Correlation of Portal Venous Velocity and Portal Venous Flow With Short-Term Graft Regeneration in Recipients of Living Donor Liver Transplants

Park, M.Y.; Lee, Y.J.; Rha, S.E.; Oh, Seungjong; Byun, Jae Young; Kim, D.G.

doi:10.1016/j.transproceed.2008.01.074

Cited by 16 publications

(9 citation statements)

References 17 publications

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“…Likewise, a previous study reported a significant correlation between the PVV/GW on POD 1 and hepatic regeneration rate at postoperative week 1, but no correlation between PVV and hepatic regeneration rate. [10] On the contrary, other studies found significant correlations between PVVs and various other indices representing hepatic regeneration obtained at different postoperative time points. [2,9] However, these studies did not analyze data with PVV/GW.…”

Section: Discussionmentioning

confidence: 96%

“…A more recent study reported the correlations of PVV/GW on POD 1 and PVF/GW on POD 1 and 5 or 6 with the hepatic regeneration rate at postoperative week 7. [10] However, this study also included 3 patients with fulminant hepatic failure and assessed the hepatic regeneration rate earlier than 2 weeks after LDLT, when the effects of early graft edema on the liver graft are still prevalent. Lastly, Jiang et al's study, [9] which showed the correlations of PVV and PVF on POD 1 and 3 with percent change in GW between preoperative period and POD 30, included only 18 patients.…”

Section: Discussionmentioning

confidence: 99%

“…[5–7] Several previous studies have demonstrated that portal venous hemodynamics representing the shear stress have a major impact on hepatic regeneration by showing the correlations between PVF or portal venous flow velocity assessed at different postoperative time points and the degree of graft regeneration. [2,8–10] The most appropriate time for evaluating graft regeneration in the early postoperative period appears to be during the 2nd postoperative week. Although a substantial amount of liver regeneration occurs within the first 2 postoperative weeks followed by a plateau within 1 to 2 months after LDLT, [2,3] a large amount of graft edema also occurs secondary to portal hyperperfusion of partial grafts and thus, precludes an accurate assessment of hepatic regeneration within 2 weeks after LDLT.…”

Section: Introductionmentioning

confidence: 99%

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Liver graft hyperperfusion in the early postoperative period promotes hepatic regeneration 2 weeks after living donor liver transplantation

2016

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Hepatic regeneration is essential to meet the metabolic demands of partial liver grafts following living donor liver transplantation (LDLT). Hepatic regeneration is promoted by portal hyperperfusion of partial grafts, which produces shear stress on the sinusoidal endothelium. Hepatic regeneration is difficult to assess within the first 2 weeks after LDLT as the size of liver graft could be overestimated in the presence of postsurgical graft edema. In this study, we evaluated the effects of graft hyperperfusion on the rate of hepatic regeneration 2 weeks after LDLT by measuring hepatic hemodynamic parameters. Thirty-six patients undergoing LDLT were enrolled in this study. Hepatic hemodynamic parameters including peak portal venous flow velocity (PVV) were measured using spectral Doppler ultrasonography on postoperative day 1. Subsequently, we calculated the ratio of each velocity to 100 g of the initial graft weight (GW) obtained immediately after graft retrieval on the day of LDLT. Ratios of GW to recipient weight (GRWR) and to standard liver volume (GW/SLV) were also obtained. The hepatic regeneration rate was defined as the ratio of the regenerated volume measured using computed tomographic volumetry at postoperative week 2 to the initial GW. Correlations of the hemodynamic parameters, GRWR, and GW/SLV with the hepatic regeneration rate were assessed using a linear regression analysis. The liver grafts regenerated to approximately 1.7 times their initial GW (1.7 ± 0.3 [mean ± standard deviation]). PVV/100 g of GW (r2 = 0.224, β1 [slope coefficient] = 2.105, P = 0.004) and velocities of the hepatic artery and vein per 100 g of GW positively correlated with the hepatic regeneration rate, whereas GRWR (r2 = 0.407, β1 = –81.149, P < 0.001) and GW/SLV (r2 = 0.541, β1 = –2.184, P < 0.001) negatively correlated with the hepatic regeneration rate. Graft hyperperfusion demonstrated by increased hepatic vascular velocities and a small-sized graft in the early postoperative period contributes to hepatic regeneration 2 weeks after LDLT.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Liver graft hyperperfusion in the early postoperative period promotes hepatic regeneration 2 weeks after living donor liver transplantation

2016

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“…The influence of a hyperdynamic portal circulation on patient outcomes is greater after adult LDLT versus whole liver LT. Many reports in the literature discuss the influence of portal hemodynamics on indices of liver function, graft regeneration, and patient survival after LDLT 2‐4, 9‐19. However, what are the ideal partial graft values for PVV, PVF, PVF per 100 g of GW, and PVP for the prevention of hyperperfusion injury and the facilitation of adequate regeneration?…”

Section: Discussionmentioning

confidence: 99%

Impact of portal venous hemodynamics on indices of liver function and graft regeneration after right lobe living donor liver transplantation

Wu¹,

Dahiya²,

Lee³

et al. 2011

Liver Transpl

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The aim of this study was to evaluate the effects of portal hemodynamics on indices of liver function and graft regeneration in patients after adult right lobe living donor liver transplantation (R-LDLT). Sixty-four patients who underwent R-LDLT and had an uneventful postoperative course were enrolled in this study. The contribution of portal flow was greater to the recipient grafts versus the donor livers (90.74% versus 69.12%, P < 0.0001). Portal flow variations decreased significantly during the first 10 days after R-LDLT (P < 0.0001); variations in the hepatic arterial flow were more constant during this period (P = 0.812). The mean portal venous pressure (PVP) before recipient hepatectomy (the initial PVP) was 23.1 ± 4.0 mm Hg; the mean PVP after reperfusion (the final PVP) was 15.0 ± 4.3 mm Hg (P < 0.0001). Furthermore, the mean hepatic portal venous gradient (ie, PVP - central venous pressure) before recipient hepatectomy was 17.1 ± 4.3 mm Hg; it decreased to 10.6 ± 4.5 mm Hg after reperfusion (P < 0.0001). These findings suggest that after graft reperfusion, the vascular resistance of the hepatic parenchyma decreased, and there was an associated mild decrease in the portal hypertension. Multiple regression analysis indicated that PVPs correlated significantly with indices of liver function after living donor liver transplantation (P < 0.05). Patients were separated into 4 groups according to their PVP values: group A (initial PVP ≥ 23 mm Hg, final PVP ≥ 15 mm Hg), group B (initial PVP < 23 mm Hg, final PVP ≥ 15 mm Hg), group C (initial PVP ≥ 23 mm Hg, final PVP < 15 mm Hg), and group D (initial PVP < 23 mm Hg, final PVP < 15 mm Hg). Immediately after R-LDLT, the peak values for aspartate aminotransferase, alanine aminotransferase, the international normalized ratio and the average ascites production varied appreciably in these groups. The regeneration rate of the liver graft 3 months after R-LDLT was significantly greater in group A versus the other groups. In conclusion, PVP is a significant hemodynamic factor that influences the functional status of the liver and graft regeneration after R-LDLT.

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“…The mechanism for the live regeneration after hepatic resection has been well documented , and change in portal blood flow is understood to be an important factor regulating the regeneration . Meanwhile, the mechanism underlying liver volume restoration after fenestration of giant liver cysts has been unclear.…”

Section: Discussionmentioning

confidence: 99%

Analysis of unique liver volume restoration after laparoscopic fenestration of liver cysts

Iimuro

Okada

Kondo

et al. 2014

Asian J Endoscop Surgery

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Correlation of Portal Venous Velocity and Portal Venous Flow With Short-Term Graft Regeneration in Recipients of Living Donor Liver Transplants

Cited by 16 publications

References 17 publications

Liver graft hyperperfusion in the early postoperative period promotes hepatic regeneration 2 weeks after living donor liver transplantation

Liver graft hyperperfusion in the early postoperative period promotes hepatic regeneration 2 weeks after living donor liver transplantation

Impact of portal venous hemodynamics on indices of liver function and graft regeneration after right lobe living donor liver transplantation

Analysis of unique liver volume restoration after laparoscopic fenestration of liver cysts

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