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Selective Hemi‐Portocaval Shunt Based on Portal Vein Pressure for Small‐for‐Size Graft in Adult Living Donor Liver Transplantation
Author(s) -
Yamada T.,
Tanaka K.,
Uryuhara K.,
Ito K.,
Takada Y.,
Uemoto S.
Publication year - 2008
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2007.02144.x
Subject(s) - medicine , surgery , shunt (medical) , portal vein , transplantation , laparotomy , living donor liver transplantation , portacaval shunt , liver transplantation , portal venous pressure , portal hypertension , cirrhosis , gastroenterology
We developed an algorithm of graft selection in which left lobe donation is considered primarily if the graft‐to‐recipient weight ratio (GRWR) is estimated to be greater than 0.6% in preoperative volumetry with utilization of a hemi‐portocaval shunt (HPCS) based on portal vein pressure (PVP) more than 20 mmHg at the time of laparotomy. A total of 11 consecutive adult living donor liver transplantations with small‐for‐size graft according to our graft selection algorithm were performed between December 2005 and August 2007. Ten patients required HPCS using a vein graft all survived without small‐for‐size syndrome (SFSS) and shunt complications with a median follow‐up of 296 days. One patient without HPCS died of chronic vascular rejection. In all cases, PVP were regulated successfully under 20 mmHg by HPCS. Graft volume reached in mean 84.3% of standard liver volume in right lobe grafts and mean 95.4% in left lobe grafts at 3 months after liver transplantation. Actuarial rate of shunt patency at 1, 3, 6 months and 1 year were 80%, 55%, 26% and 20%, respectively. Selective HPCS based on PVP is an effective procedure and results in excellent patient and graft survival with avoidance of SFSS in grafts greater than 0.6% of GRWR.