Clinical research on pathogenesis and treatment of posttransplant portal hypertension and intrahepatic circulatory disorder in adult living donor liver transplantation

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Portal venous pressure(PVP) early after adult living donor liver transplantation showed an inverse correlation with graft weight per body weight, although affected also by cirrhosis, hepatic arterial flow, and circulatory volume. On the other hand, PVP early days after transplantation had a causative relationship with posttransplant prognosis : recipients with averaged PVP>20 mmHg showed 50% reduction of survival. In patients with early posttransplant portal hypertension(PH), ascites and bilirubin increased and protein synthesis decreased in proportion to PVP. Incidence of gram-negative bacteremia also increased. However, its prognostic impact decreased with time Tissue congestion in the paramedian sector of right liver graft, attributable to interrupted venous outflow, gave no significant impact on PVP, i.e., it is post-sinusoidal congestion in contrast to presinusoidal PH.Thus it was suggested that increased splanchnic flow running into a small-for-size graft causes elevation of PVP and injury to intrahepatic portal system, and establishes a prolonged pathological condition. Portal venous flow volume(PVF) per unit tissue showed an inverse relationship with relative graft size However, increased PVF per se did not lead to tissue injury, but rather contributed a reduction of serum bilirubin. PVF and PVP showed a positive correlation in the native liver. But this was lost in early posttransplant period and dependent on portal venous compliance(PVC). PVC was highly variable among grafts and affected by donor age and graft warm ischemia.To prevent tissue injury due to early posttransplant PH, splenic artery ligation(SAL) or partial porto-caval shunt(PPCS) was done. SAL led to PVP reduction but not PVF reduction and PPCS also led to reduction of PVP, bilirubin, and ascites. Both led to better prognosis and reduction of medical costs due to ascites loss Impact of some reduction in graft regeneration and protein synthesis caused by PPCS is to be elucidated.(299 words)