Predictive Value of Hepatic Venous Pressure Gradient for Graft Hemodynamics in Living Donor Liver Transplantation

Abstract

The hepatic venous pressure gradient (HVPG) measurement is known to correlate with the severity of portal hypertension in patients with liver cirrhosis. This retrospective study investigated the clinical value of preoperative measurement of HVPG in patients who underwent adult‐to‐adult living donor liver transplantation (LDLT) and its predictive value for hepatic hemodynamics after graft reperfusion. For this study, 75 patients who underwent adult‐to‐adult LDLT were divided into 2 groups (HVPG <16 mm Hg or HVPG ≥16 mm Hg) to investigate the correlation between preoperative HVPG and characteristics and surgical outcomes of the patients, including portal vein flow (PVF) and hepatic artery flow (HAF) after graft reperfusion. In total, 35 (46.7%) patients had an HVPG ≥16 mm Hg. These patients had significantly higher international normalized ratio values, serum creatinine levels, and Model for End‐Stage Liver Disease scores compared with the 40 patients with HVPG <16 mm Hg. They also had higher rates of variceal bleeding, encephalopathy, and intractable ascites as well as lower serum albumin levels and platelet counts compared with those patients with HVPG <16 mm Hg. Portal inflow modulation (PIM) was frequently performed in the patients with HVPG ≥16 mm Hg compared with those with HVPG <16 mm Hg. No significant differences in surgical outcomes after LDLT were found between these 2 groups except for postoperative ascites. Preoperative HVPG showed a positive correlation with PVF and a negative correlation with HAF after graft reperfusion (false discovery rate [FDR] P = 0.08 and FDR P = 0.08, respectively). In linear regression analyses, preoperative HVPG was independently associated with PVF after graft reperfusion. In conclusion, our findings indicate that preoperative HVPG is associated with hepatic hemodynamics after graft implantation in LDLT. HVPG as a routine preoperative evaluation may be helpful for surgical planning of PIM.

Endoscopic therapy + β-blocker vs. covered transjugular intrahepatic portosystemic shunt for prevention of variceal rebleeding in cirrhotic patients with hepatic venous pressure gradient ≥16 mmHg

“…This may be due to that patients with higher HVPG were more likely to choose TIPS based on clinician experience which incidence of OHE was higher [35]. A similar result can be observed in the study of Matsushima et al that the incidence of HE in patients with HVPG <16 mmHg was lower in HVPG >16 mmHg [30].…”

“…A similar result can be observed in the study of Matsushima et al . that the incidence of HE in patients with HVPG <16 mmHg was lower in HVPG >16 mmHg [30].…”

“…HVPG >16 mmHg indicates a higher risk of death [18,29]. A recent study of 75 patients showed that patients with HVPG >16 mmHg had a higher incidence of variceal hemorrhage, hepatic encephalopathy, and refractory ascites than patients with HVPG <16 mmHg [30]. So we conducted the study to evaluate the effect of endoscopic therapy + β-blocker and covered TIPS for patients of high risk of bleeding with HVPG ≥16 mmHg.…”

Clinical Impact of Spontaneous Portosystemic Shunts in Liver Transplantation: A Comprehensive Assessment Through Total Shunt Area Measurement

“…42 Such hypothesis might also be tested analyzing the association of TSA and preoperative or intraoperative hepatic-venous-pressure gradient, as already reported in the living-donor liver transplantation (LDLT) setting. 43…”

Early allograft dysfunction after living donor liver transplantation—current concepts and future directions

“…At Cleveland Clinic, a HVPG is routinely measured preoperatively to determine the indication for PIM in adult LDLT. [42] Singh et al, in 135 adult LDLT recipients, highlighted the importance of estimating functional graft size quantitatively, considering the high intraoperative pressure gradient across the liver graft (portal pressurecentral venous pressure [CVP] > 12 mm Hg) and low graft to recipient splenic volume ratio ≤ 1.15 g/cc. The hyperperfusion index of ≥ 9.97 mm Hg.cc/g predicted early graft outcomes and recipient mortality.…”