Portal venous pressure and proper graft function in living donor liver transplants in 69 patients from an Egyptian center.

Abstract

BACKGROUNDSeveral 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.OBJECTIVESDetermine 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.DESIGNCross-sectional, prospectively collected data.SETTINGLiver transplantation unit.PATIENTS AND METHODSThe study included adult cirrhotic patients 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 reperfusion. These PVP measurements were correlated with the results of intraoperative and postoperative Doppler findings and graft function. Mortality in the early postoperative period (<1 month) and development of small-for-size syndrome (SFSS) were recorded.MAIN OUTCOME MEASURESPVP, 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.SAMPLE SIZE AND CHARACTERISTICS69 adult patients with end-stage liver disease.RESULTSPost-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.CONCLUSIONPVP 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.LIMITATIONSFurther study with a larger sample is needed to confirm these results.