Changes in portal vein flow after adult living-donor liver transplantation:: Does it influence postoperative liver function?
Changes in portal vein flow after adult living-donor liver transplantation:: Does it influence postoperative liver function?
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DOI：
10.1053/jlts.2003.50069
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发表时间：
2003-06-01
影响因子：
4.6
通讯作者：
Taura, P
中科院分区：
文献类型：
--
作者：
García-Valdecasas, JC;Fuster, J;Taura, P
在成人活体肝移植中，对严重门静脉高压症患者使用小移植物可能会产生不可预测的后果。所谓的小尺寸综合征存在于世界各地的大多数系列中。本研究的目的是前瞻性地评价活体肝移植中血流动力学变化对术后肝功能和肝脏体积增加百分比的影响。在2年的时间里，我们连续进行了22例成人活体肝移植。再灌注后1小时，用超声流量计测量供体和受体右门静脉血流量和右肝动脉血流量。术后通过日常实验室检查测定肝功能。我们还在术后第1、2和7天进行了多普勒超声检查。在移植后2个月通过磁共振成像移植物体积测定法估计肝脏体积增加。我们比较了血流结果与即刻肝功能和2个月时肝体积增加率。有一个显着的增加，在接受者的门静脉流量相比，捐助者（在某些情况下高达四倍）。较高的门静脉血流量增加率与更快的凝血酶原时间正常化和更快的肝脏体积增加显著相关。2个月时的中位移植物体积增加为44.9%。只要维持移植物与体重的比值（>0.8）并提供足够的流出量，肝脏质量对移植物血流量的增加耐受良好，不会影响肝细胞功能。
In adult living donor liver transplantation, using small grafts in cirrhotic patients with severe portal hypertension may have unpredictable consequences. The so-called small-for-size syndrome is present in most series worldwide. The goal of this study was to prospectively evaluate the influence of hemodynamic changes on postoperative liver function and on the percentage of liver volume increase, in the setting of living donor liver transplantation. Twenty-two consecutive adult living donor liver transplantations were performed at our institution in a 2-year period. We measured right portal flow and right hepatic arterial flow with an ultrasonic flow meter in the donor, and then in the recipient 1 hour after reperfusion. Postoperative liver function was measured by daily laboratory work. We also performed duplex ultrasounds on postoperative days 1, 2, and 7. Liver volume increase was estimated by magnetic resonance imaging graft volumetry at 2 months posttransplantation. We compared the blood flow results with the immediate liver function and its liver volume increase rate at 2 months. There was a significant increase in portal flow in the recipients compared with the donors (up to fourfold in some cases). Higher portal flow increase rates significantly correlated with faster prothrombin time normalization and faster liver volume increases. Median graft volume increase at 2 months was 44.9%. The increase in blood flow to the graft is well tolerated by the liver mass not affecting hepatocellular function as long as the graft-to body weight ratio is maintained (>0.8) and adequate outflow is provided.