Korda D, Deák P Á, Kiss G, Gerlei Z, Kóbori L, Görög D, Fehérvári I, Piros L, Máthé Z, Doros A
Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
Transplant Proc. 2017 Sep;49(7):1530-1534. doi: 10.1016/j.transproceed.2017.06.015.
Post-transplantation portal hypertension has severe complications, such as esophageal varix bleeding, therapy refractory ascites, extreme splenomegaly, and graft dysfunction. The aim of our study was to analyze the effectiveness of the therapeutic strategies and how to visualize the procedure.
A retrospective study involving liver transplantation patients from the Semmelweis University Department of Transplantation and Surgery was performed between 2005 and 2015. The prevalence, etiology, and leading complications of the condition were determined. The applied interventions' effects on the patients' ascites volume, splenic volume, and the occurrence of variceal bleeding were determined. Mean portal blood flow velocity and congestion index values were calculated using Doppler ultrasonography.
The prevalence of post-transplantation portal hypertension requiring intervention was 2.8%. The most common etiology of the disease was portal anastomotic stenosis. The most common complications were esophageal varix bleeding and therapy refractory ascites. The patients' ascites volume decreased significantly (2923.3 ± 1893.2 mL vs. 423.3 ± 634.3 mL; P < .05), their splenic volume decreased markedly. After the interventions, only one case of recurrent variceal bleeding was reported. The calculated Doppler parameters were altered in the opposite direction in cases of pre-hepatic versus intra- or post-hepatic portal hypertension. After the interventions, these parameters shifted towards the physiologic ranges.
The interventions performed in our clinic were effective in most cases. The patients' ascites volume, splenic volume, and the prevalence of variceal bleeding decreased after the treatment. Doppler ultrasonography has proved to be a valuable imaging modality in the diagnosis and the follow-up of post-transplantation portal hypertension.
移植后门静脉高压有严重并发症，如食管静脉曲张出血、治疗难治性腹水、极度脾肿大和移植物功能障碍。我们研究的目的是分析治疗策略的有效性以及如何可视化该过程。
对2005年至2015年间塞梅尔维斯大学移植与外科系的肝移植患者进行回顾性研究。确定该疾病的患病率、病因和主要并发症。确定所应用干预措施对患者腹水量、脾脏体积和静脉曲张出血发生率的影响。使用多普勒超声计算平均门静脉血流速度和充血指数值。
需要干预的移植后门静脉高压患病率为2.8%。该疾病最常见的病因是门静脉吻合口狭窄。最常见的并发症是食管静脉曲张出血和治疗难治性腹水。患者的腹水量显著减少（2923.3±1893.2 mL对423.3±634.3 mL；P <.05），脾脏体积明显减小。干预后，仅报告了1例复发性静脉曲张出血病例。在肝前性与肝内或肝后性门静脉高压病例中，计算出的多普勒参数朝相反方向改变。干预后，这些参数移向生理范围。
我们诊所进行的干预在大多数情况下是有效的。治疗后患者的腹水量、脾脏体积和静脉曲张出血患病率降低。多普勒超声已被证明是移植后门静脉高压诊断和随访中有价值的成像方式。
