Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Liver Transpl. 2011 Sep;17(9):1035-45. doi: 10.1002/lt.22326.
The aim of this study was to evaluate the effects of portal hemodynamics on indices of liver function and graft regeneration in patients after adult right lobe living donor liver transplantation (R-LDLT). Sixty-four patients who underwent R-LDLT and had an uneventful postoperative course were enrolled in this study. The contribution of portal flow was greater to the recipient grafts versus the donor livers (90.74% versus 69.12%, P < 0.0001). Portal flow variations decreased significantly during the first 10 days after R-LDLT (P < 0.0001); variations in the hepatic arterial flow were more constant during this period (P = 0.812). The mean portal venous pressure (PVP) before recipient hepatectomy (the initial PVP) was 23.1 ± 4.0 mm Hg; the mean PVP after reperfusion (the final PVP) was 15.0 ± 4.3 mm Hg (P < 0.0001). Furthermore, the mean hepatic portal venous gradient (ie, PVP - central venous pressure) before recipient hepatectomy was 17.1 ± 4.3 mm Hg; it decreased to 10.6 ± 4.5 mm Hg after reperfusion (P < 0.0001). These findings suggest that after graft reperfusion, the vascular resistance of the hepatic parenchyma decreased, and there was an associated mild decrease in the portal hypertension. Multiple regression analysis indicated that PVPs correlated significantly with indices of liver function after living donor liver transplantation (P < 0.05). Patients were separated into 4 groups according to their PVP values: group A (initial PVP ≥ 23 mm Hg, final PVP ≥ 15 mm Hg), group B (initial PVP < 23 mm Hg, final PVP ≥ 15 mm Hg), group C (initial PVP ≥ 23 mm Hg, final PVP < 15 mm Hg), and group D (initial PVP < 23 mm Hg, final PVP < 15 mm Hg). Immediately after R-LDLT, the peak values for aspartate aminotransferase, alanine aminotransferase, the international normalized ratio and the average ascites production varied appreciably in these groups. The regeneration rate of the liver graft 3 months after R-LDLT was significantly greater in group A versus the other groups. In conclusion, PVP is a significant hemodynamic factor that influences the functional status of the liver and graft regeneration after R-LDLT.
本研究旨在评估成人右半肝活体肝移植（R-LDLT）后门静脉血流动力学对肝功能和移植物再生指标的影响。本研究纳入了 64 例接受 R-LDLT 且术后无并发症的患者。供肝门静脉血流对受体移植物的贡献大于供肝（90.74%对 69.12%，P<0.0001）。R-LDLT 后 10 天内门静脉血流变化显著减少（P<0.0001）；在此期间，肝动脉血流变化更稳定（P=0.812）。受体肝切除术前平均门静脉压（初始 PVP）为 23.1±4.0mmHg；再灌注后平均 PVP（最终 PVP）为 15.0±4.3mmHg（P<0.0001）。此外，受体肝切除术前平均肝门静脉静脉压梯度（即 PVP-中心静脉压）为 17.1±4.3mmHg；再灌注后降至 10.6±4.5mmHg（P<0.0001）。这些发现表明，再灌注后肝实质血管阻力降低，门静脉高压症有轻度下降。多元回归分析表明，PVP 与活体肝移植后肝功能指标显著相关（P<0.05）。根据 PVP 值将患者分为 4 组：A 组（初始 PVP≥23mmHg，最终 PVP≥15mmHg）、B 组（初始 PVP<23mmHg，最终 PVP≥15mmHg）、C 组（初始 PVP≥23mmHg，最终 PVP<15mmHg）和 D 组（初始 PVP<23mmHg，最终 PVP<15mmHg）。R-LDLT 后即刻，各组天冬氨酸转氨酶、丙氨酸转氨酶、国际标准化比值和平均腹水产生的峰值明显不同。R-LDLT 后 3 个月，肝移植物再生率 A 组明显大于其他组。总之，PVP 是影响 R-LDLT 后肝和移植物功能状态及再生的重要血流动力学因素。
