Abstract
Background. The small-for-size (SFS) syndrome is caused by excessive portal inflow into a small-sized liver graft. Various approaches for portal decompression have been used, but details of their impact on liver regeneration in SFS graft remain unclear. We examined the effect of prophylactic splenic artery modulation (SAM). Methods. We conducted a retrospective cohort study. The study group was 39 consecutive adult-to-adult living liver transplantation recipients, with a graft-to-recipient body weight ratio of less than 0.8. Patients were assigned into the non-SAM group (n18, without any portal inflow attenuation) orSAMgroup (n21, preoperative embolization in 15 patients and intraoperative ligation in 6 patients). Hepatic hemodynamics, graft function, liver regeneration, and outcome were evaluated. Results. In the SAM group, the excessive portal flow was significantly reduced (P0.01) and the effect of embolization on portal decompression was equivalent to that of ligation. In the acute postoperative phase, serum transaminases, interleukin-6, and tumor necrosis factor, were lower in the SAM group than in non-SAM group. In both groups, a negative correlation was observed between graft-to-recipient body weight ratio and liver regeneration rate at 2 weeks after living donor liver transplantation. Splenic artery modulation was advantageous for liver regeneration, and significantly improved clinical features, hyperbilirubinemia, and prolonged ascites. Small-for-size syndrome occurred in five patients of the non-SAM group, and only one of SAM group (P0.038). Conclusion. In SFS graft with severe portal hypertension, prophylactic splenic embolization/ligation seems to relieve portal overperfusion injury and contributes in improvement of posttransplantation prognosis through liver regeneration.
| Original language | English |
|---|---|
| Pages (from-to) | 673-680 |
| Number of pages | 8 |
| Journal | Transplantation |
| Volume | 86 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Sep 15 2008 |
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Keywords
- Embolization
- Ligation
- Liver regeneration
- Small-for-size
- Splenic artery
ASJC Scopus subject areas
- Transplantation
Cite this
Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. / Umeda, Yuzo; Yagi, Takahito; Sadamori, Hiroshi; Matsukawa, Hiroyoshi; Matsuda, Hiroaki; Shinoura, Susumu; Mizuno, Kenji; Yoshida, Ryuichi; Iwamoto, Takayuki; Satoh, Daisuke; Tanaka, Noriaki.
In: Transplantation, Vol. 86, No. 5, 15.09.2008, p. 673-680.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft
AU - Umeda, Yuzo
AU - Yagi, Takahito
AU - Sadamori, Hiroshi
AU - Matsukawa, Hiroyoshi
AU - Matsuda, Hiroaki
AU - Shinoura, Susumu
AU - Mizuno, Kenji
AU - Yoshida, Ryuichi
AU - Iwamoto, Takayuki
AU - Satoh, Daisuke
AU - Tanaka, Noriaki
PY - 2008/9/15
Y1 - 2008/9/15
N2 - Background. The small-for-size (SFS) syndrome is caused by excessive portal inflow into a small-sized liver graft. Various approaches for portal decompression have been used, but details of their impact on liver regeneration in SFS graft remain unclear. We examined the effect of prophylactic splenic artery modulation (SAM). Methods. We conducted a retrospective cohort study. The study group was 39 consecutive adult-to-adult living liver transplantation recipients, with a graft-to-recipient body weight ratio of less than 0.8. Patients were assigned into the non-SAM group (n18, without any portal inflow attenuation) orSAMgroup (n21, preoperative embolization in 15 patients and intraoperative ligation in 6 patients). Hepatic hemodynamics, graft function, liver regeneration, and outcome were evaluated. Results. In the SAM group, the excessive portal flow was significantly reduced (P0.01) and the effect of embolization on portal decompression was equivalent to that of ligation. In the acute postoperative phase, serum transaminases, interleukin-6, and tumor necrosis factor, were lower in the SAM group than in non-SAM group. In both groups, a negative correlation was observed between graft-to-recipient body weight ratio and liver regeneration rate at 2 weeks after living donor liver transplantation. Splenic artery modulation was advantageous for liver regeneration, and significantly improved clinical features, hyperbilirubinemia, and prolonged ascites. Small-for-size syndrome occurred in five patients of the non-SAM group, and only one of SAM group (P0.038). Conclusion. In SFS graft with severe portal hypertension, prophylactic splenic embolization/ligation seems to relieve portal overperfusion injury and contributes in improvement of posttransplantation prognosis through liver regeneration.
AB - Background. The small-for-size (SFS) syndrome is caused by excessive portal inflow into a small-sized liver graft. Various approaches for portal decompression have been used, but details of their impact on liver regeneration in SFS graft remain unclear. We examined the effect of prophylactic splenic artery modulation (SAM). Methods. We conducted a retrospective cohort study. The study group was 39 consecutive adult-to-adult living liver transplantation recipients, with a graft-to-recipient body weight ratio of less than 0.8. Patients were assigned into the non-SAM group (n18, without any portal inflow attenuation) orSAMgroup (n21, preoperative embolization in 15 patients and intraoperative ligation in 6 patients). Hepatic hemodynamics, graft function, liver regeneration, and outcome were evaluated. Results. In the SAM group, the excessive portal flow was significantly reduced (P0.01) and the effect of embolization on portal decompression was equivalent to that of ligation. In the acute postoperative phase, serum transaminases, interleukin-6, and tumor necrosis factor, were lower in the SAM group than in non-SAM group. In both groups, a negative correlation was observed between graft-to-recipient body weight ratio and liver regeneration rate at 2 weeks after living donor liver transplantation. Splenic artery modulation was advantageous for liver regeneration, and significantly improved clinical features, hyperbilirubinemia, and prolonged ascites. Small-for-size syndrome occurred in five patients of the non-SAM group, and only one of SAM group (P0.038). Conclusion. In SFS graft with severe portal hypertension, prophylactic splenic embolization/ligation seems to relieve portal overperfusion injury and contributes in improvement of posttransplantation prognosis through liver regeneration.
KW - Embolization
KW - Ligation
KW - Liver regeneration
KW - Small-for-size
KW - Splenic artery
UR - http://www.scopus.com/inward/record.url?scp=53449101182&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=53449101182&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e318181e02d
DO - 10.1097/TP.0b013e318181e02d
M3 - Article
C2 - 18791439
AN - SCOPUS:53449101182
VL - 86
SP - 673
EP - 680
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 5
ER -