title: Attenuation of portal hypertension by continuous portal infusion of PGE1 and immunologic impact in adult-to-adult living-donor liver transplantation.
abstract: BACKGROUND
  Small-for-size syndrome remains the greatest limiting factor of expanding segmental liver transplantation from living donors. Portal hyperperfusion is considered to substantially contribute to small-for-size syndrome. We investigated the impact of continuous portal infusion of prostaglandin E1 (PGE1) on small-for-size grafts (SFSGs) in adult-to-adult living-donor liver transplantation (LDLT).
  
  
  METHODS
  From July 2003 to December 2009, LDLT was performed in 122 patients. We introduced continuous portal infusion of PGE1 to five SFSG patients (PG group) from November 2007 to December 2009 and retrospectively compared them with a historical control group of eight relevant SFSG patients without PGE1 infusion (non-PG group) from July 2003 to October 2007 to determine the safety and efficacy of continuous PGE1 portal infusion for SFSGs. Splenectomy cases were excluded from analysis.
  
  
  RESULTS
  The PG group demonstrated significantly lower postoperative portal pressure than the non-PG group. Moreover, the PG group demonstrated significantly improved liver function in the early posttransplantation period and significantly better recovery from hyperammonemia at 1 week after transplantation and from hyperbilirubinemia in the late posttransplantation period. Overall survival was significantly better in the PG group than in the non-PG group. Three patients in the non-PG group died of rejection-related reasons. Interestingly, immunomonitoring assay revealed that antidonor immune responses were significantly accelerated in the non-PG group compared with the PG group after LDLT. In contrast, the PG group showed well-suppressed antidonor immune responses.
  
  
  CONCLUSIONS
  Continuous portal infusion of PGE1 for SFSG attenuated portal hypertension, improved graft function, and suppressed antidonor immune responses, resulting in better survival.
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Onoe
authors.forename: Yuka
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ide
authors.forename: Kouhei
authors.initials: K
authors.lastname: Ishiyama
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oshita
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Hironobu
authors.initials: H
authors.lastname: Amano
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
mesh_terms: D000527:Alprostadil / Q000008:administration & dosage*; D005260:Female; D005452:Fluoresceins / Q000494:pharmacology; D006084:Graft Rejection; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008099:Liver / Q000601:surgery; D017093:Liver Failure / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011379:Prognosis; D015424:Reperfusion; D013388:Succinimides / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: C087165:5-(6)-carboxyfluorescein diacetate succinimidyl ester; D005452:Fluoresceins; D007166:Immunosuppressive Agents; D013388:Succinimides; D000527:Alprostadil