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Critical progressive small-graft injury caused by intrasinusoidal pressure elevation following living donor liver transplantation.

Abstract：

:In adult-to-adult living liver transplantation, small-for-size graft syndrome sometimes occurs. The relationship between the hemodynamic changes and histologic findings has not been studied in patients with failure of small-for-size grafts. We analyzed the relationship between the postoperative hemodynamic changes and pathologic findings in patients with small-for-size grafts that ended in graft failure. From March 1999 to December 2002, adult-to-adult living-donor liver transplantation with small-size grafts (graft volume/standard liver volume less than 40%) was performed in eight patients. Three patients died from graft failure caused by overperfusion, which was diagnosed from pathologic findings. We analyzed the relation between hepatic hemodynamic parameters, such as portal venous blood velocity or splenic arterial pulsatility index, and histologic changes in patients with graft failure. Severe portal hyperperfusion (90 cm/sec at the umbilical portion) was observed on postoperative day 1. Among patients with graft failure, critical hemodynamic changes, such as sudden onset of extremely deteriorated portal venous blood flow, occurred during the early postoperative period (postoperative day 5, 3, 6, respectively). Histologic examination revealed vacuolar changes in the cytoplasm of hepatocytes, and submassive necrosis indicated intrasinusoidal pressure elevation. These changes were not observed in the biopsy obtained soon after reperfusion. In conclusion, critically decreased vascular beds may cause intrasinusoidal pressure elevation and sinusoidal circulatory disturbances.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Sugimoto H,Kaneko T,Hirota M,Nagasaka T,Kobayashi T,Inoue S,Takeda S,Kiuchi T,Nakao A

doi

10.1016/j.transproceed.2004.09.036

subject

Has Abstract

pub_date

2004-11-01 00:00:00

pages

2750-6

issue

9

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(04)01106-6

journal_volume

36

pub_type

杂志文章

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