Hepatic Hemodynamics and Portal Flow Modulation: The A2ALL Experience. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Emond, Jean C.; Goodrich, Nathan P.; Pomposelli, James J.; Baker, Talia B.; Humar, Abhinav; Grant, David R.; Abt, Peter; Friese, Chris E.; Fisher, Robert A.; Kam, Igal; Sherker, Averell H.; Gillespie, Brenda W.; Merion, Robert M.
• Is Part Of: Transplantation. Volume 101:Issue 10(2017)
• Publication Date: 2017-10
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001823
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Objective: A principal aim of 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. Abstract : The authors from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study report the inconsistent effects of portal flow modulation on hepatic arterial and portal flow with relatively low impact on graft outcomes, suggesting the need for a study assessing a prespecified portal flow modulation protocol.