Relationship between portal venous flow and liver regeneration in patients after living donor right-lobe liver transplantation |
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| Institution: | 1. Servicio de Ecografía, Fundación Favaloro , Buenos Aires, Argentina;2. Servicio de Hepatología, Programa de Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina;1. Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy;2. Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy;3. Department of Pediatric Oncology, Ospedale Santobono- Pausilipon, Naples, Italy;4. Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS – ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy;5. Department of Anesthesia and Intensive Care, IRCCS – ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy;6. Radiology Service, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy;7. “Giovanni Di Cristina” Children’s Hospital, Pediatric Hematology and Oncology, Palermo, Italy;8. Department of Pediatric Surgery, “Spedali Civili” Children’s Hospital, Brescia, Italy;1. Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan;2. Division of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Aichi, Japan;3. Department of Hematology, Komaki City Hospital, Aichi, Japan;4. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Aichi, Japan;5. Department of Hematology and Oncology, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan;6. Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan;7. Department of Internal Medicine, Seirei Hospital, Nagoya, Aichi, Japan |
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| Abstract: | The purpose of this study is to evaluate the relationship between portal venous (PV) velocity and degree of liver regeneration in humans after living donor liver transplantation (LDLT). Between July 1997 and September 2002, a total of 15 adult-to-adult LDLTs with right-lobe grafts were performed, and 13 of these patients were enrolled in this study. Postoperative PV dynamics differed according to the primary liver disease; therefore, patients were divided into two groups: a fulminant hepatic failure (FHF) group (n = 4) and a liver cirrhosis (LC) group (n = 9). Right-lobe donors (n = 13; D group) were used as controls. Doppler ultrasound was used to measured changes in PV velocity preoperatively; postoperative days (PODs) 1, 3, 7, 14, and 28; and 3 months after LDLT. To assess hepatic regeneration, the increase in liver volume ratio (postoperative liver volume to standard liver volume SLV]) was measured. PV velocity after LDLT in the LC group increased sharply until POD 7, whereas those in the FHF and D groups were constant. In the first 3 months after LDLT, mean PV velocity was greater in the LC group than the other groups, reflecting the persistent hyperdynamic state in chronic end-stage liver disease. Liver regeneration also was more rapid in the LC group than the FHF and D groups and reached 100% as early as 2 weeks posttransplantation, whereas both the FHF and D livers reached approximately 80% of SLV at 3 months. PV velocity POD 7 correlated significantly with regeneration of the partial-liver allograft at 1 month (r = 0.84; P = .0091). In conclusion, the PV persistent hyperdynamic state in the LC group could directly trigger early liver regeneration in partial-liver allografts after LDLT. (Liver Transpl 2003;9:547-551.) |
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