门静脉压力或门体静脉梯度真的是活体肝移植术后不良预后的预兆吗？
Is Portal Venous Pressure or Porto-systemic Gradient Really A Harbinger of Poor Outcomes After Living Donor Liver Transplantation?
作者信息
Kanetkar Amol Vijay, Balakrishnan Dinesh, Sudhindran Sudhindran, Dhar Puneet, Gopalakrishnan Unnikrishnan, Menon Ramachandran, Sudheer Othiyil Vayoth
机构信息
Department of Gastro Intestinal Surgery and Solid Organ Transplantation, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
出版信息
J Clin Exp Hepatol. 2017 Sep;7(3):235-246. doi: 10.1016/j.jceh.2017.01.114. Epub 2017 Feb 6.
BACKGROUND
Portal hyperperfusion as a cause of small for size syndrome (SFSS) after living donor liver transplantation (LDLT) remains controversial. Portal venous pressure (PVP) is often measured indirectly and may be confounded by central venous pressure (CVP).
METHODS
In 42 adult cirrhotics undergoing elective LDLT, PVP was measured by direct canulation of portal vein and porto systemic gradient (PSG) was obtained after subtracting CVP from PVP. None underwent portal inflow modulation. SFSS was looked in 27 patients after excluding 15 with technical complications.
RESULTS
Clinical features of SFSS found in 6 patients, 5 with graft recipient weight ratio (GRWR) > 0.8% and PVP < 20 mm of Hg. One with GRWR < 0.8% could truly be labeled as SFSS. Incidence of SFSS was not higher in patients with elevated PVP > 20 mm of Hg (14.3% vs 0%, = 0.259) or PSG > 13 mm of Hg (33.3% vs 0%, = 0.111). Intensive care unit (ICU) stay was longer in patients with elevated PVP (14.55 vs 9.13 days, = 0.007) and PSG (16.8 vs 9.72 days, = 0.009). There was no difference in graft functions, post-operative complications and mortality in first month post-LDLT.
CONCLUSION
Elevated PVP or PSG increased morbidity but neither predicted SFSS nor affected survival.
背景
活体肝移植（LDLT）后门静脉高灌注作为小体积肝综合征（SFSS）的一个病因仍存在争议。门静脉压力（PVP）常通过间接测量，可能会受到中心静脉压（CVP）的影响。
方法
对42例接受择期LDLT的成年肝硬化患者，通过门静脉直接插管测量PVP，并从PVP中减去CVP得到门体静脉压差（PSG）。所有患者均未进行门静脉血流调节。排除15例有技术并发症的患者后，对27例患者观察是否发生SFSS。
结果
6例患者出现SFSS的临床特征，5例移植肝受体重量比（GRWR）>0.8%且PVP<20 mmHg。1例GRWR<0.8%的患者可被明确诊断为SFSS。PVP>20 mmHg（14.3%对0%，P=0.259）或PSG>13 mmHg（33.3%对0%，P=0.111）的患者中，SFSS的发生率并无升高。PVP升高的患者（14.55天对9.13天，P=0.007）和PSG升高的患者（16.8天对9.72天，P=0.009）在重症监护病房（ICU）的住院时间更长。LDLT术后第一个月，移植肝功能、术后并发症及死亡率无差异。
结论
PVP或PSG升高会增加发病率，但既不能预测SFSS，也不影响生存率。
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