Strategies for improving the outcomes of small-for-size grafts in adult-to-adult living-donor liver transplantation

Imura, Satoru; Shimada, Mitsuo; Ikegami, Toru; Morine, Yuji; Kanemura, Hirofumi

doi:10.1007/s00534-007-1297-3

Cited by 33 publications

(46 citation statements)

References 92 publications

(174 reference statements)

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“…Occlusion of the VG caused venous congestion of the right paramedian sector, thus delaying the recovery of liver function. Persistent ascites can be caused by an inadequate hepatic mass [14,15] . The regenerated liver cannot reach its adequate size in the early postoperative period and venous congestion of the right paramedian sector can further decrease the functional hepatic mass size.…”

Section: Discussionmentioning

confidence: 99%

Sonographic evaluation of vessel grafts in living donor liver transplantation recipients of the right lobe

Lu¹,

Wu²,

Fan³

et al. 2009

WJG

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AIM:To evaluate the vessel grafts (VG) used to reconstruct the middle hepatic vein (MHV) tributaries with ultrasonography. METHODS:Twenty-four patients undergone living donor liver transplantation were enrolled in our study. MHV tributaries larger than 5 mm in diameter were reconstructed with interposition VG. Blood flow of the graft and interposition VG was checked by Doppler ultrasonography daily in the first 2 postoperative weeks and monthly followed up after discharge. The sensitivity of VG detected by ultrasonography was assessed using surgical records as references. Student's t test was used to compare the velocity of VG and occluded VG in chronic patents (> 3 mo).RESULTS: Thirty-one VG were used to reconstruct the MHV tributaries. Ultrasonography identified 96.7% (30/31) of large MHV tributaries and 90.3% (28/31) of VG. The diameter of VG was 5.6 ± 0.8 mm and the velocity of VG was 19.7 ± 8.1 cm/s. Two VG (2/31, 6.5%) were occluded on the first postoperative day in one patient who suffered from persistent ascites and had a prolonged recovery of liver function. Twenty-six VG (26/31, 83.9%) were patent 2 wk after operation. Six (6/31, 19.4%) VG were patent over 3 mo after operation. Intrahepatic venous collaterals were detected in 29.2% (7/24) patients. The velocity of VG and occluded VG was 30.1 ± 5.6 cm/s, 16.5 ± 5.8 cm/s, respectively, in chronic patents. The difference between two groups was statistically significant (P < 0.001). CONCLUSION:Our results indicate that most VG are patent in the first postoperative week while only a small portion with a higher velocity remains patent after 3 mo. Intrahepatic venous collaterals can be observed in some patients after occlusion of VG.

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Section: Discussionmentioning

confidence: 99%

Sonographic evaluation of vessel grafts in living donor liver transplantation recipients of the right lobe

Lu¹,

Wu²,

Fan³

et al. 2009

WJG

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“…Die wissenschaftlichen Erkenntnisse zur Pathogenese des "Small-for-size"-Syndroms haben die Entwicklung verschiedener chirurgischer Techniken vorangetrieben [40,47,[77][78][79][80]. Erste Bestrebungen hatten die direkte Vergröße-rung des Transplantatvolumens durch auxiliäre Transplantation, die Nutzung zweier Transplantate sowie die Verwendung der größeren rechten statt der linken Leberhälfte nach Lebendspende zum Ziel.…”

Section: Modifikation Des Portalvenösen Und Hepatoarteriellen Flussesunclassified

„Small-for-size“

Eipel

Abshagen

Vollmar

2011

Chirurg

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The characteristics of the hepatic macrocirculation, i.e., the parallel portal-venous and arterial blood supply, is of utmost relevance for liver surgery. With extended hepatectomy or transplantation of a reduced-size liver the remaining or transplanted liver tissue is overperfused because the liver fails to regulate the portal-venous inflow. This portal hyperperfusion is responsible for the initiation of liver cell proliferation but represents at the same time one of the substantial events in the pathogenesis of the small-for-size syndrome. Portal-venous hyperperfusion, the so-called hepatic arterial buffer response, which describes the semi-reciprocal relationship between the portal-venous and hepatic arterial blood flows, leads to an arterial hypoperfusion of the small-for-size liver. In this article experimental and clinical data are discussed which underline the high but so far overseen relevance of this arterial underperfusion in the development of a small-for-size syndrome.

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“…[3][4][5][6][7] However, the wider application of LDLT has revealed innate problems, including small-for-size (SFS) graft syndrome. [6][7][8][9][10][11][12] Small-for-size graft syndrome and other problems related to the use of SFS grafts were reported initially in 1996 by Emond et al, 5 and have gradually come to light since then. [6][7][8][9][10][11][12] The principal pathogenesis of SFS graft syndrome is unbalance between the accelerated liver regeneration and the increased demand of liver function, leading to severe graft dysfunction with prolonged hyperbilirubinemia and increased ascites output.…”

Section: Introductionmentioning

confidence: 99%

Current concept of small-for-size grafts in living donor liver transplantation

et al. 2008

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The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called "small-for-size (SFS) graft syndrome." The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extension to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by an SFS graft, such as a portosystemic shunt or splenectomy, have been trialed with some positive results. To establish an effective strategy for transplanting SFS grafts and preventing SFS graft syndrome, it is essential to have precise knowledge and tactics to evaluate graft quality and graft volume, when performing these LDLTs with portal pressure control. We reviewed the updated literature on the pathogenesis of and strategies for using SFS grafts.

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Strategies for improving the outcomes of small-for-size grafts in adult-to-adult living-donor liver transplantation

Cited by 33 publications

References 92 publications

Sonographic evaluation of vessel grafts in living donor liver transplantation recipients of the right lobe

Sonographic evaluation of vessel grafts in living donor liver transplantation recipients of the right lobe

„Small-for-size“

Current concept of small-for-size grafts in living donor liver transplantation

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