Modulation of Portal Graft Inflow: A Necessity in Adult Living-Donor Liver Transplantation?

Abstract

When a suboptimal graft:recipient body weight ratio is accompanied by high rPVF in ALDLTx, the portal flow should be modulated perioperatively; splenic artery ligation is a simple and safe method that is sufficient to allow this modulation in most patients.

Cavoportal transposition for portal vein thrombosis in a pediatric living-related liver transplantation

“…Graft regeneration, however, is not affected, and the histologic changes are reversible with time. 8 The problem of portal hyperperfusion must be kept in mind if CPT is to be used in adult patients, especially when the GRBWR is likely to be lower than 0.8.…”

Splenectomy improves survival by increasing arterial blood supply in a rat model of reduced-size liver

“…To avoid liver failure by portal hyperperfusion, techniques for reduction of portal inflow, such as portal-caval and mesocaval shunts, splenic artery ligation, and splenectomy have been established [12][13][14]. As the splenic fraction accounts for up to 52% of the total portal venous inflow [15], its contribution to portal hypertension is evident. As a consequence, the extent of spleen-derived blood perfusion is an important factor in determining portal inflow pressure.…”

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“…3,6,7 In LDLT, the hemodynamic changes are much more pronounced than in DDLT, with a high perfusion state that is predominantly portal with increases in the PV flow and velocities and increased HA resistance. [8][9][10] Analysis of Doppler ultrasonographic findings may be confusing intrao peratively and in the early period after transplant due to complex vascular anastomoses, donor-recipient vascular size mismatch, and reduced graft volume. Regarding changes in portal and arterial parameters by Doppler ultrasonography, they are still under debate.…”