Document Detail


Portal pressure <15 mm Hg is a key for successful adult living donor liver transplantation utilizing smaller grafts than before.
MedLine Citation:
PMID:  20517905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To prevent small-for-size syndrome in adult-to-adult living donor liver transplantation (A-LDLT), larger grafts (ie, right lobe grafts) have been selected in many transplant centers. However, some centers are investigating the benefits of portal pressure modulation. Five hundred sixty-six A-LDLT procedures using right or left lobe grafts were performed between 1998 and 2008. In 2006, we introduced intentional portal pressure control, and we changed the graft selection criteria to include a graft/recipient weight ratio >0.7% instead of the original value of >0.8%. All recipients were divided into period I (1998-2006, the era of unintentional portal pressure control; n = 432) and period II (2006-2008, the era of intentional portal pressure control; n = 134). The selection of small-for-size grafts increased from 7.8% to 23.9%, and the selection of left lobe grafts increased from 4.9% to 32.1%. Despite the increase in the number of smaller grafts in period II, 1-year patient survival was significantly improved (87.9% versus 76.2%). In 129 recipients in period II, portal pressure was monitored. Patients with a portal pressure <15 mm Hg demonstrated better 2-year survival (n = 86, 93.0%) than patients with a portal pressure >or=15 mm Hg (n = 43, 66.3%). The recovery from hyperbilirubinemia and coagulopathy after transplantation was significantly better in patients with a portal pressure <15 mm Hg. In conclusion, our strategy for A-LDLT has changed from larger graft-based A-LDLT to controlled portal pressure-based A-LDLT with smaller grafts. A portal pressure <15 mm Hg seems to be a key for successful A-LDLT.
Authors:
Yasuhiro Ogura; Tomohide Hori; Walid M El Moghazy; Atsushi Yoshizawa; Fumitaka Oike; Akira Mori; Toshimi Kaido; Yasutsugu Takada; Shinji Uemoto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  16     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-02     Completed Date:  2010-09-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  718-28     Citation Subset:  IM    
Copyright Information:
(c) 2010 AASLD.
Affiliation:
Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. oguchan@kuhp.kyoto-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Ascites / etiology
Blood Coagulation Disorders / etiology
Body Weight
Female
Humans
Hyperbilirubinemia / etiology
Japan
Kaplan-Meiers Estimate
Liver / anatomy & histology,  blood supply,  surgery*
Liver Transplantation* / adverse effects,  mortality
Living Donors / supply & distribution*
Male
Middle Aged
Patient Selection
Portal Pressure*
Portasystemic Shunt, Surgical
Proportional Hazards Models
Prothrombin Time
Retrospective Studies
Risk Assessment
Risk Factors
Splenectomy
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Liver Transpl. 2010 Jun;16(6):695-6   [PMID:  20517901 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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