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Hirata, Masaru; Kita, Yoshiaki; Harihara, Yasushi; Hisatomi, S; Sano, Keiji; Mizuta, Koichi; Yoshino, Hiroyuki; Sugawara, Yasuhiko; Takayama, Tadatoshi; Kawarasaki, Hideo; Hashizume, Kohei; Makuuchi, Masatoshi

doi:10.1023/a:1020570901035

Cited by 19 publications

(10 citation statements)

References 11 publications

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“…A high risk of re-bleeding has been observed after split-liver transplantation in comparison with whole-liver transplantation [4,5]. The reduction in liver vasculature induces an increase of portal venous pressure [13,15,16].…”

Section: Discussionmentioning

confidence: 99%

“…It has already been reported that bleeding esophagogastric varices caused by portal hypertension improve after liver transplantation [1,2,3]. However, compared with full-size liver transplantation, a higher risk of re-bleeding has been observed after partial liver transplantation such as living donor liver transplantation (LDLT) [4,5]. Many issues related to esophagogastric varices after LDLT remain unresolved, and there is little information on whether LDLT results in reduction of blood supply to esophagogastric varices.…”

mentioning

confidence: 99%

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Evaluation of Esophagogastric Varices after Adult-to-Adult Living Donor Liver Transplantation Using a Left Lobe Graft

Ishizaki¹,

Konishi²,

Yoshimoto³

et al. 2014

Dig Surg

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Background: There is little information on whether living donor liver transplantation (LDLT) reduces the supply of blood to esophagogastric varices. The aim of the present study was to assess the effects of LDLT on esophagogastric varices using both endoscopy and transendoscopic microvascular Doppler sonography (EMDS). Patients and Methods: 16 LDLT recipients were enrolled in the present study. Esophagogastric varices were assessed by endoscopy before and after LDLT. Direct measurement of variceal blood velocity was performed using EMDS in 12 of the 16 patients, and portal vein pressure before and after graft implantation was measured in 10 of them. Results: The median interval between LDLT and endoscopic examination was 129 days (range 20-624). Endoscopy demonstrated improvement of esophageal varices in 15 patients and of gastric varices in 4 of 5 patients assessed. The mean blood flow velocity in esophageal varices after LDLT was significantly lower than that before LDLT (8.8 w 3.6 vs. 0.9 w 1.2 cm/s, p < 0.001). The mean portal vein pressure did not decrease significantly after LDLT in comparison with that before LDLT (from 25.2 w 5.2 to 23.1 w 3.6 mm Hg, p = 0.22). Conclusion: Although portal vein pressure does not decrease immediately after left lobe LDLT, esophagogastric varices are ameliorated after a few months, and variceal blood flow velocity is reduced in almost all patients. i 2014 S. Karger AG, Basel

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Evaluation of Esophagogastric Varices after Adult-to-Adult Living Donor Liver Transplantation Using a Left Lobe Graft

Ishizaki¹,

Konishi²,

Yoshimoto³

et al. 2014

Dig Surg

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“…Hirata et al [5,6] studied the impact of small-for-size grafts on the incidence of gastrointestinal (GI) bleeding, and reported higher occurrence of GI bleeding of 25% after living donor liver transplantation (LDLT) as compared with 8-9% after cadaveric donor liver transplantation (CDLT). Esophageal varices contributed to 80% of bleeding episodes.…”

Section: Persistent Esophageal Varicesmentioning

confidence: 99%

“…Esophageal varices contributed to 80% of bleeding episodes. The explanation for this phenomenon has been attributed to presence of transient portal hypertension after placement of small-for-size liver grafts [6].…”

Section: Persistent Esophageal Varicesmentioning

confidence: 99%

Avoiding Pitfalls: What an Endoscopist Should Know in Liver Transplantation—Part II

et al. 2008

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Over the last decade the number of patients undergoing transplantation has increased. At the same time, effective peri- and postoperative care and better surgical techniques have resulted in greater numbers of recipients achieving long-term survival. Identification and effective management in the form of adequate treatment is essential, since any delay in diagnosis or treatment may result in graft loss or serious threat to patient's life. Various aspects of endoscopic findings that can be commonly encountered among liver transplant recipients are discussed herein. Topics include: persistent and/or recurrent esophageal varices, reflux, Candida or cytomegalovirus (CMV) esophagitis, esophageal neoplasms, posttransplant peptic ulcer, biliary complications, posttransplant lymphoproliferative disorder (PTLD), Kaposi's sarcoma, CMV colitis and inflammatory bowel disease, colonic neoplasms, Clostridium difficile infection, and graft versus host disease (GVHD).

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“…MELD, ET status), in recent years, living-donor liver transplantation (LDLT) and split liver transplantation have emerged as good alternatives to bridge organ shortage [43] . Apart from donor morbidity, technical problems and small-for-size syndrome (SFSS), a higher risk of re-bleedings was observed after split-liver transplantation compared with full-size organ transplantation [44][45][46] . Graft weight to recipient body weight ratio (GRBWR) should be close to 1%.…”

Section: Liver Transplantationmentioning

confidence: 99%

Liver Transplantation as Ultimate Tool to Treat Portal Hypertension

Klupp

Köhler

Pascher

et al. 2005

Dig Dis

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Portal hypertension is a complication of liver cirrhosis that may itself cause complications such as variceal bleeding, ascites and hepatorenal syndrome. There are several options for symptomatic treatment including drug therapy, endoscopy, transjugular intrahepatic portosystemic shunt (TIPS), and various surgical procedures, notably liver transplantation, the only causal treatment. The indication for liver transplantation has to be defined carefully. Progression of the primary disease, evaluation of comorbidity and overall prognosis have to be considered. Conservative symptomatic treatment is used for bridging purposes until liver transplantation can be provided to cure portal hypertension and the underlying primary disease. Careful timing of the transplantation is necessary as well as reorganization of the waiting lists by introducing new priority systems as the Model for End-Stage Liver Disease (MELD) in order to reduce mortality. Furthermore, living donor liver transplantation and split liver transplantation are methods to enlarge the donor pool, and thus accessibility of transplantation to a greater number of patients. This review evaluates the indication of liver transplantation in the treatment of portal hypertension.

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Untitled

Cited by 19 publications

References 11 publications

Evaluation of Esophagogastric Varices after Adult-to-Adult Living Donor Liver Transplantation Using a Left Lobe Graft

Evaluation of Esophagogastric Varices after Adult-to-Adult Living Donor Liver Transplantation Using a Left Lobe Graft

Avoiding Pitfalls: What an Endoscopist Should Know in Liver Transplantation—Part II

Liver Transplantation as Ultimate Tool to Treat Portal Hypertension

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