Limits...
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.


Related in: MedlinePlus

ROC curve of estimated SVGVR in portal hypertension of more than 20 mm Hg after reperfusion, and the relation between SVGV ratio and PVP after reperfusion. The cutoff value of SVGVR was set as 0.95. In 15 recipients with SVGV of 0.95 or more, 11 (73.3%) had portal hypertension.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5120765&req=5

Figure 6: ROC curve of estimated SVGVR in portal hypertension of more than 20 mm Hg after reperfusion, and the relation between SVGV ratio and PVP after reperfusion. The cutoff value of SVGVR was set as 0.95. In 15 recipients with SVGV of 0.95 or more, 11 (73.3%) had portal hypertension.

Mentions: Because both estimated graft and spleen volumes were significantly correlated with PVP after reperfusion, it was considered that their ratio, that is, spleen volume graft volume ratio (SVGVR), reflected PVP after reperfusion more accurately. Estimated SVGVR showed a more significant positive correlation with PVP after reperfusion (R = 0.652) (Figure 6). ROC analysis of SVGVR revealed that the best cutoff value for PVP of more than 20 mm Hg was between 0.923 and 0.968 (AUC, 0.820; 95% CI, 0.689-0.952; P < 0.0001; sensitivity, 70.6-64.7%; specificity, 77.1-92.1%). Therefore, the optimal predictive SVGVR cutoff level of PVP of more than 20 mm Hg was set at 0.95. Of the 15 recipients with SVGVR of more than 0.95, 11 (73.3%) developed PVP of more than 20 mm Hg after reperfusion.


A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio
ROC curve of estimated SVGVR in portal hypertension of more than 20 mm Hg after reperfusion, and the relation between SVGV ratio and PVP after reperfusion. The cutoff value of SVGVR was set as 0.95. In 15 recipients with SVGV of 0.95 or more, 11 (73.3%) had portal hypertension.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 6: ROC curve of estimated SVGVR in portal hypertension of more than 20 mm Hg after reperfusion, and the relation between SVGV ratio and PVP after reperfusion. The cutoff value of SVGVR was set as 0.95. In 15 recipients with SVGV of 0.95 or more, 11 (73.3%) had portal hypertension.
Mentions: Because both estimated graft and spleen volumes were significantly correlated with PVP after reperfusion, it was considered that their ratio, that is, spleen volume graft volume ratio (SVGVR), reflected PVP after reperfusion more accurately. Estimated SVGVR showed a more significant positive correlation with PVP after reperfusion (R = 0.652) (Figure 6). ROC analysis of SVGVR revealed that the best cutoff value for PVP of more than 20 mm Hg was between 0.923 and 0.968 (AUC, 0.820; 95% CI, 0.689-0.952; P < 0.0001; sensitivity, 70.6-64.7%; specificity, 77.1-92.1%). Therefore, the optimal predictive SVGVR cutoff level of PVP of more than 20 mm Hg was set at 0.95. Of the 15 recipients with SVGVR of more than 0.95, 11 (73.3%) developed PVP of more than 20 mm Hg after reperfusion.

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 (&gt;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 &le; 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 &lt; 0.0001 and P &lt; 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