Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy...Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy with frequent GIM procedures,which are mostly performed by splenectomy,in LDLT.However,splenectomy can cause serious complications such as portal vein thrombosis and overwhelming postsplenectomy infection.Methods:Forty-eight adult-to-adult LDLT recipients were enrolled in this study and retrospectively reviewed.We applied the graft selection criteria,which routinely fulfill graft-to-recipient weight ratio≥0.8%,and consider GIM as a backup strategy for high portal venous pressure(PVP).Results:In our current strategy of LDLT,splenectomy was performed mostly due to hepatitis C and splenic arterial aneurysms,but splenectomy for GIM was intended to only one patient(2.1%).The final PVP values≤20 mmHg were achieved in all recipients,and no significant difference was observed in patient survival or postoperative clinical course based on whether splenectomy was performed or not.However,6 of 18 patients with splenectomy(33.3%)developed postsplenectomy portal vein thrombosis(PVT),while none of the 30 patients without splenectomy developed PVT after LDLT.Splenectomy was identified as a risk factor of PVT in this study(P<0.001).Our study revealed that a lower final PVP could be risk factor of postsplenectomy PVT.Conclusions:Using sufficient size grafts was one of the direct solutions to control PVP,and allowed GIM to be reserved as a backup procedure.Splenectomy should be avoided as much as possible during LDLT because splenectomy was found to be a definite risk factor of PVT.In splenectomy cases with a lower final PVP,a close follow-up is required for early detection and treatment of PVT.展开更多
AIM: To explore the feasibility of non-invasive quantitative estimation of portal venous pressure by contrast-enhanced ultrasound(CEUS) in a canine model.METHODS: Liver fibrosis was established in adult canines(Beagle...AIM: To explore the feasibility of non-invasive quantitative estimation of portal venous pressure by contrast-enhanced ultrasound(CEUS) in a canine model.METHODS: Liver fibrosis was established in adult canines(Beagles; n = 14) by subcutaneous injection of carbon tetrachloride(CCl4). CEUS parameters, including the area under the time-intensity curve and intensity at portal/arterial phases(Qp/Qa and Ip/Ia, respectively), were used to quantitatively assess the blood flow ratio of the portal vein/hepatic artery at multiple time points. The free portal venous pressures(FPP) were measured by a multi-channel baroreceptor using a percutaneous approach at baseline and 8, 16, and 24 wk after CCl4 injections in each canine. Liver biopsies were obtained at the end of 8, 16, and 24 wk from each animal, and the stage of the fibrosis was assessed according to the Metavir scoring system. A Pearson correlation test was performed to compare the FPP with Q p/Q a and I p/I a.RESULTS: Pathologic examination of 42 biopsies from the 14 canines at weeks 8, 16, and 24 revealed that liver fibrosis was induced by CCl4 and represented various stages of liver fibrosis, including F0(n = 3), F1(n = 12), F2(n = 14), F3(n = 11), and F4(n = 2). There were significant differences in the measurements of Qp/Qa(19.85 ± 3.30 vs 10.43 ± 1.21, 9.63 ± 1.03, and 8.77 ± 0.96) and Ip/Ia(1.77 ± 0.37 vs 1.03 ± 0.12, 0.83 ± 0.10, and 0.69 ± 0.13) between control and canine fibrosis at 8, 16, and 24 wk, respectively(all P < 0.001). There were statistically significant negative correlations between FPP and Q p/Q a(r =-0.707, P < 0.001), and between FPP and Ip/Ia(r =-0.759, P < 0.001) in the canine fibrosis model. Prediction of elevated FPP based on Q p/Q a and I p/I a was highly sensitive, as assessed by the area under the receiveroperating curve(0.866 and 0.895, respectively).CONCLUSION: C E U S i s a p o t e n t i a l m e t h o d t o accurately, but non-invasively, estimate portal venous pressure through measurement of Qp/Qa and Ip/Ia parameters.展开更多
基金partially supported by the research funding from Chugai Pharmaceutical Co.,Ltd.,Tokyo,Japan
文摘Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy with frequent GIM procedures,which are mostly performed by splenectomy,in LDLT.However,splenectomy can cause serious complications such as portal vein thrombosis and overwhelming postsplenectomy infection.Methods:Forty-eight adult-to-adult LDLT recipients were enrolled in this study and retrospectively reviewed.We applied the graft selection criteria,which routinely fulfill graft-to-recipient weight ratio≥0.8%,and consider GIM as a backup strategy for high portal venous pressure(PVP).Results:In our current strategy of LDLT,splenectomy was performed mostly due to hepatitis C and splenic arterial aneurysms,but splenectomy for GIM was intended to only one patient(2.1%).The final PVP values≤20 mmHg were achieved in all recipients,and no significant difference was observed in patient survival or postoperative clinical course based on whether splenectomy was performed or not.However,6 of 18 patients with splenectomy(33.3%)developed postsplenectomy portal vein thrombosis(PVT),while none of the 30 patients without splenectomy developed PVT after LDLT.Splenectomy was identified as a risk factor of PVT in this study(P<0.001).Our study revealed that a lower final PVP could be risk factor of postsplenectomy PVT.Conclusions:Using sufficient size grafts was one of the direct solutions to control PVP,and allowed GIM to be reserved as a backup procedure.Splenectomy should be avoided as much as possible during LDLT because splenectomy was found to be a definite risk factor of PVT.In splenectomy cases with a lower final PVP,a close follow-up is required for early detection and treatment of PVT.
文摘AIM: To explore the feasibility of non-invasive quantitative estimation of portal venous pressure by contrast-enhanced ultrasound(CEUS) in a canine model.METHODS: Liver fibrosis was established in adult canines(Beagles; n = 14) by subcutaneous injection of carbon tetrachloride(CCl4). CEUS parameters, including the area under the time-intensity curve and intensity at portal/arterial phases(Qp/Qa and Ip/Ia, respectively), were used to quantitatively assess the blood flow ratio of the portal vein/hepatic artery at multiple time points. The free portal venous pressures(FPP) were measured by a multi-channel baroreceptor using a percutaneous approach at baseline and 8, 16, and 24 wk after CCl4 injections in each canine. Liver biopsies were obtained at the end of 8, 16, and 24 wk from each animal, and the stage of the fibrosis was assessed according to the Metavir scoring system. A Pearson correlation test was performed to compare the FPP with Q p/Q a and I p/I a.RESULTS: Pathologic examination of 42 biopsies from the 14 canines at weeks 8, 16, and 24 revealed that liver fibrosis was induced by CCl4 and represented various stages of liver fibrosis, including F0(n = 3), F1(n = 12), F2(n = 14), F3(n = 11), and F4(n = 2). There were significant differences in the measurements of Qp/Qa(19.85 ± 3.30 vs 10.43 ± 1.21, 9.63 ± 1.03, and 8.77 ± 0.96) and Ip/Ia(1.77 ± 0.37 vs 1.03 ± 0.12, 0.83 ± 0.10, and 0.69 ± 0.13) between control and canine fibrosis at 8, 16, and 24 wk, respectively(all P < 0.001). There were statistically significant negative correlations between FPP and Q p/Q a(r =-0.707, P < 0.001), and between FPP and Ip/Ia(r =-0.759, P < 0.001) in the canine fibrosis model. Prediction of elevated FPP based on Q p/Q a and I p/I a was highly sensitive, as assessed by the area under the receiveroperating curve(0.866 and 0.895, respectively).CONCLUSION: C E U S i s a p o t e n t i a l m e t h o d t o accurately, but non-invasively, estimate portal venous pressure through measurement of Qp/Qa and Ip/Ia parameters.
