title: Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft.
abstract: 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.
authors.affiliation: Department of Gastroenterological Transplant Surgery and Surgical Oncology, Okayama University Graduate School of Medicine and Dentistry, Shikata-cho, Okayama City, Okayama, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Umeda
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sadamori
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Matsukawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuda
authors.forename: Susumu
authors.initials: S
authors.lastname: Shinoura
authors.forename: Kenji
authors.initials: K
authors.lastname: Mizuno
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Yoshida
authors.forename: Takayuki
authors.initials: T
authors.lastname: Iwamoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Satoh
authors.forename: Noriaki
authors.initials: N
authors.lastname: Tanaka
mesh_terms: 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*