Serial Monitoring of Portal Venous Pressure/Flow during Living Donor Liver Transplantation

PURPOSE: Although living donor liver transplantations (LDLTs) are widely performed, a shortage of living donors exists continuously, which makes it difficult to find the optimal graft. A high portal venous pressure (PVP) is mainly related to small for size syndrome (SFSS), and low portal venous flow (PVF), to ischemic liver damage, leading to potential liver failure after surgery. We reviewed the literature in search of optimal PVP and PVF values during LDLTs, and tried to determine the clinical meaning of measurements of PVP and PVF for liver transplantation. METHODS: Between June, 2008 and June, 2009, we did 38 LDLTs. PVP and PVF were measured in 13 patients after laparotomy, after implantation of graft and after splenectomy. In addition, compliance (PVF/PVP) and compliance (mL/min/mmHg/g) per unit graft weight were calculated. Splenectomy was done when continuously maintained portal hypertension (>20 mmHg) occurred even after implantation. Splenectomy was also done for patients who presented preoperatively with splenomegaly and pancytopenia. RESULTS: After graft implantation, portal venous pressure decreased (16.8+/-4.1 mmHg vs. 14.7+/-3.1 mmHg)(p=.003), whereas portal venous flow increased (1236.4+/-725.3 mL/min vs. 1916.9+/-603 mL/min)(p=.019). Also, after splenectomy, portal venous pressure/flow decreased (16.4+/-3.7 mmHg vs. 13.8+/-3.3 mmHg)(p=.009)/(2136.4 mL/min vs. 1619.1+/-336.3 mL/min) (p=.001). Finally, after implantation, compliance increased (60+/-40 mL/min/mmHg vs. 126+/-18 mL/min/mmHg)(p=.007). CONCLUSION: After splenectomy, compliance remained constant (126+/-18 mL/min/mmHg vs. 122+/-34 mL/min/mmHg)(p=.364). After implantation of the graft, portal pressure decreased and portal venous flow increased. The compliance of the graft was not influenced by splenectomy. This shows that splenectomy is a good method to control high portal pressure without influencing the compliance of the graft.

Low Intensity Exercise Dose not Repress the Increase in Portal Venous Flow After a Feeding / 体力科学

It is generally accepted that exercise induces a decrease in splanchnic circulation, because of the increase of blood in working skeletal muscle. On the other hand, ingestion of a meal increases blood flow in splanchnic circulation. However, it remains to be clarified whether splanchnic circulation decreases due to exercise after ingestion of a meal. The present study examined the effect of different intensities of cycling exercise after ingestion of a carbohydrate-drink on portal venous blood flow, blood glucose, serum insulin and plasma catecholamine concentrations. Six volunteers ingested 200 ml of martodextrine solution (12%) [M (200) ] before 20 min exercise sessions of 30% maximal oxygen uptake (VO<SUB>2</SUB>max) and 60% VO<SUB>2</SUB>max. Before and after the exercise sessions, portal venous blood flow was measured by a combined ultrasonic system of an electronic sector scanner and pulsed Doppler flowmeter. Portal venous blood flow in the exercise at 30% VO<SUB>2</SUB>max increased due to the M (200) ingestion. However, a decrease in portal blood flow resulting from exercise at 60% VO<SUB>2</SUB>max was observed in spite of a M (200) ingestion compared with portal blood flow after both rest and the exercise at 30% VO<SUB>2</SUB>max. Immediately after exercise, an increase in blood glucose and serum insulin level was shown for 30% VO<SUB>2</SUB>max with M (200), but not 60% VO<SUB>2</SUB>max. In addition, plasma epinephrine concentration after taking M (200) did not increase as a result of either exercise intensity.<BR>These results suggest that the response of portal venous blood flow caused by carbohydratedrink ingestion immediately before exercise is influenced by exercise intensity, and it corresponds to the changes in blood glucose, serum insulin and plasma epinephrine. We concluded that ingestion of food, rather than exercise, has a regulatory action in splanchnic circulation in low intensity exercise.