Portal flow modulation in living donor liver transplantation: review with a focus on splenectomy

Research output: Contribution to journalReview article

Abstract

Small-for-size graft (SFSG) syndrome after living donor liver transplantation (LDLT) is the dysfunction of a small graft, characterized by coagulopathy, cholestasis, ascites, and encephalopathy. It is a serious complication of LDLT and usually triggered by excessive portal flow transmitted to the allograft in the postperfusion setting, resulting in sinusoidal congestion and hemorrhage. Portal overflow injures the liver directly through nutrient excess, endothelial activation, and sinusoidal shear stress, and indirectly through arterial vasoconstriction. These conditions may be attenuated with portal flow modulation. Attempts have been made to control excessive portal flow to the SFSG, including simultaneous splenectomy, splenic artery ligation, hemi-portocaval shunt, and pharmacological manipulation, with positive outcomes. Currently, a donor liver is considered a SFSG when the graft-to-recipient weight ratio is less than 0.8 or the ratio of the graft volume to the standard liver volume is less than 40%. A strategy for transplanting SFSG safely into recipients and avoiding extensive surgery in the living donor could effectively address the donor shortage. We review the literature and assess our current knowledge of and strategies for portal flow modulation in LDLT.

Original languageEnglish
Pages (from-to)21-29
Number of pages9
JournalSurgery today
Volume50
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

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Living Donors
Splenectomy
Liver Transplantation
Transplants
Liver
Tissue Donors
Splenic Artery
Cholestasis
Brain Diseases
Vasoconstriction
Ascites
Allografts
Ligation
Pharmacology
Hemorrhage
Weights and Measures
Food

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Portal flow modulation in living donor liver transplantation : review with a focus on splenectomy. / Yoshizumi, Tomoharu; Mori, Masaki.

In: Surgery today, Vol. 50, No. 1, 01.01.2020, p. 21-29.

Research output: Contribution to journalReview article

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AB - Small-for-size graft (SFSG) syndrome after living donor liver transplantation (LDLT) is the dysfunction of a small graft, characterized by coagulopathy, cholestasis, ascites, and encephalopathy. It is a serious complication of LDLT and usually triggered by excessive portal flow transmitted to the allograft in the postperfusion setting, resulting in sinusoidal congestion and hemorrhage. Portal overflow injures the liver directly through nutrient excess, endothelial activation, and sinusoidal shear stress, and indirectly through arterial vasoconstriction. These conditions may be attenuated with portal flow modulation. Attempts have been made to control excessive portal flow to the SFSG, including simultaneous splenectomy, splenic artery ligation, hemi-portocaval shunt, and pharmacological manipulation, with positive outcomes. Currently, a donor liver is considered a SFSG when the graft-to-recipient weight ratio is less than 0.8 or the ratio of the graft volume to the standard liver volume is less than 40%. A strategy for transplanting SFSG safely into recipients and avoiding extensive surgery in the living donor could effectively address the donor shortage. We review the literature and assess our current knowledge of and strategies for portal flow modulation in LDLT.

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