How Do Transplant Surgeons Accomplish Optimal Portal Venous Flow During Living-Donor Liver Transplantation? Noninvasive Measurement of Indocyanine Green Elimination Rate

作者：Hori Tomohide^*; Ogura Yasuhiro; Yagi Shintaro; Iida Taku; Taniguchi Kentaro; El Moghazy Walid M; Hedaya Mohammed Saied; Segawa Hajime; Ogawa Kohei; Kogure Takayuki; Uemoto Shinji

来源：Surgical Innovation, 2014, 21(1): 43-51.

DOI：10.1177/1553350613487803

• indocyanine green
• graft/recipient body-weight ratio
• small-for-size
• portal pressure
• portal hypertension

Background. Balancing donor safety and graft volume is difficult. We previously reported that intentional modulation of portal venous pressure (PVP) during living-donor liver transplantation (LDLT) is crucial to overcoming problems with small-for-size grafts; however, detailed studies of portal venous flow (PVF) and a reliable parameter are still required. Patients and Methods. The elimination rate (k) of indocyanine green (ICG) was measured in 49 adult LDLT recipients. PVP was controlled during LDLT, with a target of kICG value is divided by the graft weight to calculate PVF. Recipients were divided into 2 groups: those with severe and/or fatal complications within 1 month after LDLT and those without. Results. Survival rates and postoperative profiles were significantly different between the 2 groups. Univariate analysis showed significant differences in ABO blood group, final PVP, final kICG, and the final kICG/graft weight value; however, multivariate analysis showed that only the kICG/graft weight value was significant. The cutoff level for the final kICG/graft weight value for predicting successful LDLT was 3.1175 x 10(-4)/g. Conclusion. Accurate evaluation and monitoring of optimal PVF during LDLT should overcome the use of small-for-size grafts and improve donor safety and recipient outcomes.

• 出版日期2014-2