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A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio

View Article: PubMed Central - PubMed

ABSTRACT

Background: In adult living donor liver transplantation (ALDLT), graft-to-recipient weight ratio of less than 0.8 is incomplete for predicting portal hypertension (>20 mm Hg) after reperfusion. We aimed to identify preoperative factors contributing to portal venous pressure (PVP) after reperfusion and to predict portal hypertension, focusing on spleen volume-to-graft volume ratio (SVGVR).

Methods: In 73 recipients with ALDLT between 2002 and 2013, first we analyzed survival according to PVP of 20 mm Hg as the threshold, evaluating the efficacy of splenectomy. Second, we evaluated various preoperative factors contributing to portal hypertension after reperfusion.

Results: All of the recipients with PVP greater than 20 mm Hg (n = 19) underwent PVP modulation by splenectomy, and their overall survival was favorable compared with 54 recipients who did not need splenectomy (PVP ≤ 20 mm Hg). Graft-to-recipient weight ratio had no correlation with PVP.

Results: Multivariate analysis revealed that estimated graft and spleen volume were significant factors contributing to PVP after reperfusion (P < 0.0001 and P < 0.0001, respectively). Furthermore, estimated SVGVR showed a significant negative correlation to PVP after reperfusion (R = 0.652), and the best cutoff value for portal hypertension was 0.95.

Conclusions: In ALDLT, preoperative assessment of SVGVR is a good predictor of portal hypertension after reperfusion can be used to indicate the need for splenectomy before reperfusion.

No MeSH data available.


Flow chart detailing recipients who underwent ALDLTs. In study 1, efficacy of splenectomy was investigated in 73 recipients whose precise records of PVP were preserved. In study 2, factors contributing to PVP after reperfusion were analyzed in 55 recipients whose preoperative spleen volumetry was available.
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Figure 1: Flow chart detailing recipients who underwent ALDLTs. In study 1, efficacy of splenectomy was investigated in 73 recipients whose precise records of PVP were preserved. In study 2, factors contributing to PVP after reperfusion were analyzed in 55 recipients whose preoperative spleen volumetry was available.

Mentions: Adult living donor liver transplantation was performed in 112 consecutive recipients at Mie University Hospital from March 2002 to March 2013. We reviewed precise records on PVP in 75 recipients (Figure 1).


A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio
Flow chart detailing recipients who underwent ALDLTs. In study 1, efficacy of splenectomy was investigated in 73 recipients whose precise records of PVP were preserved. In study 2, factors contributing to PVP after reperfusion were analyzed in 55 recipients whose preoperative spleen volumetry was available.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120765&req=5

Figure 1: Flow chart detailing recipients who underwent ALDLTs. In study 1, efficacy of splenectomy was investigated in 73 recipients whose precise records of PVP were preserved. In study 2, factors contributing to PVP after reperfusion were analyzed in 55 recipients whose preoperative spleen volumetry was available.
Mentions: Adult living donor liver transplantation was performed in 112 consecutive recipients at Mie University Hospital from March 2002 to March 2013. We reviewed precise records on PVP in 75 recipients (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

Background: In adult living donor liver transplantation (ALDLT), graft-to-recipient weight ratio of less than 0.8 is incomplete for predicting portal hypertension (>20 mm Hg) after reperfusion. We aimed to identify preoperative factors contributing to portal venous pressure (PVP) after reperfusion and to predict portal hypertension, focusing on spleen volume-to-graft volume ratio (SVGVR).

Methods: In 73 recipients with ALDLT between 2002 and 2013, first we analyzed survival according to PVP of 20 mm Hg as the threshold, evaluating the efficacy of splenectomy. Second, we evaluated various preoperative factors contributing to portal hypertension after reperfusion.

Results: All of the recipients with PVP greater than 20 mm Hg (n = 19) underwent PVP modulation by splenectomy, and their overall survival was favorable compared with 54 recipients who did not need splenectomy (PVP ≤ 20 mm Hg). Graft-to-recipient weight ratio had no correlation with PVP.

Results: Multivariate analysis revealed that estimated graft and spleen volume were significant factors contributing to PVP after reperfusion (P < 0.0001 and P < 0.0001, respectively). Furthermore, estimated SVGVR showed a significant negative correlation to PVP after reperfusion (R = 0.652), and the best cutoff value for portal hypertension was 0.95.

Conclusions: In ALDLT, preoperative assessment of SVGVR is a good predictor of portal hypertension after reperfusion can be used to indicate the need for splenectomy before reperfusion.

No MeSH data available.