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Left lobe adult‐to‐adult living donor liver transplantation: Should portal inflow modulation be added?
Author(s) -
Ishizaki Yoichi,
Kawasaki Seiji,
Sugo Hiroyuki,
Yoshimoto Jiro,
Fujiwara Noriko,
Imamura Hiroshi
Publication year - 2012
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.22440
Subject(s) - medicine , liver transplantation , transplantation , portal venous pressure , hemodynamics , surgery , portal hypertension , urology , nuclear medicine , cardiology , cirrhosis
Recently, the successful application of portal inflow modulation has led to renewed interest in the use of left lobe grafts in adult‐to‐adult living donor liver transplantation (LDLT). However, data on the hepatic hemodynamics supporting portal inflow modulation are limited, and the optimal portal circulation for a liver graft is still unclear. We analyzed 42 consecutive adult‐to‐adult left lobe LDLT cases without splenectomy or a portocaval shunt. The mean actual graft volume (GV)/recipient standard liver volume (SLV) ratio was 39.8% ± 5.7% (median = 38.9%, range = 26.1%‐54.0%). The actual GV/SLV ratio was less than 40% in 24 of the 42 cases, and the actual graft‐to‐recipient weight ratio was less than 0.8% in 17 of the 42 recipients. The mean portal vein pressure (PVP) was 23.9 ± 7.6 mm Hg (median = 23.5 mm Hg, range = 9‐38 mm Hg) before transplantation and 21.5 ± 3.6 mm Hg (median = 22 mm Hg, range = 14‐27 mm Hg) after graft implantation. The mean portal pressure gradient (PVP − central venous pressure) was 14.5 ± 6.8 mm Hg (median = 13.5 mm Hg, range = 3‐26 mm Hg) before transplantation and 12.4 ± 4.4 mm Hg (median = 13 mm Hg, range = 1‐21 mm Hg) after graft implantation. The mean posttransplant portal vein flow was 301 ± 167 mL/minute/100 g of liver in the 38 recipients for whom it was measured. None of the recipients developed small‐for‐size syndrome, and all were discharged from the hospital despite portal hyperperfusion. The overall 1‐, 3‐, and 5‐year patient and graft survival rates were 100%, 97%, and 91%, respectively. In conclusion, LDLT with a left liver graft without splenectomy or a portocaval shunt yields good long‐term results for adult patients with a minimal donor burden. Liver Transpl 18:305–314, 2012. © 2012 AASLD.