Hepatic Hemodynamics and Portal Flow Modulation: The A2ALL Experience

被引：40

作者：

Emond, Jean C. ^{[1
]}

Goodrich, Nathan P. ^{[2
]}

Pomposelli, James J. ^{[3
]}

Baker, Talia B. ^{[4
]}

Humar, Abhinav ^{[5
]}

Grant, David R. ^{[6
]}

Abt, Peter ^{[7
]}

Friese, Chris E. ^{[8
]}

Fisher, Robert A. ^{[9
,10
]}

Kam, Igal ^{[11
]}

Sherker, Averell H. ^{[12
]}

Gillespie, Brenda W. ^{[13
]}

Merion, Robert M. ^{[2
,14
]}

机构：

[1] Columbia Univ, Med Ctr, Dept Surg, New York, NY USA

[2] Arbor Res Collaborat Hlth, Ann Arbor, MI USA

[3] Lahey Hosp & Med Ctr, Dept Transplantat, Burlington, MA USA

[4] Northwestern Univ, Dept Surg, Chicago, IL 60611 USA

[5] Univ Pittsburgh, Dept Surg, Med Ctr, Pittsburgh, PA USA

[6] Univ Toronto, Univ Hlth Network, Toronto Gen Hosp, Dept Surg, Toronto, ON, Canada

[7] Univ Penn, Dept Surg, Philadelphia, PA 19104 USA

[8] Univ Calif San Francisco, Dept Surg, San Francisco, CA USA

[9] Virginia Commonwealth Univ, Dept Transplant Surg, Richmond, VA USA

[10] Harvard Univ, Dept Transplant Surg, Beth Israel Deaconess Dept Surg, Boston, MA 02115 USA

[11] Univ Colorado, Dept Surg, Denver, CO 80202 USA

[12] NIDDK, Liver Dis Res Branch, Div Digest Dis & Nutr, NIH, Bethesda, MD 20892 USA

[13] Univ Michigan, Dept Biostat, Ann Arbor, MI 48109 USA

[14] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA

来源：

TRANSPLANTATION | 2017年 / 101卷 / 10期

关键词：

DONOR LIVER-TRANSPLANTATION; FOR-SIZE SYNDROME; ARTERIAL BUFFER RESPONSE; BLOOD-FLOW; HOSPITAL MORTALITY; ADULT RECIPIENTS; LIVING DONORS; VEIN PRESSURE; NITRIC-OXIDE; BODY-WEIGHT;

D O I：

10.1097/TP.0000000000001823

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objective. A principal aimof the Adult-to-Adult Living Donor Liver Transplantation Cohort Study was to study hepatic blood flow and effect of portal flow modulation on graft outcomes in the setting of increasing use of smaller and left lobe grafts. Methods. Recipients of 274 living donor liver transplant were enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, including 233 (85.0%) right lobes, 40 (14.6%) left lobes, and 1 (0.5%) left lateral section. Hepatic hemodynamics were recorded after reperfusion. A total of 57 portal flow modulations were performed on 52 subjects. Results. Modulation lowered portal pressure in 68% of subjects with inconsistent effects on hepatic arterial and portal flow. A higher rate of graft dysfunction was observed in modulated vs. unmodulated subjects (31% vs. 18%; P = 0.03); however, graft survival in modulated subjects was not different from unmodulated subjects at 3 years. Conclusions. These results suggest the need for a study using a prespecified portal flow modulation protocol with defined indications to better define the effects of these interventions.

引用

页码：2375 / 2384

页数：10

共 39 条

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