Optimal portal venous circulation for liver graft function after living-donor liver transplantation

Background. Previous studies have shown poor outcome after living-donor liver transplantation (LDLT) as a result of excessive portal venous pressure (PVP), excessive portal venous flow (PVF), or inadequate PVF. We investigated optimal portal venous circulation for liver graft function after LDLT in adult recipients retrospectively. Methods. Between June 2003 and November 2004, 28 adult patients underwent LDLT in our institution. We modulated PVP under 20 mmHg in these 28 cases by performing a splenectomy (n=4) or splenorenal shunt (n=1). The PVF and PVP were measured at the end of the operation. Compliance was calculated by dividing PVF by PVP. Results. PVF and compliance showed a significant inverse correlation with peak billirubin levels after LDLT (r = -0.63: r=-0.60, P < 0.01), and with peak international normalized ratio after LDLT (r=-0.41: r=-0.51, P < 0.05). Compliance was higher in right-lobe graft with middle hepatic vein cases (148 +/- 27 ml/min/mmHg), and lower in left-lobe graft cases (119 +/- 50 ml/min/mmHg). Conclusions. Liver graft function was better when PVF and graft compliance were higher and PVP was maintained under 20 mmHg.