Optimal changes in portal hemodynamics induced by splenectomy during living donor liver transplantation

详细信息    查看全文

• 作者：Huanlin Wang ; Toru Ikegami ; Noboru Harada ; Tomoharu Yoshizumi…
• 关键词：Living donor liver transplantation ; Hyperbilirubinemia ; Small for size ; Graft dysfunction ; Donor age
• 刊名：Surgery Today
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：45
• 期：8
• 页码：979-985
• 全文大小：594 KB
• 参考文献：1.Morioka D, Egawa H, Kasahara M, Ito T, Haga H, Takada Y, et al. Outcomes of adult-to-adult living donor liver transplantation: a single institution’s experience with 335 consecutive cases. Ann Surg. 2007;245:315-5.PubMed Central PubMed View Article
  2.Soejima Y, Shirabe K, Taketomi A, Yoshizumi T, Uchiyama H, Ikegami T, et al. Left lobe living donor liver transplantation in adults. Am J Transplant. 2012;12:1877-5.PubMed View Article
  3.Kiuchi T, Tanaka K, Ito T, Oike F, Ogura Y, Fujimoto Y, Ogawa K. Small-for-size graft in living donor liver transplantation: how far should we go? Liver Transpl. 2003;9:S29-5.PubMed View Article
  4.Trotter JF, Adam R, Lo CM, Kenison J. Documented deaths of hepatic lobe donors for living donor liver transplantation. Liver Transpl. 2006;12:1485-.PubMed View Article
  5.Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation. 1999;67:321-.PubMed View Article
  6.Moon JI, Kwon CH, Joh JW, Jung GO, Choi GS, Park JB, et al. Safety of small-for-size grafts in adult-to-adult living donor liver transplantation using the right lobe. Liver Transpl. 2010;16:864-.PubMed View Article
  7.Boillot O, Delafosse B, Méchet I, Boucaud C, Pouyet M. Small-for-size partial liver graft in an adult recipient; a new transplant technique. Lancet. 2002;359:406-.PubMed View Article
  8.Troisi R, Ricciardi S, Smeets P, Petrovic M, Van Maele G, Colle I, et al. Effects of hemi-portocaval shunts for inflow modulation on the outcome of small-for-size grafts in living donor liver transplantation. Am J Transplant. 2005;5:1397-04.PubMed View Article
  9.Botha JF, Langnas AN, Campos BD, Grant WJ, Freise CE, Ascher NL, et al. Left lobe adult-to-adult living donor liver transplantation: small grafts and hemiportocaval shunts in the prevention of small-for-size syndrome. Liver Transpl. 2010;16:649-7.PubMed View Article
  10.Yamada T, Tanaka K, Uryuhara K, Ito K, Takada Y, Uemoto S. Selective hemi-portocaval shunt based on portal vein pressure for small-for-size graft in adult living donor liver transplantation. Am J Transplant. 2008;8:847-3.PubMed View Article
  11.Ikegami T, Soejima Y, Taketomi A, Sanefuji K, Kayashima H, Harada N, et al. Living donor liver transplantation with extra-small graft; inflow modulation using splenectomy and temporary portocaval shunt. Hepatogastroenterology. 2008;55:670-.PubMed
  12.Shimada M, Ijichi H, Yonemura Y, Harada N, Shiotani S, Ninomiya M, et al. The impact of splenectomy or splenic artery ligation on the outcome of a living donor adult liver transplantation using a left lobe graft. Hepatogastroenterology. 2004;51:625-.PubMed
  13.Umeda Y, Yagi T, Sadamori H, Matsukawa H, Matsuda H, Shinoura S, et al. Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. Transplantation. 2008;86:673-0.PubMed View Article
  14.Hiroshige S, Shimada M, Harada N, Shiotani S, Ninomiya M, Minagawa R, et al. Accurate preoperative estimation of liver-graft volumetry using three-dimensional computed tomography. Transplantation. 2003;75:1561-.PubMed View Article
  15.Taketomi A, Morita K, Toshima T, Takeishi K, Kayashima H, Ninomiya M, et al. Living donor hepatectomies with procedures to prevent biliary complications. J Am Coll Surg. 2010;211:456-4.PubMed View Article
  16.Ikegami T, Soejima Y, Taketomi A, Yoshizumi T, Harada N, Uchiyama H, et al. Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. Transplantation. 2007;84:836-1.PubMed View Article
  17.Ikegami T, Soejima Y, Taketomi A, Kawanaka H, Yoshizumi T, Shimada M, et al. Hypersplenism after living donor liver transplantation. Hepatogastroenterology. 2009;56:778-2.PubMed
  18.Yagi S, Iida T, Taniguchi K, Hori T, Hamada T, Fujii K, Mizuno S, Uemoto S. Impact of portal venous pressure on regeneration and graft damage after living-donor liver transplantation. Liver Transpl. 2005;11:68-5.PubMed View Article
  19.Ikegami T, Toshima T, Takeishi K, Soejima Y, Kawanaka H, Yoshizumi T, et al. Bloodless splenectomy during liver transplantation for terminal liver diseases with portal hypertension. J Am Coll Surg. 2009;208:e1-.PubMed View Article
  20.Ikegami T, Shirabe K, Yoshizumi T, Aishima S, Taketomi A, Soejima Y, et al. Primary graft dysfunction after living donor liver transplantation is characterized by delayed functional hyperbilirubinemia. Am J Transplant. 2012;12:1886-7.PubMed View Article
  21.Nagao Y, Akahoshi T, Kamori M, Uehara H, Hashimoto N, Kinjo N, et al. Liver regeneration is promoted by increasing serotonin content in rat liver with secondary biliary cirrhosis. Hepatol Res. 2011;41:784-4.PubMed View Article
  22.Furrer K, Rickenbacher A, Tian Y, Jochum W, Bittermann AG, K?ch A, et al. Serotonin reverts age-related capillarizat
• 作者单位：Huanlin Wang (1)
  Toru Ikegami (1)
  Noboru Harada (1)
  Tomoharu Yoshizumi (1)
  Yuji Soejima (1)
  Hideaki Uchiyama (1)
  Yo-Ichi Yamashita (1)
  Shinji Itoh (1)
  Norifumi Harimoto (1)
  Hirofumi Kawanaka (1)
  Ken Shirabe (1)
  Yoshihiko Maehara (1)
  
  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Abdominal Surgery
  Thoracic Surgery
  Vascular Surgery
  Cardiac Surgery
  Surgical Oncology
  
• 出版者：Springer Japan
• ISSN：1436-2813

文摘

Purposes The purpose of this study was to evaluate the impact of splenectomy in adult-to-adult living donor liver transplantation (LDLT). Methods Adult-to-adult LDLTs (n?=?276) were divided into those with simultaneous splenectomy during LDLT (Splenectomy group, n?=?154) and those without (Non-Splenectomy group, n?=?122). Results In the Splenectomy group, splenectomy decreased the portal venous pressure from 24.0 to 19.1?mmHg (p?<?0.001). At the end of surgery, the portal venous pressure was significantly lower and the graft compliance was significantly higher in the Splenectomy group compared with the Non-Splenectomy group. The graft portal venous flow was also better in the Splenectomy group (y?=?625-.1x; r 2?=?0.08, p?<?0.01) than in the Non-Splenectomy group (y?=?470-.9x; r 2?=?0.04, p?=?0.03). Fourteen days after LDLT, the total bilirubin and ascites output were lower in the Splenectomy group than in the Non-Splenectomy group. Among the patients with hepatitis C, splenectomy was associated with a significantly higher rate of a sustained viral response (59.4 vs. 35.9?%, p?=?0.020) than was noted in those without splenectomy (n?=?39). There were no patients with post-splenectomy sepsis under vaccination. Conclusions By decreasing the portal pressure and increasing the graft vascular compliance, splenectomy conferred better graft outcomes in adult-to-adult LDLT