Variations of surgical reconstruction in liver transplantation depending on vasculature

Settmacher, Utz; Haase, Roland; Heise, Michael; Bechstein, Wolf O.; Neuhaus, P.

doi:10.1007/s004230050217

Cited by 26 publications

(17 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18 Another way to reduce graft inflow is represented by SAL, a technique permitting adequate HAF in standard liver transplantation and amelioration of secondary hypersplenism. 19,20 We recently proposed the use of SAL to resolve graft dysfunction in SFSG in ALDLT. 21,22 Poor graft outcome has been reported in patients with PVF values of more than 260 mL/min/ 100-g graft and small grafts and in case of enhanced portal vein pressure (PVP).…”

Section: S39mentioning

confidence: 99%

Clinical relevance of adapting portal vein flow in living donor liver transplantation in adult patients

Troisi

2003

Liver Transplantation

147

119

View full text Add to dashboard Cite

Size mismatching is a major concern in adult living donor liver transplantation (ALDLT). Graft hyperperfusion in these grafts is considered the main factor leading to graft dysfunction and poor survival. We describe the clinical significance of graft inflow modification (GIM) by splenic artery ligation in a series of 24 consecutive ALDLT. Between September 1999 and December 2001, 24 patients underwent ALDLT at our institution. Patients were divided into two groups: G1, n ‫؍‬ 11 without GIM, and G2, n ‫؍‬ 13 with GIM. Both groups were equivalent in terms of preoperative clinical state, graft characteristics, and surgical technique. Graft hyperperfusion was noticed overall, especially in small grafts (graft-to-recipient body weight ratio <0.8), with mean recipient portal vein (rPVF) values at least three times greater than those recorded in the donors. GIM permitted in G2 a significant decrease in rPVF. Small-for-size syndrome (SFSS) occurred in three (27%) patients in G1 with small grafts showing graft hyperperfusion and necessitating a retransplantation. SFSS did not occur in G2. One-year overall survival was 62% and 93% respectively for G1 and G2. It is concluded that when small-for-size grafts are accompanied by graft hyperperfusion, the rPVF should be lowered to avoid the SFSS and to improve the outcome. (Liver Transpl 2003;9:S36-S41.)

show abstract

Section: S39mentioning

confidence: 99%

Clinical relevance of adapting portal vein flow in living donor liver transplantation in adult patients

Troisi

2003

Liver Transplantation

147

119

View full text Add to dashboard Cite

show abstract

“…Preoperative imaging with MR-angiography or CT-angiography, and duplex sonography of all hepatic vessels are the standard of reference and can reveal altered vascular anatomy and flow dynamics. 38 A general principle of liver transplant surgery has been to reconstruct all donor accessory hepatic arteries while attempting to keep the number of arterial anastomoses low. However, only about 10% of accessory left hepatic arteries have to be reconstructed.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Effectiveness of a New Algorithm in Preventing Hepatic Artery Thrombosis after Liver Transplantation

Müller

Schmied

Mehrabi

et al. 2009

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

show abstract

“…The therapeutic approaches may comprise several modalities: positioning of the arterial anastomosis to the aorta, secondary (post-transplantation) splenectomy or embolization of the enlarged splenic artery [8,91. Since embolization holds the risk of major splenic infarction with subsequent abscess formation, we prefer a therapeutic secondary splenectomy.…”

Section: Discussionmentioning

confidence: 99%

Splenohepatic arterial steal syndrome in liver transplantation: clinical features and management

Geissler¹,

Lamesch²,

Witzigmann³

et al. 2002

Transplant Int

View full text Add to dashboard Cite

Well-known arterial complications after liver transplantation comprise thrombosis and major stenosis, which usually necessitate a retransplantation procedure. In our institution, in a series of 165 consecutive liver transplantations, we report the first recognized case of a splenohepatic arterial steal syndrome. This is characterized by an arterial malperfusion of the hepatic graft caused by a marked diversion of blood flow to a significantly enlarged spleen, which leads to major ischemic damage of the hepatic graft. After splenectomy the perfusion through the hepatic artery increased substantially and the graft was salvaged, with a following favorable clinical course. Splenohepatic arterial steal syndrome may ultimately result in graft loss if it is falsely diagnosed or recognized too late. A post-transplantation splenectomy represents a successful therapeutic approach; alternatively a primary arterial anastomosis to the aorta prevents the development of this condition.

show abstract

Variations of surgical reconstruction in liver transplantation depending on vasculature

Abstract: There is no increase in complications (stenosis and thrombosis) with modifications of arterial reconstruction (4.9 vs 6.3%); however, with modification of portal reconstruction the increase is from 2.4% to 8.3%.

Cited by 26 publications

References 8 publications

Clinical relevance of adapting portal vein flow in living donor liver transplantation in adult patients

Clinical relevance of adapting portal vein flow in living donor liver transplantation in adult patients

Feasibility and Effectiveness of a New Algorithm in Preventing Hepatic Artery Thrombosis after Liver Transplantation

Splenohepatic arterial steal syndrome in liver transplantation: clinical features and management

Contact Info

Product

Resources

About