Selective hemi-portocaval shunt based on portal vein pressure for small-for-size graft in adult living donor liver transplantation.
We developed an algorithm of graft selection in which left lobe donation is considered primarily if the graft-to-recipient weight ratio (GRWR) is estimated to be greater than 0.6% in preoperative volumetry with utilization of a hemi-portocaval shunt (HPCS) based on portal vein pressure (PVP) more than 20 mmHg at the time of laparotomy. A total of 11 consecutive adult living donor liver transplantations with small-for-size graft according to our graft selection algorithm were performed between December 2005 and August 2007. Ten patients required HPCS using a vein graft all survived without small-for-size syndrome (SFSS) and shunt complications with a median follow-up of 296 days. One patient without HPCS died of chronic vascular rejection. In all cases, PVP were regulated successfully under 20 mmHg by HPCS. Graft volume reached in mean 84.3% of standard liver volume in right lobe grafts and mean 95.4% in left lobe grafts at 3 months after liver transplantation. Actuarial rate of shunt patency at 1, 3, 6 months and 1 year were 80%, 55%, 26% and 20%, respectively. Selective HPCS based on PVP is an effective procedure and results in excellent patient and graft survival with avoidance of SFSS in grafts greater than 0.6% of GRWR.
Yamada
T
T
Department of Surgery, Hepato-Pancreato-Biliary Surgery and Transplantation, Kyoto University, Kyoto, Japan. kytacako@kcgh.gr.jp
Tanaka
K
K
Uryuhara
K
K
Ito
K
K
Takada
Y
Y
Uemoto
S
S
D000328:Adult; D000368:Aged; D000465:Algorithms; D001794:Blood Pressure; D001835:Body Weight; D005260:Female; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011169:Portal Vein / Q000502:physiology* / Q000601:surgery*; D012189:Retrospective Studies