Osman Ayman M A, Hosny Adel A, El-Shazli Mostafa A, Uemoto Shinji, Abdelaziz Omar, Helmy Ayman S
Department of General Surgery, Unit of Hepatobiliary Surgery, Faculty of Medicine, Cairo University, Egypt.
Department of Surgery, Division of Hepato-Pancreatico-Biliary Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Japan.
Hepatol Res. 2017 Mar;47(4):293-302. doi: 10.1111/hepr.12727. Epub 2016 May 11.
Portal hypertension has recently been implicated in the pathogenesis of small-for-size syndrome (SFSS) in adult-to-adult living-donor liver transplantation (A-LDLT). The aim of our study is to compare the portal venous pressure (PVP) cut-off values of 15 mmHg and 20 mmHg in terms of prevention of SFSS in A-LDLT.
Seventy-six patients underwent A-LDLT. A PVP <20 mmHg at the end of the operation was targeted using graft inflow modulation. Patients were divided into two groups: group A, final PVP <15 mmHg; and group B, final PVP 15-19 mmHg. Peak serum bilirubin and peak international normalized ratio in the first month after A-LDLT, as well as hepatic encephalopathy, SFSS, 90-day morbidity, and mortality were observed in both groups.
Final PVP was well controlled below 20 mmHg in all patients (group A, n = 39; group B, n = 37). Six patients suffered SFSS in group B (16.2%) compared to one patient (2.6%) in group A (P = 0.04). Nine patients died in group B (24.3%), four of whom died of SFSS, compared to three patients in group A (7.7%) (P = 0.047).
A PVP cut-off of 15 mmHg seems to be a more appropriate target level than a cut-off of 20 mmHg for prevention of postoperative SFSS in A-LDLT.
门静脉高压最近被认为与成人活体肝移植（A-LDLT）中肝体积过小综合征（SFSS）的发病机制有关。我们研究的目的是比较门静脉压力（PVP）15mmHg和20mmHg的临界值在预防A-LDLT中SFSS方面的效果。
76例患者接受了A-LDLT。通过调节移植物血流，目标是使手术结束时PVP<20mmHg。患者分为两组：A组，最终PVP<15mmHg；B组，最终PVP为15-19mmHg。观察两组患者A-LDLT术后第一个月的血清胆红素峰值和国际标准化比值峰值，以及肝性脑病、SFSS、90天发病率和死亡率。
所有患者的最终PVP均良好控制在20mmHg以下（A组，n = 39；B组，n = 37）。B组有6例患者发生SFSS（16.2%），而A组有1例患者发生（2.6%）（P = 0.04）。B组有9例患者死亡（24.3%），其中4例死于SFSS，而A组有3例患者死亡（7.7%）（P = 0.047）。
对于预防A-LDLT术后SFSS，PVP临界值为15mmHg似乎比20mmHg更合适。
