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

Abstract

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.

Is Portal Venous Pressure Modulation Still Indicated for All Recipients in Living Donor Liver Transplantation?

“…Posttransplant portal hypertension (PHT) causes critical problems with liver function and graft regeneration after liver transplantation; intraoperative portal venous pressure (PVP) modulation has been performed to reduce PHT. (1)(2)(3)(4)(5)(6) With accumulated evidence, consensus has been reached on the use of PVP modulation to improve graft function and prevent small-for-size syndrome (SFSS). PVP modulation was initially achieved with portocaval shunting; splenectomy is currently the most common procedure for PVP modulation.…”

Long-term Combined Therapy with Very-low-dose Peginterferon and Ursodeoxycholic Acid Decreased the Spleen Size in a Patient with Hepatitis C Virus-related Cirrhosis

“…Therefore, enlargement of liver volume is considered to be due to liver regeneration. Liver regeneration decreases portal venous pressure (24). Hence, in the present case, liver regeneration may have contributed to shrinkage of the spleen.…”

Blood Flows in Tributaries of the Portal Vein: Anatomical and Angiographic Studies in Normal Beagle Dogs

“…This new information is of paramount importance because it throws light on some of the implications of various digestive disorders on the hepatic parenchyma, especially the preferential localization of secondary hepatic metastasis in the case of aggressive intestinal tumours. Conversely, it would also impact the portal blood flow after certain liver surgery techniques, particularly right lobe liver resection, as demonstrated recently in humans (Wu et al., ).…”