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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

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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.


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ROC curve of graft volume and spleen volume in portal hypertension of 20 mm Hg or more after reperfusion. The cutoff value of graft and spleen volume was 557 and 488 mL, respectively. PVP after reperfusion had a significant correlation with graft and spleen volume.
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Figure 5: ROC curve of graft volume and spleen volume in portal hypertension of 20 mm Hg or more after reperfusion. The cutoff value of graft and spleen volume was 557 and 488 mL, respectively. PVP after reperfusion had a significant correlation with graft and spleen volume.

Mentions: A significant negative correlation was observed between estimated graft volume and PVP after reperfusion (R = 0.509). Furthermore, a significant positive correlation was observed between spleen volume and PVP after reperfusion (R = 0.483). ROC analysis of estimated graft volume revealed that the best cutoff value for PVP of more than 20 mm Hg was 557 mL (area under the curve [AUC], 0.784, 95% confidence interval [95% CI], 0.662-0.906; P = 0.001; sensitivity, 78.9%; specificity, 70.6%). Therefore, the optimal cutoff level of graft volume for PVP of 20 mm Hg or more after reperfusion was set at 560 mL. ROC analysis of estimated spleen volume revealed that the best cutoff value for PVP of more than 20 mm Hg was between 488 and 510 mL (AUC, 0.734; 95% CI, 0.587-0.880; P = 0.006; sensitivity, 58.8-52.9%; specificity, 78.9-84.2%). Therefore, the optimal cutoff level of estimated spleen volume for PVP of more than 20 mm Hg after reperfusion was set at 500 mL (Fig. 5).


A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio
ROC curve of graft volume and spleen volume in portal hypertension of 20 mm Hg or more after reperfusion. The cutoff value of graft and spleen volume was 557 and 488 mL, respectively. PVP after reperfusion had a significant correlation with graft and spleen volume.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 5: ROC curve of graft volume and spleen volume in portal hypertension of 20 mm Hg or more after reperfusion. The cutoff value of graft and spleen volume was 557 and 488 mL, respectively. PVP after reperfusion had a significant correlation with graft and spleen volume.
Mentions: A significant negative correlation was observed between estimated graft volume and PVP after reperfusion (R = 0.509). Furthermore, a significant positive correlation was observed between spleen volume and PVP after reperfusion (R = 0.483). ROC analysis of estimated graft volume revealed that the best cutoff value for PVP of more than 20 mm Hg was 557 mL (area under the curve [AUC], 0.784, 95% confidence interval [95% CI], 0.662-0.906; P = 0.001; sensitivity, 78.9%; specificity, 70.6%). Therefore, the optimal cutoff level of graft volume for PVP of 20 mm Hg or more after reperfusion was set at 560 mL. ROC analysis of estimated spleen volume revealed that the best cutoff value for PVP of more than 20 mm Hg was between 488 and 510 mL (AUC, 0.734; 95% CI, 0.587-0.880; P = 0.006; sensitivity, 58.8-52.9%; specificity, 78.9-84.2%). Therefore, the optimal cutoff level of estimated spleen volume for PVP of more than 20 mm Hg after reperfusion was set at 500 mL (Fig. 5).

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.


Related in: MedlinePlus