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Randomized Controlled Trial
. 2025 Apr 1;281(4):561-572.
doi: 10.1097/SLA.0000000000006369. Epub 2024 Jun 6.

Graft Inflow Modulation by Splenic Artery Ligation for Portal Hyperperfusion Does Not Decrease Rates of Early Allograft Dysfunction in Adult Live Donor Liver Transplantation: A Randomized Control Trial

Viniyendra Pamecha  1 , Gattu Tharun  1 , Nilesh Sadashiv Patil  1 , Nihar Mohapatra  1 , Anubhav Kumar  1 , Shalini Thapar  2 , Gaurav Sindwani  3 , Udit Dhingra  3 , Anil Yadav  3
Affiliations
Randomized Controlled Trial

Graft Inflow Modulation by Splenic Artery Ligation for Portal Hyperperfusion Does Not Decrease Rates of Early Allograft Dysfunction in Adult Live Donor Liver Transplantation: A Randomized Control Trial

Viniyendra Pamecha et al. Ann Surg. .

Abstract

Objective: The primary objective was to compare the rates of early allograft dysfunction (EAD) in patients undergoing elective adult live donor liver transplantation (ALDLT) with and without graft portal inflow modulation (GIM) for portal hyperperfusion. The secondary objectives were to compare time to normalization of bilirubin and International Normalized Ratio, day 14 ascitic output more than 1 L, small-for-size syndrome, intensive care unit/high dependency unit and total hospital stay, and 90-day morbidity and mortality.

Background: GIM can prevent EAD in ALDLT patients with portal hyperperfusion.

Methods: A single-center randomized trial with and without GIM for portal hyperperfusion by splenic artery ligation (SAL) in ALDLT was performed. After reperfusion, patients with portal venous pressure (PVP)>15 mm Hg with a gradient (PVP-central venous pressure) of ≥7 mm Hg and/or portal venous flow (PVF) >250 mL/min/100 g of liver were randomized into 2 groups: GIM and No GIM.

Results: 75 of 209 patients satisfied the inclusion criteria, and 38 underwent GIM. Baseline PVF and PVP were comparable between the GIM and no GIM groups. SAL significantly reduced the PVF and PVP ( P <0.001). There were no significant differences in the primary and secondary outcomes between the 2 groups. In the subgroup analysis, with a Graft to Recipient Weight Ratio ≤0.8, there were no significant differences in the primary and secondary outcomes.

Conclusions: SAL significantly decreased PVP and PVF but did not decrease rates of EAD in adult LDLT.

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Conflict of interest statement

The authors report no conflicts of interest.

Comment in

References

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