Is Portal Venous Pressure Modulation Still Indicated for All Recipients in Living Donor Liver Transplantation?
Is Portal Venous Pressure Modulation Still Indicated for All Recipients in Living Donor Liver Transplantation?
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DOI：
10.1002/lt.25180
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发表时间：
2018-11-01
影响因子：
4.6
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
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作者：
Yao, Siyuan;Kaido, Toshimi;Uemoto, Shinji
目前的共识是门静脉压力（PVP）调节可以预防成人间活体肝移植（ALDLT）后的门静脉高压（PHT）及其并发症。然而，PVP调节策略需要根据最新的发现进行更新。我们检查了我们10年的PVP调节经验，并重新评估是否有必要对所有受者或选定的受者进行ALDLT。在这项回顾性研究中，根据PVP调节的必要性和结果，将2007年至2016年接受ALDLT的319例患者分为3组：无适应症（n = 189），适应症和成功（n = 92），适应症但失败（n = 38）。研究了移植物存活率及其与各种临床因素的关系。PVP调节主要通过脾切除术进行，以将最终PVP降低至≥ 45岁（风险比[HR]，3.67; P = 0.02），ABO血型不合（HR，3.90; P = 0.01）是移植物丢失的独立风险因素。生存分析显示，对于ABO血型不合或年龄≥ 45岁的老年供者，PVP > 15 mm Hg与移植物预后不良相关（P < 0.001），但对于ABO血型相合/完全相同和年龄< 45岁的年轻供者，PVP > 15 mm Hg对移植物预后无负面影响（P = 0.27）。总之，并非所有接受者都需要有意的PVP调制。尽管来自ABO相容/相同和年轻供体的移植物都可以耐受PHT，但将PVP降低至
There is a consensus that portal venous pressure (PVP) modulation prevents portal hypertension (PHT) and consequent complications after adult-to-adult living donor liver transplantation (ALDLT). However, PVP-modulation strategies need to be updated based on the most recent findings. We examined our 10-year experience of PVP modulation and reevaluated whether it was necessary for all recipients or for selected recipients in ALDLT. In this retrospective study, 319 patients who underwent ALDLT from 2007 to 2016 were divided into 3 groups according to the necessity and results of PVP modulation: not indicated (n = 189), indicated and succeeded (n = 92), and indicated but failed (n = 38). Graft survival and associations with various clinical factors were investigated. PVP modulation was performed mainly by splenectomy to lower final PVP to = 45 years (hazard ratio [HR], 3.67; P = 0.02) and ABO incompatibility (HR, 3.90; P = 0.01) were independent risk factors for graft loss. Survival analysis showed that PVP > 15 mm Hg was related to poor prognosis in grafts from either ABO-incompatible or older donor age >= 45 years (P < 0.001), but it did not negatively affect grafts from ABO-compatible/identical and young donor age < 45 years (P = 0.27). In conclusion, intentional PVP modulation is not necessarily required in all recipients. Although grafts from both ABO-compatible/identical and young donors can tolerate PHT, lowering PVP to