Intentional portal pressure control is key to improving the outcome of living donor liver transplantation: the Kyoto University Hospital experience.
This study indicates that intentional portal pressure control under 20 mmHg can improve patient survival not only for recipients of small-for-size grafts but also in classically appropriately sized grafts undergoing A-LDLT. In a retrospective analysis of 100 transplants with intentional portal pressure control, we found that patient survival was significantly better at an even lower final portal pressure of 15 mmHg. As a result, we have adjusted our target portal pressure control protocol, targeting a final portal pressure below 15 mmHg. Portal pressure control allows living donors to donate the smaller left lobe in many cases, which is safer in terms of living donors' post-operative morbidity. As intentional portal pressure control can overcome size-mismatching between the donor and recipient, we propose that it may also be applied to deceased donor liver grafts and in the split-liver transplant setting when the graft size is considered small for the recipient. Intentional portal pressure control can be applied in many liver transplantation situations to overcome small-for-size problems.
Ogura
Yasuhiro
Y
Department of Hepatobiliary, Pancreas and Transplant Surgery, Kyoto University Hospital.
Hori
Tomohide
T
Uemoto
Shinji
S
D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008099:Liver / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008107:Liver Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D019520:Living Donors / Q000600:supply & distribution*; D009929:Organ Size; D018579:Patient Selection; D017082:Portal Pressure; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome