Effects of Prophylactic Splenic Artery Modulation on Portal Overperfusion and Liver Regeneration in Small-for-Size Graft

Umeda, Yuzo; Yagi, T.; Shinmoto, Hiroshi; Matsukawa, Hiroyoshi; Matsuda, Hiroaki; Shinoura, Susumu; Mizuno, Kenji; Yoshida, Ryuichi; Inomata, Takayuki; Satoh, Daisuke; Tanaka, Noriaki

doi:10.1097/tp.0b013e318181e02d

Cited by 94 publications

(87 citation statements)

References 42 publications

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“…Although portal inflow modulation has been reported to prevent SFSS, (33)(34)(35)(36) the role of modulation remains controversial. (37,38) We previously reported that small graft size is associated with high PVP and that high PVP (25 mm Hg) is correlated with posttransplant thrombocytopenia, (39) but we have not performed any portal inflow modulation because there has not been a recipient with high PVP since that study.…”

Section: Discussionmentioning

confidence: 99%

Minimum graft size calculated from preoperative recipient status in living donor liver transplantation

et al. 2016

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Small-for-size graft syndrome is an inevitable complication in living donor liver transplantation (LDLT). We hypothesized that graft weight (GW) measured after graft procurement is one of the variables predicting postoperative graft function. A total of 138 consecutive recipients of adult-to-adult LDLT between March 1999 and October 2014 were included in this study. We investigated the factors associated with small-for-size-associated graft loss (SAGL) to determine the GW required for each patient. Both preoperatively assessed and postoperatively obtained risk factors for SAGL were analyzed in univariate and multivariate logistic regression analysis. Twelve (8.8%) of the transplant recipients had SAGL. In multivariate logistic regression analyses using preoperatively assessed variables, the preoperative Model for End-Stage Liver Disease (MELD) score (P < 0.001) and actual GW/recipient standard liver volume (SLV) ratio (P 5 0.008) were independent predictors of SAGL. Living donor liver transplantation (LDLT) has been established as a lifesaving treatment for end-stage liver disease (ESLD) and acute liver failure, though it is not considered to be as ideal a treatment as deceased donor liver transplantation due to substantial risk of mortality for living donors.(1-6) Morbidities among living donors are reported to be more frequent in right lobectomy than left lobectomy or left lateral sectionectomy. (7) Many transplant programs use a left lobe graft in LDLT to minimize morbidities in living donors. (8,9) However, despite excellent postoperative results using the left lobe, it is not applicable to a certain group of LDLT candidates. We previously reported that a high preoperative Model for End-Stage Liver Disease (MELD) score (10,11) was associated with postoperative graft failure. (12,13) A Kyushu group also pointed out that ESLD patients with high MELD scores are not suitable candidates for LDLT using a left lobe graft because of poor postoperative prognosis. (9,14) A study in Hong Kong reported that acute or chronic hepatitis B virus (HBV)-infected ESLD patients can be rescued by right lobe with middle hepatic vein (MHV) graft in their LDLT series. (15) Graft volume and recipient prognosis are thought to be correlated, and the minimal graft volume required

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Section: Discussionmentioning

confidence: 99%

Minimum graft size calculated from preoperative recipient status in living donor liver transplantation

et al. 2016

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“…23,33,35 This modulation may be done by performing splenectomy, splenic artery ligation, or hemiportocaval shunt. [35][36][37][38][39][40][41][42][43] The frequency of portal flow modulation was similar with left and right lobe grafts. The mean baseline portal vein flow was greater with left than right lobes (Table 2).…”

Section: Discussionmentioning

confidence: 69%

Untitled

2014

Exp Clin Transplant

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“…However, an exaggerated HABR may contribute to ischemic injury in states of portal hyperfusion, as seen in small for size grafts [48,49] . Prophylactic splenic artery modulation [50,51] produced a significant reduction in portal flow causing a significant reduction in incidence of SFSS.…”

Section: Intraoperative Featuresmentioning

confidence: 99%

Split liver transplantation: What’s unique?

Dalal

2015

WJT

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The intraoperative management of split liver transplantation (SLT) has some unique features as compared to routine whole liver transplantations. Only the liver has this special ability to regenerate that confers benefits in survival and quality of life for two instead of one by splitting livers. Primary graft dysfunction may result from small for size syndrome. Graft weight to recipient body weight ratio is significant for both trisegmental and hemiliver grafts. Intraoperative surgical techniques aim to reduce portal hyperperfusion and decrease venous portal pressure. Ischemic preconditioning can be instituted to protect against ischemic reperfusion injury which impacts graft regeneration. Advancement of the technique of SLT is essential as use of split cadaveric grafts expands the donor pool and potentially has an excellent future.

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Effects of Prophylactic Splenic Artery Modulation on Portal Overperfusion and Liver Regeneration in Small-for-Size Graft

Abstract: In SFS graft with severe portal hypertension, prophylactic splenic embolization/ligation seems to relieve portal overperfusion injury and contributes in improvement of posttransplantation prognosis through liver regeneration.

Cited by 94 publications

References 42 publications

Minimum graft size calculated from preoperative recipient status in living donor liver transplantation

Minimum graft size calculated from preoperative recipient status in living donor liver transplantation

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Split liver transplantation: What’s unique?

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