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. 2016 Oct;100(10):2138-45.
doi: 10.1097/TP.0000000000001370.

A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio

Kazuyuki Gyoten  1 , Shugo Mizuno, Hiroyuki Kato, Yasuhiro Murata, Akihiro Tanemura, Yoshinori Azumi, Naohisa Kuriyama, Masashi Kishiwada, Masanobu Usui, Hiroyuki Sakurai, Shuji Isaji
Affiliations

A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio

Kazuyuki Gyoten et al. Transplantation. 2016 Oct.

Abstract

Background: In adult living donor liver transplantation (ALDLT), graft-to-recipient weight ratio of less than 0.8 is incomplete for predicting portal hypertension (>20 mm Hg) after reperfusion. We aimed to identify preoperative factors contributing to portal venous pressure (PVP) after reperfusion and to predict portal hypertension, focusing on spleen volume-to-graft volume ratio (SVGVR).

Methods: In 73 recipients with ALDLT between 2002 and 2013, first we analyzed survival according to PVP of 20 mm Hg as the threshold, evaluating the efficacy of splenectomy. Second, we evaluated various preoperative factors contributing to portal hypertension after reperfusion.

Results: All of the recipients with PVP greater than 20 mm Hg (n = 19) underwent PVP modulation by splenectomy, and their overall survival was favorable compared with 54 recipients who did not need splenectomy (PVP ≤ 20 mm Hg). Graft-to-recipient weight ratio had no correlation with PVP.Multivariate analysis revealed that estimated graft and spleen volume were significant factors contributing to PVP after reperfusion (P < 0.0001 and P < 0.0001, respectively). Furthermore, estimated SVGVR showed a significant negative correlation to PVP after reperfusion (R = 0.652), and the best cutoff value for portal hypertension was 0.95.

Conclusions: In ALDLT, preoperative assessment of SVGVR is a good predictor of portal hypertension after reperfusion can be used to indicate the need for splenectomy before reperfusion.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart detailing recipients who underwent ALDLTs. In study 1, efficacy of splenectomy was investigated in 73 recipients whose precise records of PVP were preserved. In study 2, factors contributing to PVP after reperfusion were analyzed in 55 recipients whose preoperative spleen volumetry was available.
FIGURE 2
FIGURE 2
Change of PVP after splenectomy. Splenectomy was performed in 19 (26%) of the 73 recipients. After splenectomy, mean portal pressure significantly decreased from 25.8 ± 4.7 to 16.7 ± 4.0 mm Hg (mean ± SD).
FIGURE 3
FIGURE 3
Cumulative survival rate according to PVP after reperfusion with a threshold of more than 20 mm Hg. Survival rate of 19 recipients who underwent splenectomy for PVP > 20 mm Hg after reperfusion was as favorable as that of 54 recipients with PVP ≤ 20 mm Hg after reperfusion.
FIGURE 4
FIGURE 4
Relationship between estimated GRWR and PVP after reperfusion. Estimated GRWR had no correlation with PVP after reperfusion (R = 0.360). In 19 recipients with estimated GRWR < 0.8, PVP > 20 mm Hg occurred in 8 (42%). In 36 recipients with estimated GRWR ≥ 0.8, PVP > 20 mm Hg occurred in 9 (25%).
FIGURE 5
FIGURE 5
ROC curve of graft volume and spleen volume in portal hypertension of 20 mm Hg or more after reperfusion. The cutoff value of graft and spleen volume was 557 and 488 mL, respectively. PVP after reperfusion had a significant correlation with graft and spleen volume.
FIGURE 6
FIGURE 6
ROC curve of estimated SVGVR in portal hypertension of more than 20 mm Hg after reperfusion, and the relation between SVGV ratio and PVP after reperfusion. The cutoff value of SVGVR was set as 0.95. In 15 recipients with SVGV of 0.95 or more, 11 (73.3%) had portal hypertension.
FIGURE 7
FIGURE 7
Relationship between SVGVR and PVP after reperfusion according to MELD score. In high and low MELD, SVGVR showed a positive correlation with PVP (R = 0.581 and R = 0.692, respectively).
FIGURE 8
FIGURE 8
Relationship between SVGVR and PVP after reperfusion according to graft type. In left lobe grafts (n = 24) as well as right lobe grafts (n = 30), SVGVR had a significant correlation with PVP after reperfusion (R = 0.57 and R = 0.73, respectively).
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