title: A portal pressure cut-off of 15 versus a cut-off of 20 for prevention of small-for-size syndrome in liver transplantation: A comparative study.
abstract: OBJECTIVE
  Portal hypertension has recently been implicated in the pathogenesis of small-for-size syndrome (SFSS) in adult-to-adult living-donor liver transplantation (A-LDLT). The aim of our study is to compare the portal venous pressure (PVP) cut-off values of 15 mmHg and 20 mmHg in terms of prevention of SFSS in A-LDLT.
  
  
  METHODS
  Seventy-six patients underwent A-LDLT. A PVP <20 mmHg at the end of the operation was targeted using graft inflow modulation. Patients were divided into two groups: group A, final PVP <15 mmHg; and group B, final PVP 15-19 mmHg. Peak serum bilirubin and peak international normalized ratio in the first month after A-LDLT, as well as hepatic encephalopathy, SFSS, 90-day morbidity, and mortality were observed in both groups.
  
  
  RESULTS
  Final PVP was well controlled below 20 mmHg in all patients (group A, n = 39; group B, n = 37). Six patients suffered SFSS in group B (16.2%) compared to one patient (2.6%) in group A (P = 0.04). Nine patients died in group B (24.3%), four of whom died of SFSS, compared to three patients in group A (7.7%) (P = 0.047).
  
  
  CONCLUSIONS
  A PVP cut-off of 15 mmHg seems to be a more appropriate target level than a cut-off of 20 mmHg for prevention of postoperative SFSS in A-LDLT.
authors.affiliation: Department of General Surgery, Unit of Hepatobiliary Surgery, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Ayman M A
authors.initials: AM
authors.lastname: Osman
authors.affiliation: Department of General Surgery, Unit of Hepatobiliary Surgery, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Adel A
authors.initials: AA
authors.lastname: Hosny
authors.affiliation: Department of General Surgery, Unit of Hepatobiliary Surgery, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: El-Shazli
authors.affiliation: Department of Surgery, Division of Hepato-Pancreatico-Biliary Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.affiliation: Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdelaziz
authors.affiliation: Department of General Surgery, Unit of Hepatobiliary Surgery, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Ayman S
authors.initials: AS
authors.lastname: Helmy
keywords: adult; bilirubin; international normalized ratio; liver transplantation; portal pressure; postoperative period