Portal flow modulation in auxiliary partial orthotopic liver transplantation

Rela, Mohamed; Bharathan, Anand; Kumar, Pankaj; Cherian, P. Thomas; Reddy, Mettu S.

doi:10.1111/petr.12436

Cited by 22 publications

(20 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Portal steal may be a major issue in APOLT for NCMLD . It increases the risk of graft atrophy and recurrence of the original symptoms of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…The technique of OLT for NCMLD involved standard inferior vena cava (IVC) preserving hepatectomy after complete portal vein (PV) and IVC clamping. The technique of APOLT for MLD has previously been described by us in detail . Briefly, left‐sided APOLT was preferred, unless the patient was over 50 kg and/or had an organic acidemia, wherein a right lobe APOLT was favored.…”

Section: Methodsmentioning

confidence: 99%

“…As described previously, all patients undergoing APOLT for NCMLD had portal flow modulation using graded hemiportal banding, the aim being to ensure preferential portal flow to the graft and avoid the phenomenon of portal steal (Fig. ) …”

Section: Methodsmentioning

confidence: 99%

“…Schematic representation of the technique of graded hemiportal banding in a LL APOLT (Rela et al [2015]). (A) Portal pressure measured in the remnant liver after left hepatectomy (P1).…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Auxiliary Partial Orthotopic Liver Transplantation for Selected Noncirrhotic Metabolic Liver Disease

et al. 2019

Self Cite

View full text Add to dashboard Cite

Auxiliary partial orthotopic liver transplantation (APOLT) in selected noncirrhotic metabolic liver diseases (NCMLDs) is a viable alternative to orthotopic liver transplantation (OLT) as it supplements the function of the native liver with the missing functional protein. APOLT for NCMLD is not universally accepted due to concerns of increased technical complications and longterm graft atrophy. Review of a prospectively collected database of all pediatric patients (age ≤16 years) who underwent liver transplantation for NCMLD from August 2009 up to June 2017 was performed. Patients were divided into 2 groups: group 1 underwent APOLT and group 2 underwent OLT. In total, 18 OLTs and 12 APOLTs were performed for NCMLDs during the study period. There was no significant difference in the age and weight of the recipients in both groups. All APOLT patients needed intraoperative portal flow modulation. Intraoperative peak and end of surgery lactate were significantly higher in the OLT group, and cold ischemia time was longer in the APOLT group. There were no differences in postoperative liver function tests apart from higher peak international normalized ratio in the OLT group. The incidence of postoperative complications, duration of hospital stay, and 1‐ and 5‐year survivals were similar in both groups. In conclusion, we present the largest series of APOLT for NCMLD. APOLT is a safe and effective alternative to OLT and may even be better than OLT due to lesser physiological stress and the smoother postoperative period for selected patients with NCMLD.

show abstract

“…Portal steal may be a major issue in APOLT for NCMLD . It increases the risk of graft atrophy and recurrence of the original symptoms of the disease.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Schematic representation of the technique of graded hemiportal banding in a LL APOLT (Rela et al [2015]). (A) Portal pressure measured in the remnant liver after left hepatectomy (P1).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Auxiliary Partial Orthotopic Liver Transplantation for Selected Noncirrhotic Metabolic Liver Disease

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Another less extended indication for APOLT are metabolic liver diseases, mainly in children, where the rationale for LT is not to withdraw immunosuppression long term but to provide enough liver mass to replace the missing enzymatic function, with the advantage that if the graft fails the native liver is still functional to act as security net30 and also for future gene therapy 31. The main indications have been Crigler Najjar type 1 and urea cycle disorders 32.…”

Section: What Can Be Done To Achieve An Ideal Outcome?mentioning

confidence: 99%

Liver transplantation in children: state of the art and future perspectives

et al. 2017

View full text Add to dashboard Cite

In this review, we provide a state of the art of liver transplantation in children, as the procedure is now carried out for more than 30 years and most of our paediatric colleagues are managing these patients jointly with liver transplant centres. Our goal for this article is to enhance the understanding of the liver transplant process that a child and his family goes through while explaining the surgical advances and the associated complications that could happen in the immediate or long-term follow-up. We have deliberately introduced the theme that 'liver transplant is a disease' and 'not a cure', to emphasise the need for adherence with immunosuppression, a healthy lifestyle and lifelong medical follow-up.

show abstract