Role of splanchnic hemodynamics in liver regeneration after living donor liver transplantation

Abstract

The aim of this study was to investigate the changes in splanchnic hemodynamics after LDLT and their relationship with graft regeneration. Eighteen patients with LDLT December 2006 and June 2008 were enrolled, and color Doppler ultrasonography was performed preoperatively and on postoperative days (PODs) 1, 3, 5, 7, 30, and 90 after transplantation. The changes in the portal blood flow mean velocity (PBV) and portal blood flow volume (PBF) were monitored, and their effects on hepatic function were observed simultaneously. Graft sizes were measured on PODs 7, 30, and 90 after the operation. The regeneration rates of grafts were calculated. PBF increased in the recipient group from 1081.17 +/- 277.50 to 2171.44 +/- 613.15 mL/minute, and PBV increased from 15.01 +/- 5.67 to 56.00 +/- 22.11 cm/s; they were both significantly higher than those in the donor group (P < 0.01). On POD 1, serum aspartic aminotransferase, alanine aminotransferase, and total bilirubin all peaked; however, these indices in patients with PBF/graft weight (GW) > 300 mL/minute . 100 g were significantly higher than those in patients with PBF/GW < 300 mL/minute . 100 g. Livers in the recipient group regenerated rapidly. The graft regeneration rate reached 119.40% +/- 28.21% as early as 1 month post-transplantation. PBF and PBV on PODs 1 and 3 were greatly related to liver regeneration at 30 days. The portal venous flow in patients with portal hypertension after LDLT showed a high perfusion state, which could promote graft regeneration, but PBF/GW after the operation should be controlled below 300 mL/minute . 100 g in order to protect grafts from hyperperfusion injury.

Mediastinal pulmonary artery is associated with greater artery diameter and lingular division volume

“…Regarding correlation between blood flow and organ volume, portal blood flow was associated with degree of liver regeneration after hepatectomy 26 as well as after liver transplantation 27 . Our finding is more likely to be collateral evidence that blood flow can be a determinant of lung volume in normal lung development.…”

Liver graft hyperperfusion in the early postoperative period promotes hepatic regeneration 2 weeks after living donor liver transplantation

“…[10] On the contrary, other studies found significant correlations between PVVs and various other indices representing hepatic regeneration obtained at different postoperative time points. [2,9] However, these studies did not analyze data with PVV/GW. At this point, it is difficult to explain discrepancies in results between the studies because of differences in study designs.…”

“…[10] However, this study also included 3 patients with fulminant hepatic failure and assessed the hepatic regeneration rate earlier than 2 weeks after LDLT, when the effects of early graft edema on the liver graft are still prevalent. Lastly, Jiang et al's study, [9] which showed the correlations of PVV and PVF on POD 1 and 3 with percent change in GW between preoperative period and POD 30, included only 18 patients. All the above studies standardized only the surgical technique without considering standardization of anesthetic management.…”

Living donor liver transplantation

“…Cheng et al [29] demonstrated that modulation of portal flow to prevent hyperperfusion through splenic artery ligation or splenectomy can promote graft regeneration. Jiang et al [30] also demonstrated that portal hyperperfusion has to be kept under 300 ml/min per 100 g of hepatic tissue to maintain regeneration of the graft.…”