title: Left lobe adult-to-adult living donor liver transplantation: Should portal inflow modulation be added?
abstract: Recently, the successful application of portal inflow modulation has led to renewed interest in the use of left lobe grafts in adult-to-adult living donor liver transplantation (LDLT). However, data on the hepatic hemodynamics supporting portal inflow modulation are limited, and the optimal portal circulation for a liver graft is still unclear. We analyzed 42 consecutive adult-to-adult left lobe LDLT cases without splenectomy or a portocaval shunt. The mean actual graft volume (GV)/recipient standard liver volume (SLV) ratio was 39.8% ± 5.7% (median = 38.9%, range = 26.1%-54.0%). The actual GV/SLV ratio was less than 40% in 24 of the 42 cases, and the actual graft-to-recipient weight ratio was less than 0.8% in 17 of the 42 recipients. The mean portal vein pressure (PVP) was 23.9 ± 7.6 mm Hg (median = 23.5 mm Hg, range = 9-38 mm Hg) before transplantation and 21.5 ± 3.6 mm Hg (median = 22 mm Hg, range = 14-27 mm Hg) after graft implantation. The mean portal pressure gradient (PVP - central venous pressure) was 14.5 ± 6.8 mm Hg (median = 13.5 mm Hg, range = 3-26 mm Hg) before transplantation and 12.4 ± 4.4 mm Hg (median = 13 mm Hg, range = 1-21 mm Hg) after graft implantation. The mean posttransplant portal vein flow was 301 ± 167 mL/minute/100 g of liver in the 38 recipients for whom it was measured. None of the recipients developed small-for-size syndrome, and all were discharged from the hospital despite portal hyperperfusion. The overall 1-, 3-, and 5-year patient and graft survival rates were 100%, 97%, and 91%, respectively. In conclusion, LDLT with a left liver graft without splenectomy or a portocaval shunt yields good long-term results for adult patients with a minimal donor burden.
authors.affiliation: Department of Hepatobiliary Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ishizaki
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugo
authors.forename: Jiro
authors.initials: J
authors.lastname: Yoshimoto
authors.forename: Noriko
authors.initials: N
authors.lastname: Fujiwara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology*; D012039:Regional Blood Flow