This paper was orally presented at the Annual Meeting of the American Transplant Congress, May 30–June 4, 2003, Washington, D.C.
Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation
Article first published online: 9 MAR 2005
American Journal of Transplantation
Volume 5, Issue 6, pages 1397–1404, June 2005
How to Cite
Troisi, R., Ricciardi, S., Smeets, P., Petrovic, M., Van Maele, G., Colle, I., Van Vlierberghe, H. and De Hemptinne, B. (2005), Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation. American Journal of Transplantation, 5: 1397–1404. doi: 10.1111/j.1600-6143.2005.00850.x
- Issue published online: 9 MAR 2005
- Article first published online: 9 MAR 2005
- Received 10 May 2004, revised 5 January 2005 and accepted for publication 5 January 2005
- Small-for-size syndrome;
- small-for-size grafts;
- graft regeneration;
- portocaval shunt;
- portal vein hyperperfusion;
- splenic artery ligation;
- living donor liver transplantation
Graft hyperperfusion in small-for-size grafts (SFSG) is considered the main causal factor of small-for-size syndrome (SFSS). We compared SFSG with a graft-to-recipient body ratio ≤0.8, with and without graft inflow modulation (GIM) by means of a hemi-portocaval shunt (HPCS). Thirteen patients underwent adult-to-adult living donor liver transplantation (AALDLT): G1, n = 5 [4 right livers (RL) and 1 left liver (LL)] without GIM, and G2, n = 8 (4 RL and 4 LL) with GIM. In G2 patients, portal vein flow (PVF) was significantly reduced by HPCS: 190 ± 70 mL/min/100 g liver in G2 vs. 401 ± 225 ml/min in G1 (p = 0.002). One- and 6-month post-transplantation graft volume/standard liver volume (GV/SLV) ratio was of 72% and 79.5% in G1; 80% and 101% in G2 (p = ns). SFSS was observed in three G1 recipients (who were retransplanted), but in none of the G2 patients. At 1-year, patient and graft survival was respectively of 40% and 20% in G1, 87.5% and 75% in G2 (p = 0.024 and 0.03).
It is concluded that drastic reduction of PVF by means of HPCS improves overall patient and graft survival by averting the occurrence of SFSS. Graft inflow modulation through HPCS reduces the risk of complications when transplanting SFSG in adult recipients.