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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.


Cumulative survival rate according to PVP after reperfusion with a threshold of more than 20 mm Hg. Survival rate of 19 recipients who underwent splenectomy for PVP > 20 mm Hg after reperfusion was as favorable as that of 54 recipients with PVP ≤ 20 mm Hg after reperfusion.
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Figure 3: Cumulative survival rate according to PVP after reperfusion with a threshold of more than 20 mm Hg. Survival rate of 19 recipients who underwent splenectomy for PVP > 20 mm Hg after reperfusion was as favorable as that of 54 recipients with PVP ≤ 20 mm Hg after reperfusion.

Mentions: In the 73 recipients, PVP after reperfusion was 18.3 ± 5.7 mm Hg. Splenectomy was performed in 19 recipients because PVP was more than 20 mm Hg (25.8 ± 4.7) after reperfusion, and PVP decreased to 20 mm Hg or less (16.7 ± 4.0) in 17 of them, but was still more than 20 mm Hg in the other 2 recipients (23 and 25 mm Hg, respectively) (Figure 2). The 2 recipients with PVP of more than 20 mm Hg even after splenectomy had prolonged hyperbilirubinemia but recovered in the postoperative acute phase. One of them especially, had complications with massive ascites and sepsis. The 1-, 3-, 5-year cumulative survival rates were 79.6%, 73.3%, and 71.2%, respectively, in the 54 recipients with PVP of 20 mm Hg or less after reperfusion and 89.5%, 77.5%, and 69.8% in the 19 with PVP of more than 20 mm Hg followed by splenectomy, showing no significant difference between the 2 groups (P = 0.803) (Figure 3). In 54 patients with PVP of 20 mm Hg or less after reperfusion, 9 recipients (16.7%) died within 6 months after LT, despite the large graft volume: the median GRWR was 1.12 (0.67-1.32). However, the median MELD score was high: 28 (9-44), and the causes of death were not related with the graft size (sepsis in 3 recipients, pneumonia in 2, fibrosing cholestatic hepatitis of HCV in 1, cerebral bleeding in 1, rupture of splenic arterial aneurysm in 1 and gastrointestinal bleeding in 1). Additionally, precise records on CVP measured at the same time as PVP after reperfusion were available for 53 recipients, whose CVP was 7.0 ± 2.8 mm Hg. Portal venous pressure after reperfusion had no correlation to CVP after reperfusion (R = 0.057).


A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio
Cumulative survival rate according to PVP after reperfusion with a threshold of more than 20 mm Hg. Survival rate of 19 recipients who underwent splenectomy for PVP > 20 mm Hg after reperfusion was as favorable as that of 54 recipients with PVP ≤ 20 mm Hg after reperfusion.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 3: Cumulative survival rate according to PVP after reperfusion with a threshold of more than 20 mm Hg. Survival rate of 19 recipients who underwent splenectomy for PVP > 20 mm Hg after reperfusion was as favorable as that of 54 recipients with PVP ≤ 20 mm Hg after reperfusion.
Mentions: In the 73 recipients, PVP after reperfusion was 18.3 ± 5.7 mm Hg. Splenectomy was performed in 19 recipients because PVP was more than 20 mm Hg (25.8 ± 4.7) after reperfusion, and PVP decreased to 20 mm Hg or less (16.7 ± 4.0) in 17 of them, but was still more than 20 mm Hg in the other 2 recipients (23 and 25 mm Hg, respectively) (Figure 2). The 2 recipients with PVP of more than 20 mm Hg even after splenectomy had prolonged hyperbilirubinemia but recovered in the postoperative acute phase. One of them especially, had complications with massive ascites and sepsis. The 1-, 3-, 5-year cumulative survival rates were 79.6%, 73.3%, and 71.2%, respectively, in the 54 recipients with PVP of 20 mm Hg or less after reperfusion and 89.5%, 77.5%, and 69.8% in the 19 with PVP of more than 20 mm Hg followed by splenectomy, showing no significant difference between the 2 groups (P = 0.803) (Figure 3). In 54 patients with PVP of 20 mm Hg or less after reperfusion, 9 recipients (16.7%) died within 6 months after LT, despite the large graft volume: the median GRWR was 1.12 (0.67-1.32). However, the median MELD score was high: 28 (9-44), and the causes of death were not related with the graft size (sepsis in 3 recipients, pneumonia in 2, fibrosing cholestatic hepatitis of HCV in 1, cerebral bleeding in 1, rupture of splenic arterial aneurysm in 1 and gastrointestinal bleeding in 1). Additionally, precise records on CVP measured at the same time as PVP after reperfusion were available for 53 recipients, whose CVP was 7.0 ± 2.8 mm Hg. Portal venous pressure after reperfusion had no correlation to CVP after reperfusion (R = 0.057).

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.