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• W1963526860 abstract "P491 Aims: In the field of living donor liver transplantation (LDLT), small for size syndrome (SFS) seriously affects on prognosis of LDLT especially in adults. We reports whether graft size affects on portal shear stress in early phase, production of hepatrophic cytokines, clinical symptom of SFS and morphological hepatic regeneration. Methods: In our 68 LDLTs, fulminant hepatic failure was excluded because of normodynamic hepatic circulation. Sixteen recipients without rejection, infectous episodes and vascular complication within a month were studied and divided into 2 groups: Group L (n=8): Graft / body weight of recipient (G/R) ratio ≥1.0, Group S (n=8): G/R ratio < 1.0. Serum IL-6 and HGF were measured as hepatrophic cytokines by ELISA. The maximum portal velocity on Doppler US (Vpmax) was examined as an index of postoperative shear stress. Serial changes of C-reactive protein, clinical parameters and symptom of SFS were also compared. Regeneration of the graft was assessed by helical dynamic CT on POD 14 in all patients. Results: Group L included 3 pediatric and 5 adult patients (G/R ratio: 1.95±0.37). All patients in Group S were adults (G/R ratio: 0.786±0.05, p<0.01). There were no significant differences in the backgrounds including MELD score, intra-operative bleeding per weight and operating time between two groups. In clinical parameters, incidence of massive ascites (>1.0L/day), hyperbilirubinemia and thrombocytopenia were significantly higher in Group S. Two recipients died of fungal infection more than 2 months after LDLT in Group S. There was no lost case in Group L and nobody died of graft failure in both groups. IL-6 and HGF in Group S were significantly higher than in Group L. Although CRP production, representing protein production, drew a biphasic curve in both groups, 2nd peak of Group S delayed 2 weeks compared to Group L. All patients clinically manifests portal hypertension. The mean Vpmax of Group S was two times higher than that of Group L on POD0, and was significantly higher during a first week. Indeed G/R ratio in Group S did not catch up that in Group L in CT volumetry(1.65±0.32vs. 2.96±1.21, p<0.05), but hypertrophic ratio of Group S was significantly higher than that of Group L (212±39.5 % vs. 159±24%, p<0.02). Conclusions: Heavier portal shear stress (Vpmax) in Group S, a physical trigger of graft regeneration, promotes greater hepatic regeneration with intervention of hepatrophic cytokines, however, symptom of SFS remains by delay of protein synthesis and/or sustained portal hypertension in Group S." @default.
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• W1963526860 date "2004-07-01" @default.
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• W1963526860 title "PORTAL SHEAR STRESS PROMOTES LIVER REGENERATION AFTER LIVING DONOR LIVER TRANSPLANTATION USING A SMALL FOR SIZE GRAFT" @default.
• W1963526860 doi "https://doi.org/10.1097/00007890-200407271-00986" @default.
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