Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft

Yuzo Umeda, Takahito Yagi, Hiroshi Sadamori, Hiroyoshi Matsukawa, Hiroaki Matsuda, Susumu Shinoura, Kenji Mizuno, Ryuichi Yoshida, Takayuki Iwamoto, Daisuke Satoh, Noriaki Tanaka

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)673-680
Number of pages8
JournalTransplantation
Volume86
Issue number5
DOIs
Publication statusPublished - Sep 15 2008

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Splenic Artery
Liver Regeneration
Transplants
Ligation
Arteries
Decompression
Liver Transplantation
Body Weight
Hyperbilirubinemia
Living Donors
Liver
Portal Hypertension
Transaminases
Ascites
Interleukin-6
Cohort Studies
Retrospective Studies
Tumor Necrosis Factor-alpha
Hemodynamics
Wounds and Injuries

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 journalArticle

Umeda, Yuzo ; Yagi, Takahito ; Sadamori, Hiroshi ; Matsukawa, Hiroyoshi ; Matsuda, Hiroaki ; Shinoura, Susumu ; Mizuno, Kenji ; Yoshida, Ryuichi ; Iwamoto, Takayuki ; Satoh, Daisuke ; Tanaka, Noriaki. / Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. In: Transplantation. 2008 ; Vol. 86, No. 5. pp. 673-680.
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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

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