2024-03-29T11:51:31Z
https://u-ryukyu.repo.nii.ac.jp/oai
oai:u-ryukyu.repo.nii.ac.jp:02011171
2023-08-03T05:33:01Z
1642838163960:1642838338003
1642838403551:1642838407795
Post-transplant inflow modulation for early allograft dysfunction after living donor liver transplantation
Elshawy, Mohamed
Toshima, Takeo
Asayama, Yoshiki
Kubo, Yuichiro
Ikeda, Shinichiro
Ikegami, Toru
Arakaki, Shingo
Yoshizumi, Tomoharu
Mori, Masaki
open access
Creative Commons Attribution 4.0 right
https://creativecommons.org/licenses/by/4.0/
Liver transplantation
Portal flow
Modulation
Graft dysfunction
Small-for-size syndrome
Splenic artery
Embolization
Background:To treat small-for-size syndrome (SFSS) after living donor liver transplantation (LDLT), many procedures were described for portal flow modulation before, during, or after transplantation. The selection of the procedure as well as the best timing remains controversial.\nCase presentation:A 43-year-old female with end-stage liver disease underwent LDLT with extended left with caudate lobe graft from her donor who was her 41-year-old brother (graft volume/standard liver volume (GV/SLV), 35.7%; graft to recipient weight ratio (GRWR), 0.67%). During the surgery, splenectomy could not be performed owing to severe peri-splenic adhesions to avoid the ruined bleedings. The splenic artery ligation was not also completely done because it was dorsal to the pancreas and difficult to be approached. Finally, adequate portal vein (PV) inflow was confirmed after portal venous thrombectomy. As having post-transplant optional procedures that are accessible for PV flow modulation, any other procedures for PV modulation during LDLT were not done until the postoperative assessment of the graft function and PV flow for possible postoperative modulation of the portal flow accordingly. Postoperative PV flow kept as high as 30 cm/s. By the end of the 1st week, there was a progressive deterioration of the total bilirubin profile (peak as 19.4 mg/dL) and ascitic fluid amount exceeded 1000 mL/day. Therefore, splenic artery embolization was done effectively and safely on the 10th postoperative day (POD) to reverse early allograft dysfunction as PV flow significantly decreased to keep within 20 cm/s and serum total bilirubin levels gradually declined with decreased amounts of ascites below 500 mL on POD 11 and thereafter. The patient was discharged on POD 28 with good condition.\nConclusions:SFSS can be prevented or reversed by the portal inflow modulation, even by post-transplant procedure. This case emphasizes that keeping accessible angiographic treatment options for PV modulation, such as splenic artery embolization, after LDLT is quite feasible.
論文
Springer Nature
2020-07-08
eng
journal article
VoR
http://hdl.handle.net/20.500.12000/47027
http://hdl.handle.net/20.500.12000/47027
https://u-ryukyu.repo.nii.ac.jp/records/2011171
https://doi.org/10.1186/s40792-020-00897-8
https://doi.org/10.1186/s40792-020-00897-8
2198-7793
Surgical Case Reports
6
https://u-ryukyu.repo.nii.ac.jp/record/2011171/files/Elshawy2020_Article_Post-transplantInflowModulatio.pdf