Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain.
Liver Transpl. 2013 Feb;19(2):174-83. doi: 10.1002/lt.23558.
Adult living donor liver transplantation (aLDLT) is associated with surgical risks for the donor and with the possibility of small-for-size syndrome (SFSS) for the recipient, with both events being of great importance. An excessively small liver graft entails a relative increase in the portal blood flow during reperfusion, and this factor predisposes the recipient to an increased risk of SFSS in the postoperative period, although other causes related to recipient, graft, and technical factors have also been reported. A hemodynamic monitoring protocol was used for 45 consecutive aLDLT recipients. After various hemodynamic parameters before reperfusion were analyzed, a significant correlation between the temporary portocaval shunt flow during the anhepatic phase and the portal vein flow (PVF) after reperfusion of the graft (R(2) = 0.3, P < 0.001) was found, and so was a correlation between the native liver portal pressure and PVF after reperfusion (R(2) = 0.21, P = 0.007). The identification of patients at risk for excessive portal hyperflow will allow its modulation before reperfusion. This could favor the use of smaller grafts and ultimately lead to a reduction in donor complications because it would allow more limited hepatectomies to be performed.
成人活体肝移植（aLDLT）与供体的手术风险以及受体的小肝综合征（SFSS）的可能性相关，这两个事件都非常重要。过大的肝移植会导致再灌注期间门静脉血流量相对增加，而这一因素使受体在术后更容易发生 SFSS 的风险，尽管也有报道称与受体、移植物和技术因素有关的其他原因。我们对 45 例连续的 aLDLT 受体进行了血流动力学监测方案。在分析了再灌注前的各种血流动力学参数后，发现无肝期临时门腔分流流量与移植物再灌注后的门静脉流量（R²=0.3，P<0.001）之间存在显著相关性，而固有肝脏门静脉压力与再灌注后的门静脉流量（R²=0.21，P=0.007）之间也存在相关性。确定发生门静脉过度高血流的风险患者将允许在再灌注前对其进行调节。这可以有利于在更小的供体中使用，最终减少供体并发症，因为这将允许进行更有限的肝切除术。
