Sánchez Cabús Santiago, Calatayud David, Fondevila Constantino, Ferrer Joana, Fuster José, García-Valdecasas Juan Carlos
Unidad de Cirugía Hepática y Trasplante, Hospital Clínic de Barcelona, Barcelona, España.
Cir Esp. 2013 Mar;91(3):169-76. doi: 10.1016/j.ciresp.2012.07.002. Epub 2012 Dec 6.
The recipient of an adult living donor liver transplant (ALDLT) is subjected to great haemodynamic changes that could lead to the appearance of a "small-for-size" syndrome in the post-operative period due to portal hyperflow. The aim of this article is to evaluate these changes, and try to correlate them with portal vein flow during reperfusion.
A protocol for monitoring various liver haemodynamic data of the ALDLT recipient before, during and after surgery has been used since the year 2003. The haemodynamic outcome of the recipient after the transplant, as well as the correlation between the portal vein flow during reperfusion and the collected haemodynamic data is analysed.
There was no small for size syndrome. A significant relationship was found between the portal flow during reperfusion and the portal vein pressure at the beginning of the operation (r=0.46, P<.006) and with the portocaval shunt flow during the anhepatic phase (r=0.55, P<.001). The recipients showed a normal splanchnic hemodynamic state at 3 months after the transplant.
Haemodynamic monitoring of the ALDLT recipient is essential to prevent portal hyperflow. The relationship between flow during reperfusion and flow through the portocaval shunt means that patients with a higher risk of hyperflow can be identified and can be modified before reperfusion.
成人活体供肝移植（ALDLT）受者会经历巨大的血流动力学变化，由于门静脉高流量，这可能导致术后出现“小肝综合征”。本文旨在评估这些变化，并尝试将其与再灌注期间的门静脉血流相关联。
自2003年起采用一项监测ALDLT受者手术前、手术期间和手术后各种肝脏血流动力学数据的方案。分析移植后受者的血流动力学结果，以及再灌注期间门静脉血流与收集的血流动力学数据之间的相关性。
未出现小肝综合征。发现再灌注期间的门静脉血流与手术开始时的门静脉压力之间存在显著关系（r = 0.46，P <.006），与无肝期的门腔分流血流之间也存在显著关系（r = 0.55，P <.001）。受者在移植后3个月显示出正常的内脏血流动力学状态。
对ALDLT受者进行血流动力学监测对于预防门静脉高流量至关重要。再灌注期间的血流与通过门腔分流的血流之间的关系意味着，可以识别出高流量风险较高的患者，并在再灌注前对其进行调整。
