regeneration / Q000502:physiology*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000502:physiology*; D012189:Retrospective Studies
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin