Left lobe adult-to-adult living donor liver transplantation: Should portal inflow modulation be added?

✍ Scribed by Yoichi Ishizaki; Seiji Kawasaki; Hiroyuki Sugo; Jiro Yoshimoto; Noriko Fujiwara; Hiroshi Imamura

• Book ID: 102933663
• Publisher: John Wiley and Sons
• Year: 2012
• Tongue: English
• Weight: 998 KB
• Volume: 18
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.22440

✦ Synopsis

Recently, the successful application of portal inflow modulation has led to renewed interest in the use of left lobe grafts in adult-to-adult living donor liver transplantation (LDLT). However, data on the hepatic hemodynamics supporting portal inflow modulation are limited, and the optimal portal circulation for a liver graft is still unclear. We analyzed 42 consecutive adultto-adult left lobe LDLT cases without splenectomy or a portocaval shunt. The mean actual graft volume (GV)/recipient standard liver volume (SLV) ratio was 39.8% 6 5.7% (median ¼ 38.9%, range ¼ 26.1%-54.0%). The actual GV/SLV ratio was less than 40% in 24 of the 42 cases, and the actual graft-to-recipient weight ratio was less than 0.8% in 17 of the 42 recipients. The mean portal vein pressure (PVP) was 23.9 6 7.6 mm Hg (median ¼ 23.5 mm Hg, range ¼ 9-38 mm Hg) before transplantation and 21.5 6 3.6 mm Hg (median ¼ 22 mm Hg, range ¼ 14-27 mm Hg) after graft implantation. The mean portal pressure gradient (PVP À central venous pressure) was 14.5 6 6.8 mm Hg (median ¼ 13.5 mm Hg, range ¼ 3-26 mm Hg) before transplantation and 12.4 6 4.4 mm Hg (median ¼ 13 mm Hg, range ¼ 1-21 mm Hg) after graft implantation. The mean posttransplant portal vein flow was 301 6 167 mL/minute/100 g of liver in the 38 recipients for whom it was measured. None of the recipients developed small-for-size syndrome, and all were discharged from the hospital despite portal hyperperfusion. The overall 1-, 3-, and 5-year patient and graft survival rates were 100%, 97%, and 91%, respectively. In conclusion, LDLT with a left liver graft without splenectomy or a portocaval shunt yields good long-term results for adult patients with a minimal donor burden.