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

Osman, Ayman M. A.; Hosny, Adel; Elshazli, Mostafa; Üemoto, Shinji; Abdelaziz, Omar; Salah, Ayman

doi:10.1111/hepr.12727

Cited by 11 publications

(15 citation statements)

References 27 publications

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“…On the other hand, in order to improve outcomes without amending KONOS policy, inflow modulation could be one option to improve the outcome of RTS‐SLT with DRWR < 1.0, especially with no sufficient collateral. However, these procedures, which are performed in LDLTs using a small graft in adult recipients, are according to surgeons’ preferences, outflow issues, the degree of portal hypertension, and the presence of collateral circulation which could reduce the portal pressure of a small graft . It would require further study to apply in SLTs.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Split Compared With Whole Liver Transplantation

et al. 2018

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Split-liver transplantation (SLT) should be cautiously considered because the right trisection (RTS) graft can be a marginal graft in adult recipients. Herein, we analyzed the outcomes of RTS-SLT in Korea, where >75% of adult liver transplantations are performed with living donor liver transplantation. Among 2462 patients who underwent deceased donor liver transplantations (DDLTs) from 2005 to 2014, we retrospectively reviewed 86 (3.5%) adult patients who received a RTS graft (RTS-SLT group). The outcomes of the RTS-SLT group were compared with those of 303 recipients of whole liver (WL; WL-DDLT group). Recipient age, laboratory Model for End-Stage-Liver Disease (L-MELD) score, ischemia time, and donor-to-recipient weight ratio (DRWR) were not different between the 2 groups (P > 0.05). However, malignancy was uncommon (4.7% versus 36.3%), and the donor was younger (25.2 versus 42.7 years) in the RST-SLT group than in the WL-DDLT group (P < 0.05). The technical complication rates and the 5-year graft survival rates (89.0% versus 92.8%) were not different between the 2 groups (P > 0.05). The 5-year overall survival (OS) rate (63.1%) and graft-failure-free survival rate (63.1%) of the RTS-SLT group were worse than that of the WL-DDLT group (79.3% and 79.3%; P < 0.05). The factors affecting graft survival rates were not definite. However, the factors affecting OS in the RTS-SLT group were L-MELD score >30 and DRWR ≤1.0. In the subgroup analysis, OS was not different between the 2 groups if the DRWR was >1.0, regardless of the L-MELD score (P > 0.05). In conclusion, a sufficient volume of the graft estimated from DRWR-matching could lead to better outcomes of adult SLTs with a RTS graft, even in patients with high L-MELD scores.

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Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Split Compared With Whole Liver Transplantation

et al. 2018

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“…26 Finally, Osman et al found that in their 'high' PVP group (PVP 15-19 mmHg) significantly more patients died by 90 days. 19 Taken together these results strongly suggest that high PVP (>15 mmHg) increases the risk of post-operative mortality in both the LDLT and MH settings.…”

Section: Post-operative Morbiditymentioning

confidence: 71%

“…All studies included data on the development of SFSS or PHLF (including SFSS), according to whether they were, [16][17][18][19][20][21][22][23] whilst six studies utilised the following; bilirubin >10 mg/dL on postoperative day (POD) 14 alongside intractable ascites (>1000 mls/day on POD14 or >500 mls/day on POD28). 3,15,[24][25][26][27] Three studies used a similar definition with bilirubin >5 mg/ dL 2,28,29 and one study increased the bilirubin cut off to >20 mg/ dL.…”

Section: Primary Outcome -Sfssmentioning

confidence: 99%

“…24 Furthermore, Vasavada et al reported no difference in terms of post-operative infection according to GRWR. 29 Kanetkar 19 The authors went on to show that the presence of both these risk factors significantly increased the risk of SFSS (OR 10.0, p = 0.001).…”

Section: Hpbmentioning

confidence: 99%

“…Four studies demonstrated that high PVP was significantly associated with worse survival. 2,19,26,32 Two patients died within 90-days of Stage 2 ALPPS and both these patients had PVP >20 mmHg as well as insufficient liver regeneration (0.9% and 1.8% volume increase/ day). Sanefuji et al reported 1 year survival in patients with SFSS, 71% compared to 87% in patients without SFSS.…”

Section: Post-operative Morbiditymentioning

confidence: 99%

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A systematic review of small for size syndrome after major hepatectomy and liver transplantation

Riddiough

Christophi

Jones

et al. 2020

HPB

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Background: Major hepatectomy (MH) and particular types of liver transplantation (LT) (reduced size graft, living-donor and split-liver transplantation) lead to a reduction in liver mass. As the portal venous return remains the same it results in a reciprocal and proportionate rise in portal venous pressure potentially resulting in small for size syndrome (SFSS). The aim of this study was to review the incidence, diagnosis and management of SFSS amongst recipients of LT and MH.Methods: A systematic review was performed in accordance with the 2010 Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following terms were used to search PubMed, Embase and Cochrane Library in July 2019: ("major hepatectomy" or "liver resection" or "liver transplantation") AND ("small for size syndrome" or "post hepatectomy liver failure"). The primary outcome was a diagnosis of SFSS.Results: Twenty-four articles met the inclusion criteria and could be included in this review. In total 2728 patients were included of whom 316 (12%) patients met criteria for SFSS or post hepatectomy liver failure (PHLF). Of these, 31 (10%) fulfilled criteria for PHLF following MH. 8 of these patients developed intractable ascites alongside elevated portal venous pressure following MH indicative of SFSS. Conclusion: SFSS is under-recognised following major hepatectomy and should be considered as an underlying cause of PHLF. Surgical and pharmacological therapies are available to reduce portal congestion and reverse SFSS.

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Role of the portal system in liver regeneration: From molecular mechanisms to clinical management

Xu,

Qiu,

Wang

et al. 2024

Liver Research

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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: 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.

Cited by 11 publications

References 27 publications

Survival Outcomes in Split Compared With Whole Liver Transplantation

Survival Outcomes in Split Compared With Whole Liver Transplantation

A systematic review of small for size syndrome after major hepatectomy and liver transplantation

Role of the portal system in liver regeneration: From molecular mechanisms to clinical management

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