Delayed splenic artery occlusion for treatment of established small-for-size syndrome after partial liver transplantation.

We looked at the impact of delayed splenic artery occlusion (SAO) on recipients with established small-for-size syndrome (SFSS) after partial graft liver transplantation [either from a living donor (LD) or split from a deceased donor (DD)]. Between 1999 and 2007 we performed a total of 100 partial liver transplantations in adult recipients: 66 LD transplantations and 34 DD split transplantations. Of these, 7 (7%) developed SFSS, diagnosed by the clinical features of cholestasis, coagulopathy, and ascites. Mean graft weight/recipient weight (GW/RW) ratio in these 7 recipients was 0.94%. Five of these 7 recipients underwent relaparotomy at a mean of 10 days post-transplantation to rule out a technical complication, and then intraoperative splenic artery ligation was performed. The other 2 recipients were treated radiologically by splenic artery coiling-at 9 and 13 days post-transplantation. Median serum bilirubin at the time of the splenic artery procedure was 20 mg/dL; by 3 weeks postprocedure this had decreased to 2.5 mg/dL. Of the 7 recipients with SFSS, 6 improved and eventually obtained normal graft function; 1 recipient did not improve and ultimately underwent retransplantation because of persistent cholestasis and failure to thrive. Delayed SAO represents a potential option for the treatment of recipients with established SFSS after partial liver transplantation.

Humar A ，Beissel J ，Crotteau S ，Cohen M ，Lake J ，Payne WD ... -  《-》

Graft weight/recipient weight ratio: how well does it predict outcome after partial liver transplants?

Partial graft liver recipients with graft weight/recipient weight (GW/RW) ratios < 0.8% are thought to have a higher incidence of postoperative complications, including small-for-size syndrome (SFSS). We analyzed a cohort of such recipients and compared those with GW/RW < 0.8% to those with GW/RW >or= 0.8%. Between 1999 and 2008, 107 adult patients underwent partial graft liver transplants: 76 from live donors [living donor liver transplantation (LDLT)] and 31 from deceased donors [split liver transplantation (SLT)]. Of these, 22 had GW/RW < 0.8% (12 with LDLT and 10 with SLT), and 85 had GW/RW >or= 0.8% (64 with LDLT and 21 with SLT). The baseline demographics and median length of follow-up were similar. SFSS developed in 3 recipients with GW/RW < 0.8% (13.6%) and in 8 recipients with GW/RW >or= 0.8% (9.4%; P = not significant). Other early complications were similar between the 2 groups. Inflow modification with splenic artery occlusion was performed in 13 recipients: 7 with GW/RW < 0.8% and 6 with GW/RW >or= 0.8%. Graft survival at 1 year post-transplant did not differ (91% versus 92%; P = not significant). In conclusion, GW/RW did not appear to be the only determinant of outcome after partial liver transplantation. Using techniques such as inflow modification may help to prevent some of the problems seen with smaller grafts.

Hill MJ ，Hughes M ，Jie T ，Cohen M ，Lake J ，Payne WD ，Humar A ... -  《-》

Successful treatment of small-for-size syndrome in adult-to-adult living-related liver transplantation: single center series.

Gruttadauria S ，Mandala' L ，Miraglia R ，Caruso S ，Minervini MI ，Biondo D ，Volpes R ，Vizzini G ，Marsh JW ，Luca A ，Marcos A ，Gridelli B ... -  《CLINICAL TRANSPLANTATION》

Delayed splenic artery occlusion for treatment of established small-for-size syndrome after partial liver transplantation.

Singhal A ，Goyal N ，Gupta VV 《-》

Modulation of portal graft inflow: a necessity in adult living-donor liver transplantation?

Troisi R ，Cammu G ，Militerno G ，De Baerdemaeker L ，Decruyenaere J ，Hoste E ，Smeets P ，Colle I ，Van Vlierberghe H ，Petrovic M ，Voet D ，Mortier E ，Hesse UJ ，de Hemptinne B ... -  《-》