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A portal pressure cut‐off of 15 versus a cut‐off of 20 for prevention of small‐for‐size syndrome in liver transplantation: A comparative study
Author(s) -
Osman Ayman M.A.,
Hosny Adel A.,
ElShazli Mostafa A.,
Uemoto Shinji,
Abdelaziz Omar,
Helmy Ayman S.
Publication year - 2017
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12727
Subject(s) - medicine , portal venous pressure , liver transplantation , portal hypertension , hepatic encephalopathy , bilirubin , group b , gastroenterology , transplantation , surgery , living donor liver transplantation , cirrhosis
Aim Portal hypertension has recently been implicated in the pathogenesis of small‐for‐size syndrome (SFSS) in adult‐to‐adult living‐donor liver transplantation (A‐LDLT). The aim of our study is to compare the portal venous pressure (PVP) cut‐off values of 15 mmHg and 20 mmHg in terms of prevention of SFSS in A‐LDLT.Methods Seventy‐six patients underwent A‐LDLT. A PVP <20 mmHg at the end of the operation was targeted using graft inflow modulation. Patients were divided into two groups: group A, final PVP <15 mmHg; and group B, final PVP 15–19 mmHg. Peak serum bilirubin and peak international normalized ratio in the first month after A‐LDLT, as well as hepatic encephalopathy, SFSS, 90‐day morbidity, and mortality were observed in both groups.Results Final PVP was well controlled below 20 mmHg in all patients (group A, n = 39; group B, n = 37). Six patients suffered SFSS in group B (16.2%) compared to one patient (2.6%) in group A ( P = 0.04). Nine patients died in group B (24.3%), four of whom died of SFSS, compared to three patients in group A (7.7%) ( P = 0.047).Conclusion A PVP cut‐off of 15 mmHg seems to be a more appropriate target level than a cut‐off of 20 mmHg for prevention of postoperative SFSS in A‐LDLT.