Role of splanchnic hemodynamics in liver regeneration after living donor liver transplantation

Abstract

The aim of this study was to investigate the changes in splanchnic hemodynamics after LDLT and their relationship with graft regeneration. Eighteen patients with LDLT December 2006 and June 2008 were enrolled, and color Doppler ultrasonography was performed preoperatively and on postoperative days (PODs) 1, 3, 5, 7, 30, and 90 after transplantation. The changes in the portal blood flow mean velocity (PBV) and portal blood flow volume (PBF) were monitored, and their effects on hepatic function were observed simultaneously. Graft sizes were measured on PODs 7, 30, and 90 after the operation. The regeneration rates of grafts were calculated. PBF increased in the recipient group from 1081.17 ± 277.50 to 2171.44 ± 613.15 mL/minute, and PBV increased from 15.01 ± 5.67 to 56.00 ± 22.11 cm/s; they were both significantly higher than those in the donor group (P < 0.01). On POD 1, serum aspartic aminotransferase, alanine aminotransferase, and total bilirubin all peaked; however, these indices in patients with PBF/graft weight (GW) > 300 mL/minute · 100 g were significantly higher than those in patients with PBF/GW < 300 mL/minute · 100 g. Livers in the recipient group regenerated rapidly. The graft regeneration rate reached 119.40% ± 28.21% as early as 1 month post-transplantation. PBF and PBV on PODs 1 and 3 were greatly related to liver regeneration at 30 days. The portal venous flow in patients with portal hypertension after LDLT showed a high perfusion state, which could promote graft regeneration, but PBF/GW after the operation should be controlled below 300 mL/minute · 100 g in order to protect grafts from hyperperfusion injury. © 2009 AASLD.