ABSTRACT
Objective To explore the effectiveness of octreotide therapeutic strategy to attenuate portal hyperperfusion resulted from small-for-size graft in infant liver transplantation.Methods A total of 22 infants received small-for-size liver graft (defined as GV/SLV＜0.5,and GV＜ 150 g) in our hospital from December 2013 to August 2016.Twelve cases (octreotide group) were treated with intravenous octreotide infusion (300 g daily for 24-96 h) to attenuate the portal hyperperfusion after transplantation,and the rest 10 cases given liver transplantation at the early stage did not receive the intervention of octreotide and served as control group.Results The initial portal vein flows (PVFs) in octreotide group and control group were (413.43 ± 76.24) (390.83 ± 107.89) ml/(min 100 g),and there was no significant difference between two groups (P＞0.05).The PVFs on postoperative day (POD) 3 and POD5 in octreotide group and control group were (334.90 ± 96.67) and (441.04 ± 117.41),and (322.20 ± 81.04) and (423.23 ± 100.81) mL/(min 100 g) respectively (P＜0.05 for all).However,there were no significant differences in serum AST and bilirubin levels at four time points (initial,POD3,POD5 and POD7) after transplantation between two groups (P＞0.05).The incidence of hepatic artery occlusion,and biliary complications in octreotide group and ontrol group was 33.33％ and 44.44％,and 33.33％ and 11.11％ respectively (P ＞ 0.05 for all).Conclusion Octreotide treatment attenuated portal hyperperfusion resulted from small-for-size graft in infant liver transplantation.However,the effects of octreotide therapy on graft biochemical tests,the hepatic artery and biliary complications were still unclear,and further investigation is needed.
ABSTRACT
Objective To explore the effectiveness of octreotide therapeutic strategy to attenuate portal hyperperfusion resulted from small-for-size graft in infant liver transplantation.Methods A total of 22 infants received small-for-size liver graft (defined as GV/SLV＜0.5,and GV＜ 150 g) in our hospital from December 2013 to August 2016.Twelve cases (octreotide group) were treated with intravenous octreotide infusion (300 g daily for 24-96 h) to attenuate the portal hyperperfusion after transplantation,and the rest 10 cases given liver transplantation at the early stage did not receive the intervention of octreotide and served as control group.Results The initial portal vein flows (PVFs) in octreotide group and control group were (413.43 ± 76.24) (390.83 ± 107.89) ml/(min 100 g),and there was no significant difference between two groups (P＞0.05).The PVFs on postoperative day (POD) 3 and POD5 in octreotide group and control group were (334.90 ± 96.67) and (441.04 ± 117.41),and (322.20 ± 81.04) and (423.23 ± 100.81) mL/(min 100 g) respectively (P＜0.05 for all).However,there were no significant differences in serum AST and bilirubin levels at four time points (initial,POD3,POD5 and POD7) after transplantation between two groups (P＞0.05).The incidence of hepatic artery occlusion,and biliary complications in octreotide group and ontrol group was 33.33％ and 44.44％,and 33.33％ and 11.11％ respectively (P ＞ 0.05 for all).Conclusion Octreotide treatment attenuated portal hyperperfusion resulted from small-for-size graft in infant liver transplantation.However,the effects of octreotide therapy on graft biochemical tests,the hepatic artery and biliary complications were still unclear,and further investigation is needed.
ABSTRACT
Excessive portal venous inflow has been known as a determining factor for hepatic injury in small-for-size graft in living-donor liver transplantation. Partial diversion of portal inflow to the systemic circulation by portacaval shunt has been reported as a promising treatment modality to prevent patient from small-for-size graft syndrome. In addition, splenectomy itself is not only a method to decrease portal flow, but also a treatment for the gastric fundal variceal bleeding. We performed living-donor liver transplantation with transient portacaval shunt and splenectomy due to small-for-size graft in a 50 year-old male suffering from hepatitis B virus related liver cirrhosis with bleeding gastric fundal varices, not amenable to control endoscopically. The donor was patient's wife and a graft to recipient body weight ratio (GRWR) was 0.64. During surgery, left portal vein was used for temporary portacaval shunt and the right portal vein was anatomosed to the graft portal vein. After all vascular anastomoses completed, an endoloop (OpenLoop(R), SJM, Paju, Korea) was placed around portacaval shunt without tightening, and the knot pusher was brought out through abdominal wall introduced in a silastic drain tube. Concomitant splenectomy was performed. Twenty-four hours after transplantation, the loop placed around portacaval shunt was tightened as a bedside procedure. The recipient had an uneventful postoperative course and was discharged with normal graft function 26 days after transplantation. Living-donor liver transplantation with transient portacaval shunt and splenectomy could be an acceptable surgical treatment strategy for patients with end-stage liver disease with small-for-size graft and bleeding gastric fundal varices.
Subject(s)
Humans , Male , Abdominal Wall , Body Weight , Dimethylpolysiloxanes , Hemorrhage , Hepatitis B virus , Liver , Liver Cirrhosis , Liver Diseases , Liver Transplantation , Portacaval Shunt, Surgical , Portal Vein , Splenectomy , Spouses , Stress, Psychological , Tissue Donors , Transplants , Varicose VeinsABSTRACT
The indications for living donor liver transplantation (LDLT) were successfully expanded from pediatric to adult cases last 15 years. During this process, graft type has been shifted from left side liver to right side liver. Although the introduction of right lobe graft can successfully increase the actual graft size in LDLT, problem related to "small-for-size grafts" have gradually come to light. "Small-for-size syndrome", such as poor bile production, delayed synthetic function, prolonged cholestasis, and intractable ascites, leading to septic complications and higher mortality, are neither specific nor inevitable in low-weight liver grafts. Many factors other than actual graft weight contribute to the occurrence of "small-for-size syndrome". In the clinical setting, surgical modification targeting portal hemodynamics and tissue congestion is a key to overcome "small-for-size syndrome". Until now, several therapeutic options were reported, but further elucidation of the pathogenesis in "small-for-size syndrome" will be a solution for improving the outcomes in adult-to-adult LDLT.