Optimal portal venous circulation for liver graft function after living-donor liver transplantation.
BACKGROUND
Previous studies have shown poor outcome after living-donor liver transplantation (LDLT) as a result of excessive portal venous pressure (PVP), excessive portal venous flow (PVF), or inadequate PVF. We investigated optimal portal venous circulation for liver graft function after LDLT in adult recipients retrospectively.


METHODS
Between June 2003 and November 2004, 28 adult patients underwent LDLT in our institution. We modulated PVP under 20 mmHg in these 28 cases by performing a splenectomy (n=4) or splenorenal shunt (n=1). The PVF and PVP were measured at the end of the operation. Compliance was calculated by dividing PVF by PVP.


RESULTS
PVF and compliance showed a significant inverse correlation with peak billirubin levels after LDLT (r = -0.63: r=-0.60, P<0.01), and with peak international normalized ratio after LDLT (r=-0.41: r=-0.51, P<0.05). Compliance was higher in right-lobe graft with middle hepatic vein cases (148+/-27 ml/min/mmHg), and lower in left-lobe graft cases (119+/-50 ml/min/mmHg).


CONCLUSIONS
Liver graft function was better when PVF and graft compliance were higher and PVP was maintained under 20 mmHg.
First Department of Surgery, Mie University School of Medicine, Tsu City, Japan. shintaro@clin.medic.mie-u.ac.jp
Shintaro
S
Yagi
Taku
T
Iida
Tomohide
T
Hori
Kentaro
K
Taniguchi
Chizuru
C
Yamamoto
Kentaro
K
Yamagiwa
Shinji
S
Uemoto
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008099:Liver / Q000098:blood supply; D008102:Liver Circulation; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011169:Portal Vein / Q000502:physiology / Q000503:physiopathology; D019737:Transplants; D016896:Treatment Outcome