Obstructing spontaneous major shunt vessels is mandatory to keep adequate portal inflow in living-donor liver transplantation

Toru Ikegami, Ken Shirabe, Hidekazu Nakagawara, Tomoharu Yoshizumi, Takeo Toshima, Yuji Soejima, Hideaki Uchiyama, Yo Ichi Yamashita, Norifumi Harimoto, Yoshihiko Maehara

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND: It has not been addressed whether the major spontaneous portosystemic shunt vessels should be ligated in living-donor liver transplantation (LDLT). METHODS: We performed a retrospective analysis of 324 cases of adult-to-adult LDLT. RESULTS: Factors associated with the presence of major (>10 mm) shunt vessels (n=130) included portal vein (PV) thrombosis (27.7%), lower PV pressure at laparotomy, Child-Pugh class C, and transplantation of right-side grafts. The types of major portosystemic shunt vessels included splenorenal shunts (46.2%), gastroesophageal shunts (26.9%), mesocaval shunts (13.8%), and others (13.1%). Ligation of the major shunt vessels increased PV pressure (mean [SD], from 16.8 [3.9] mm Hg to 18.6 [4.3] mm Hg; P<0.001) and PV flow (mean [SD], from 1.35 [0.67] L/min to 1.67 [0.67] L/min; P<0.001) into the grafts. Post-LDLT computed tomography showed patent major shunts in 14 patients. Nine of such patients (64.3%) with unligated major shunt vessels (undetected shunt vessels, n=5; incomplete ligation, n=2; and the shunt was newly created or left open to maintain high PV pressure after reperfusion, n=3) required secondary interventions. Two of these patients died because of graft dysfunction. PV flow was significantly lower in the nine patients who underwent secondary ligation of the major shunt vessels compared with patients with successful primary ligation (mean [SD], 0.96 [0.34] L/min vs. 1.65 [0.63] L/min; P=0.001). CONCLUSIONS: It is an appropriate option to obstruct the major portosystemic shunt vessels to ensure adequate graft inflow in LDLT.

Original languageEnglish
Pages (from-to)1270-1277
Number of pages8
JournalTransplantation
Volume95
Issue number10
DOIs
Publication statusPublished - May 27 2013

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Living Donors
Portal Vein
Liver Transplantation
Surgical Portasystemic Shunt
Portal Pressure
Ligation
Transplants
Surgical Splenorenal Shunt
Laparotomy
Reperfusion
Thrombosis
Transplantation
Tomography

All Science Journal Classification (ASJC) codes

  • Transplantation

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Obstructing spontaneous major shunt vessels is mandatory to keep adequate portal inflow in living-donor liver transplantation. / Ikegami, Toru; Shirabe, Ken; Nakagawara, Hidekazu; Yoshizumi, Tomoharu; Toshima, Takeo; Soejima, Yuji; Uchiyama, Hideaki; Yamashita, Yo Ichi; Harimoto, Norifumi; Maehara, Yoshihiko.

In: Transplantation, Vol. 95, No. 10, 27.05.2013, p. 1270-1277.

Research output: Contribution to journalArticle

Ikegami, Toru ; Shirabe, Ken ; Nakagawara, Hidekazu ; Yoshizumi, Tomoharu ; Toshima, Takeo ; Soejima, Yuji ; Uchiyama, Hideaki ; Yamashita, Yo Ichi ; Harimoto, Norifumi ; Maehara, Yoshihiko. / Obstructing spontaneous major shunt vessels is mandatory to keep adequate portal inflow in living-donor liver transplantation. In: Transplantation. 2013 ; Vol. 95, No. 10. pp. 1270-1277.
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abstract = "BACKGROUND: It has not been addressed whether the major spontaneous portosystemic shunt vessels should be ligated in living-donor liver transplantation (LDLT). METHODS: We performed a retrospective analysis of 324 cases of adult-to-adult LDLT. RESULTS: Factors associated with the presence of major (>10 mm) shunt vessels (n=130) included portal vein (PV) thrombosis (27.7{\%}), lower PV pressure at laparotomy, Child-Pugh class C, and transplantation of right-side grafts. The types of major portosystemic shunt vessels included splenorenal shunts (46.2{\%}), gastroesophageal shunts (26.9{\%}), mesocaval shunts (13.8{\%}), and others (13.1{\%}). Ligation of the major shunt vessels increased PV pressure (mean [SD], from 16.8 [3.9] mm Hg to 18.6 [4.3] mm Hg; P<0.001) and PV flow (mean [SD], from 1.35 [0.67] L/min to 1.67 [0.67] L/min; P<0.001) into the grafts. Post-LDLT computed tomography showed patent major shunts in 14 patients. Nine of such patients (64.3{\%}) with unligated major shunt vessels (undetected shunt vessels, n=5; incomplete ligation, n=2; and the shunt was newly created or left open to maintain high PV pressure after reperfusion, n=3) required secondary interventions. Two of these patients died because of graft dysfunction. PV flow was significantly lower in the nine patients who underwent secondary ligation of the major shunt vessels compared with patients with successful primary ligation (mean [SD], 0.96 [0.34] L/min vs. 1.65 [0.63] L/min; P=0.001). CONCLUSIONS: It is an appropriate option to obstruct the major portosystemic shunt vessels to ensure adequate graft inflow in LDLT.",
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T1 - Obstructing spontaneous major shunt vessels is mandatory to keep adequate portal inflow in living-donor liver transplantation

AU - Ikegami, Toru

AU - Shirabe, Ken

AU - Nakagawara, Hidekazu

AU - Yoshizumi, Tomoharu

AU - Toshima, Takeo

AU - Soejima, Yuji

AU - Uchiyama, Hideaki

AU - Yamashita, Yo Ichi

AU - Harimoto, Norifumi

AU - Maehara, Yoshihiko

PY - 2013/5/27

Y1 - 2013/5/27

N2 - BACKGROUND: It has not been addressed whether the major spontaneous portosystemic shunt vessels should be ligated in living-donor liver transplantation (LDLT). METHODS: We performed a retrospective analysis of 324 cases of adult-to-adult LDLT. RESULTS: Factors associated with the presence of major (>10 mm) shunt vessels (n=130) included portal vein (PV) thrombosis (27.7%), lower PV pressure at laparotomy, Child-Pugh class C, and transplantation of right-side grafts. The types of major portosystemic shunt vessels included splenorenal shunts (46.2%), gastroesophageal shunts (26.9%), mesocaval shunts (13.8%), and others (13.1%). Ligation of the major shunt vessels increased PV pressure (mean [SD], from 16.8 [3.9] mm Hg to 18.6 [4.3] mm Hg; P<0.001) and PV flow (mean [SD], from 1.35 [0.67] L/min to 1.67 [0.67] L/min; P<0.001) into the grafts. Post-LDLT computed tomography showed patent major shunts in 14 patients. Nine of such patients (64.3%) with unligated major shunt vessels (undetected shunt vessels, n=5; incomplete ligation, n=2; and the shunt was newly created or left open to maintain high PV pressure after reperfusion, n=3) required secondary interventions. Two of these patients died because of graft dysfunction. PV flow was significantly lower in the nine patients who underwent secondary ligation of the major shunt vessels compared with patients with successful primary ligation (mean [SD], 0.96 [0.34] L/min vs. 1.65 [0.63] L/min; P=0.001). CONCLUSIONS: It is an appropriate option to obstruct the major portosystemic shunt vessels to ensure adequate graft inflow in LDLT.

AB - BACKGROUND: It has not been addressed whether the major spontaneous portosystemic shunt vessels should be ligated in living-donor liver transplantation (LDLT). METHODS: We performed a retrospective analysis of 324 cases of adult-to-adult LDLT. RESULTS: Factors associated with the presence of major (>10 mm) shunt vessels (n=130) included portal vein (PV) thrombosis (27.7%), lower PV pressure at laparotomy, Child-Pugh class C, and transplantation of right-side grafts. The types of major portosystemic shunt vessels included splenorenal shunts (46.2%), gastroesophageal shunts (26.9%), mesocaval shunts (13.8%), and others (13.1%). Ligation of the major shunt vessels increased PV pressure (mean [SD], from 16.8 [3.9] mm Hg to 18.6 [4.3] mm Hg; P<0.001) and PV flow (mean [SD], from 1.35 [0.67] L/min to 1.67 [0.67] L/min; P<0.001) into the grafts. Post-LDLT computed tomography showed patent major shunts in 14 patients. Nine of such patients (64.3%) with unligated major shunt vessels (undetected shunt vessels, n=5; incomplete ligation, n=2; and the shunt was newly created or left open to maintain high PV pressure after reperfusion, n=3) required secondary interventions. Two of these patients died because of graft dysfunction. PV flow was significantly lower in the nine patients who underwent secondary ligation of the major shunt vessels compared with patients with successful primary ligation (mean [SD], 0.96 [0.34] L/min vs. 1.65 [0.63] L/min; P=0.001). CONCLUSIONS: It is an appropriate option to obstruct the major portosystemic shunt vessels to ensure adequate graft inflow in LDLT.

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