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Open Access 25.09.2019 | Review Article

Portal flow modulation in living donor liver transplantation: review with a focus on splenectomy

verfasst von: Tomoharu Yoshizumi, Masaki Mori

Erschienen in: Surgery Today | Ausgabe 1/2020

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Abstract

Small-for-size graft (SFSG) syndrome after living donor liver transplantation (LDLT) is the dysfunction of a small graft, characterized by coagulopathy, cholestasis, ascites, and encephalopathy. It is a serious complication of LDLT and usually triggered by excessive portal flow transmitted to the allograft in the postperfusion setting, resulting in sinusoidal congestion and hemorrhage. Portal overflow injures the liver directly through nutrient excess, endothelial activation, and sinusoidal shear stress, and indirectly through arterial vasoconstriction. These conditions may be attenuated with portal flow modulation. Attempts have been made to control excessive portal flow to the SFSG, including simultaneous splenectomy, splenic artery ligation, hemi-portocaval shunt, and pharmacological manipulation, with positive outcomes. Currently, a donor liver is considered a SFSG when the graft-to-recipient weight ratio is less than 0.8 or the ratio of the graft volume to the standard liver volume is less than 40%. A strategy for transplanting SFSG safely into recipients and avoiding extensive surgery in the living donor could effectively address the donor shortage. We review the literature and assess our current knowledge of and strategies for portal flow modulation in LDLT.

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Titel: Portal flow modulation in living donor liver transplantation: review with a focus on splenectomy
verfasst von: Tomoharu Yoshizumi
Masaki Mori
Publikationsdatum: 25.09.2019
Verlag: Springer Singapore
Erschienen in: Surgery Today / Ausgabe 1/2020
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-019-01881-y

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