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- Title
L/I-5 Hemodynamics in adult-to-adult living donor liver transplantation: personal experience.
- Authors
Nadalin, S.; Li, J.; Radtke, A.; Sotiropoulos, G. C.; Malamutmann, E.; Broelsch, C. E.; Malagó, M.
- Abstract
Introduction: The interaction and modulation of inflow and outflow in adult living donor liver transplants (LDLTs) is very complex; small-for-size syndrome (SFSS) still represents the most dangerous complication in this regard. Methods: We measured the liver hemodynamics, in both donors and recipients, in 21 LDLTs. Measured parameters included hepatic artery flow (HAF) and portal vein flow (PVF) (ml/min/100 g ), PVF/HAF ratio (PAR) by means of transit time flowmeter, and portal vein pressure (PVP). For all recipients, we used a maximalized outflow with blanket technique (with MHV in 19). According to the results, in order to prevent SFSS, we performed either splenic artery ligation (SAL) or modified porto-caval-shunt (PCS) or intrarterial PGI2 + steroid infusion. Results: The median reference values in donors were as follows: HAF, 26.5 ml/min/100g; PVF, 78.5 ml/min/100g; and PAR, 2.5. At total of 5 patients underwent SAL because of GBWR ≤ 0.9; HAF decreased from 32% to 82% in 4; PVF increased from 300% to 400% in 3; PAR was > 20 in 2. None of these patients developed SFSS. Two patients underwent intraarterial infusion of PGI2 + steroids over 14 days because of a PVF increase ≥ 300%, HAF decrease of 82% in 1, PAR 66 and 22, PVP > 20 in 1, and impossibility of SAL. No SFSS was observed. One patient underwent a modified PCS because of PVF increase of 250%, HAF decrease of 70%, PAR 27. No complications occurred. Discusssion: Strength monitoring of liver hemodynamics at pre-, intra-, and posthepatic level allows specific management at the different levels in order to prevent SFSS and graft loss.
- Subjects
LIVING related donor transplantation; HEMODYNAMICS; LIVER transplantation; ORGAN donors; TRANSPLANTATION of organs, tissues, etc.; SURGICAL nursing; HEPATIC artery physiology; DISEASES; PATIENTS; PHYSIOLOGY
- Publication
Clinical Transplantation, 2006, Vol 20, p29
- ISSN
0902-0063
- Publication type
Article
- DOI
10.1111/j.1399-0012.2006.00577_3_5.x