Risk factors for portal vein stenosis in living-donor liver transplantation.
BACKGROUND
In living-donor liver transplantation (LDLT), the recipient's portal vein is short. Furthermore, portal vein thrombosis and stenosis can be lethal complications. We had begun the systemic administration of gabexate mesilate, a strong serine protease inhibitor, which has cytoprotective effects of endothelial cells. It is often effective on disseminated intravascular coagulation. The purpose of this study was to examine the effects of gabexate mesilate and to reveal risk factors for portal vein stenosis in LDLT.


METHODS
From 1991 to 2012, we performed 153 LDLTs. For the present cohort study, patients were divided into 2 groups. In group I, we treated with gabexate mesilate mildly (0-20 mg/kg/d; n = 29). In group II, we treated with gabexate mesilate at full dose (40 mg/kg/d; n = 124). We investigated the survival rates of both groups and performed univariate and multivariate analyses to identify the independent risk factors for portal vein stenosis.


RESULTS
The survival rate of group II was significantly better than that of group I (P < .05). On univariate analysis, the risk factors identified to be associated with a P value of <.20 were old age (P = .0385), heavy body weight (P = .1840), tall height (P = .1122), small lumen diameter of portal vein (P = .1379), high volume of blood loss (P = .0589), small amount of gabexate mesilate infusion (P = .0103), and large graft weight (P = .1326). On multiple logistic regression analysis we identified old age (P = .0073) and small amount of gabexate mesilate infusion (P = .0339) to be the independent risk factors for portal vein stenosis.


CONCLUSIONS
On multivariate analysis, we found that gabexate mesilate infusion contributed to the reduction of portal vein stenosis.
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. Electronic address: msmsmiyagi@yahoo.co.jp.
S
S
Miyagi
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
N
N
Kawagishi
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
K
K
Maida
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
W
W
Nakanishi
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Y
Y
Hara
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
C
C
Nakanishi
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
I
I
Takeda
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
K
K
Satoh
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
N
N
Ohuchi
Division of Transplantation, Reconstruction, and Endoscopic Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
S
S
Satomi
D000328:Adult; D002648:Child; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011169:Portal Vein / Q000473:pathology*; D012307:Risk Factors; D055815:Young Adult