A portal pressure cut-off of 15 versus a cut-off of 20 for prevention of small-for-size syndrome in liver transplantation: A comparative study

Ayman M A Osman; Adel A Hosny; Mostafa A El-Shazli; Shinji Uemoto; Omar Abdelaziz; Ayman S Helmy

doi:10.1111/hepr.12727

A portal pressure cut-off of 15 versus a cut-off of 20 for prevention of small-for-size syndrome in liver transplantation: A comparative study

Hepatol Res. 2017 Mar;47(4):293-302. doi: 10.1111/hepr.12727. Epub 2016 May 11.

Authors

Ayman M A Osman¹, Adel A Hosny¹, Mostafa A El-Shazli¹, Shinji Uemoto², Omar Abdelaziz³, Ayman S Helmy¹

Affiliations

¹ Department of General Surgery, Unit of Hepatobiliary Surgery, Faculty of Medicine, Cairo University, Egypt.
² Department of Surgery, Division of Hepato-Pancreatico-Biliary Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Japan.
³ Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Egypt.

PMID: 27084787
DOI: 10.1111/hepr.12727

Abstract

Aim: Portal hypertension has recently been implicated in the pathogenesis of small-for-size syndrome (SFSS) in adult-to-adult living-donor liver transplantation (A-LDLT). The aim of our study is to compare the portal venous pressure (PVP) cut-off values of 15 mmHg and 20 mmHg in terms of prevention of SFSS in A-LDLT.

Methods: Seventy-six patients underwent A-LDLT. A PVP <20 mmHg at the end of the operation was targeted using graft inflow modulation. Patients were divided into two groups: group A, final PVP <15 mmHg; and group B, final PVP 15-19 mmHg. Peak serum bilirubin and peak international normalized ratio in the first month after A-LDLT, as well as hepatic encephalopathy, SFSS, 90-day morbidity, and mortality were observed in both groups.

Results: Final PVP was well controlled below 20 mmHg in all patients (group A, n = 39; group B, n = 37). Six patients suffered SFSS in group B (16.2%) compared to one patient (2.6%) in group A (P = 0.04). Nine patients died in group B (24.3%), four of whom died of SFSS, compared to three patients in group A (7.7%) (P = 0.047).

Conclusion: A PVP cut-off of 15 mmHg seems to be a more appropriate target level than a cut-off of 20 mmHg for prevention of postoperative SFSS in A-LDLT.

Keywords: adult; bilirubin; international normalized ratio; liver transplantation; portal pressure; postoperative period.