Sholkamy Amany, Salman Ahmed, El-Garem Nouman, Hosny Karim, Abdelaziz Omar
Dr. Ahmed Salman, Department of Internal Medicine,, Faculty of Medicine, Cairo University, Kasr Alainy, 6th Khorsheid St. Mesaha Harm,, Cairo 12345, Giza, Egypt, T: 00201000468664
Ann Saudi Med. 2018 May-Jun;38(3):181-188. doi: 10.5144/0256-4947.2018.181.
Several studies have defined the optimal portal pressure suitable for adequate graft renewal in liver transplantation (LT) but none have studied an Egyptian population to our knowledge.
Determine the level of portal venous pressure (PVP) for adequate graft function, and study the effect of PVP modulation on the outcome of LT in an Egyptian population.
Cross-sectional, prospectively collected data.
Liver transplantation unit.
The study included adult cirrhotic pa.tients who underwent right lobe liver donor living transplantation (LDLT) at our transplantation center. Intraoperative Doppler was performed on all LDLT patients. Two PVP measurements were obtained during the recipient operation: before PV clamping and after graft re-perfusion. These PVP measurements were correlated with the results of intraoperative and postoperative Doppler findings and graft function. Mortality in the early postoperative period ( less than 1 month) and development of small-for-size syndrome (SFSS) were recorded.
PVP, graft injury, and the effect of PVP modulation on the outcome of LT were the primary outcome measures. Secondary outcome measures were to correlate PVP to portal vein hemodynamics and intraoperative mean hepatic artery, peak systolic velocity, and also to correlate PVP with the postoperative graft function and mean postoperative platelet count.
69 adult patients with end-stage liver disease.
Post-reperfusion PVP was lower than pre-clamping PVP. The mean pre-clamping and post-reperfusion values were higher in patients who experienced early mortality and in patients with smaller grafts. A PVP greater than 16.5 mm Hg at the end of the operation predicted the development of SFSS (sensitivity=91.7% and specificity=50.5%). Cases of high PVP that were modulated to a lower level had a smooth and uneventful postoperative outcome.
PVP is a significant hemodynamic factor that influences the functional status of the transplanted liver, including the development of SFSS, in the Egyptian population. PVP modulation may improve the outcome of LDLT.
Further study with a larger sample is needed to confirm these results.
None.
多项研究已确定了肝移植（LT）中适合充分移植肝更新的最佳门静脉压力，但据我们所知，尚无研究针对埃及人群。
确定适合移植肝功能的门静脉压力（PVP）水平，并研究PVP调节对埃及人群LT结局的影响。
横断面研究，前瞻性收集数据。
肝移植科。
该研究纳入了在我们移植中心接受右叶活体肝供体肝移植（LDLT）的成年肝硬化患者。对所有LDLT患者进行术中多普勒检查。在受体手术期间获得两次PVP测量值：门静脉夹闭前和移植肝再灌注后。这些PVP测量值与术中及术后多普勒检查结果和移植肝功能相关。记录术后早期（小于1个月）的死亡率和小肝综合征（SFSS）的发生情况。
PVP、移植肝损伤以及PVP调节对LT结局的影响是主要观察指标。次要观察指标是将PVP与门静脉血流动力学以及术中平均肝动脉、收缩期峰值流速相关联，还将PVP与术后移植肝功能和术后平均血小板计数相关联。
69例终末期肝病成年患者。
再灌注后的PVP低于夹闭前的PVP。早期死亡患者和移植肝较小的患者夹闭前和再灌注后的平均PVP值较高。手术结束时PVP大于16.5 mmHg可预测SFSS的发生（敏感性=91.7%，特异性=50.5%）。将高PVP调节至较低水平的病例术后过程顺利。
在埃及人群中，PVP是影响移植肝功能状态（包括SFSS发生）的重要血流动力学因素。PVP调节可能改善LDLT的结局。
需要更大样本量的进一步研究来证实这些结果。
无。
