Optimal changes in portal hemodynamics induced by splenectomy during living donor liver transplantation
Optimal changes in portal hemodynamics induced by splenectomy during living donor liver transplantation
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DOI：
10.1007/s00595-014-0999-9
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发表时间：
2015-08-01
期刊：
影响因子：
2.5
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Wang, Huanlin;Ikegami, Toru;Maehara, Yoshihiko
目的本研究的目的是评估脾切除对成人活体肝移植（LDLT）的影响。方法将成人活体肝移植（LDLT）（n = 276）分为LDLT期间同时进行脾切除的患者（脾切除组，n = 154）和未进行脾切除的患者（非脾切除组，n = 122）。结果 在脾切除组中，脾切除减少了门脉静脉压从 24.0 至 19.1 mmHg (p < 0.001)。手术结束时，与非脾切除组相比，脾切除组门静脉压显着降低，移植血管顺应性显着升高。脾切除组 (y = 625-5.1x; r(2) = 0.08, p < 0.01) 的移植物门静脉流量也优于非脾切除组 (y = 470-2.9x; r(2) = 0.04, p = 0.03)。 LDLT 14 天后，脾切除组的总胆红素和腹水排出量低于非脾切除组。在丙型肝炎患者中，与未切除脾的患者 (n = 39) 相比，脾切除患者的持续病毒应答率显着较高 (59.4% vs. 35.9%，p = 0.020)。没有接种疫苗后出现脾切除后脓毒症的患者。 结论 通过降低门静脉压力和增加移植物血管顺应性，脾切除术在成人至成人 LDLT 中提供了更好的移植结果
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 = 625-5.1x; r(2) = 0.08, p < 0.01) than in the Non-Splenectomy group (y = 470-2.9x; 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