Background: Due to the shortage of available cadaveric organs, living donor liver transplantation (LDLT) has been recently applied extensively in adults. The use of the left lobe should be encouraged because of donor safety, but frequently the metabolic requirements of severely cirrhotic patients are great and subsequent graft dysfunction is encountered after transplantation. The importance of increased portal inflow to the graft in previously severely cirrhotic patients and other hemodynamic changes in LDLT using left lobes are still under debate, as are the surgical modulations to correct them. In this study, we have reported an initial series of adult-to-adult LDLT using left lobes, underlining the hemodynamic changes encountered during the transplant and the surgical modulations we applied to correct them. Methods: Eight adult recipients underwent left lobe liver transplantation from living donors. Portal vein pressure and central venous pressure were measured before and after surgical modulation. Results: We encountered four cases of small-for-size syndrome. Two patients were retransplanted; the other two died. Seventy-five percent of our recipients survived and 50% did not require further surgery. Conclusion: Surgical portal inflow modulation should be considered in cases of left lobe liver transplantation between adults. © 2007 Elsevier Inc. All rights reserved.
Background. Due to the shortage of available cadaveric organs, living donor liver transplantation (LDLT) has been recently applied extensively in adults. The use of the left lobe should be encouraged because of donor safety, but frequently the metabolic requirements of severely cirrhotic patients are great and subsequent graft dysfunction is encountered after transplantation. The importance of increased portal inflow to the graft in previously severely cirrhotic patients and other hemodynamic changes in LDLT using left lobes are still under debate, as are the surgical modulations to correct them. In this study, we have reported an initial series of adult-to-adult LDLT using left lobes, underlining the hemodynamic changes encountered during the transplant and the surgical modulations we applied to correct them. Methods. Eight adult recipients underwent left lobe liver transplantation from living donors. Portal vein pressure and central venous pressure were measured before and after surgical modulation. Results. We encountered four cases of small-for-size syndrome. Two patients were retransplanted; the other two died. Seventy-five percent of our recipients survived and 50% did not require further surgery. Conclusion. Surgical portal inflow modulation should be considered in cases of left lobe liver transplantation between adults.
Adult-to-adult living donor liver transplantation using left lobes: The importance of surgical modulations on portal graft inflow / Lauro, A.; Diago Uso, T.; Quintini, C.; Di Benedetto, F.; Dazzi, A.; De Ruvo, N.; Masetti, M.; Cautero, N.; Risaliti, A.; Zanfi, C.; Ramacciato, G.; Begliomini, B.; Siniscalchi, A.; Miller, C. M.; Pinna, A. D.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - 39:6(2007), pp. 1874-1876. (Intervento presentato al convegno 30th Congress of the Italian-Society-of-Organ-Transplantation tenutosi a Padova, ITALY nel NOV 30-DEC 02, 2006) [10.1016/j.transproceed.2007.05.052].
Adult-to-adult living donor liver transplantation using left lobes: The importance of surgical modulations on portal graft inflow
Lauro A.
Primo
Writing – Review & Editing
;Ramacciato G.;
2007
Abstract
Background: Due to the shortage of available cadaveric organs, living donor liver transplantation (LDLT) has been recently applied extensively in adults. The use of the left lobe should be encouraged because of donor safety, but frequently the metabolic requirements of severely cirrhotic patients are great and subsequent graft dysfunction is encountered after transplantation. The importance of increased portal inflow to the graft in previously severely cirrhotic patients and other hemodynamic changes in LDLT using left lobes are still under debate, as are the surgical modulations to correct them. In this study, we have reported an initial series of adult-to-adult LDLT using left lobes, underlining the hemodynamic changes encountered during the transplant and the surgical modulations we applied to correct them. Methods: Eight adult recipients underwent left lobe liver transplantation from living donors. Portal vein pressure and central venous pressure were measured before and after surgical modulation. Results: We encountered four cases of small-for-size syndrome. Two patients were retransplanted; the other two died. Seventy-five percent of our recipients survived and 50% did not require further surgery. Conclusion: Surgical portal inflow modulation should be considered in cases of left lobe liver transplantation between adults. © 2007 Elsevier Inc. All rights reserved.| File | Dimensione | Formato | |
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