Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft.
BACKGROUND
The small-for-size (SFS) syndrome is caused by excessive portal inflow into a small-sized liver graft. Various approaches for portal decompression have been used, but details of their impact on liver regeneration in SFS graft remain unclear. We examined the effect of prophylactic splenic artery modulation (SAM).


METHODS
We conducted a retrospective cohort study. The study group was 39 consecutive adult-to-adult living liver transplantation recipients, with a graft-to-recipient body weight ratio of less than 0.8. Patients were assigned into the non-SAM group (n=18, without any portal inflow attenuation) or SAM group (n=21, preoperative embolization in 15 patients and intraoperative ligation in 6 patients). Hepatic hemodynamics, graft function, liver regeneration, and outcome were evaluated.


RESULTS
In the SAM group, the excessive portal flow was significantly reduced (P<0.01) and the effect of embolization on portal decompression was equivalent to that of ligation. In the acute postoperative phase, serum transaminases, interleukin-6, and tumor necrosis factor-alpha, were lower in the SAM group than in non-SAM group. In both groups, a negative correlation was observed between graft-to-recipient body weight ratio and liver regeneration rate at 2 weeks after living donor liver transplantation. Splenic artery modulation was advantageous for liver regeneration, and significantly improved clinical features, hyperbilirubinemia, and prolonged ascites. Small-for-size syndrome occurred in five patients of the non-SAM group, and only one of SAM group (P=0.038).


CONCLUSIONS
In SFS graft with severe portal hypertension, prophylactic splenic embolization/ligation seems to relieve portal overperfusion injury and contributes in improvement of posttransplantation prognosis through liver regeneration.
Umeda
Yuzo
Y
Department of Gastroenterological Transplant Surgery and Surgical Oncology, Okayama University Graduate School of Medicine and Dentistry, Shikata-cho, Okayama City, Okayama, Japan.
Yagi
Takahito
T
Sadamori
Hiroshi
H
Matsukawa
Hiroyoshi
H
Matsuda
Hiroaki
H
Shinoura
Susumu
S
Mizuno
Kenji
K
Yoshida
Ryuichi
R
Iwamoto
Takayuki
T
Satoh
Daisuke
D
Tanaka
Noriaki
N
D004621:Embolization, Therapeutic; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000517:prevention & control*; D008099:Liver / Q000033:anatomy & histology; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D009929:Organ Size; D017082:Portal Pressure; D011168:Portal System / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D013157:Splenic Artery / Q000601:surgery*