Intra-operative controls of portal venous pressure in adult liver transplantation

Abstract

Intra-operative control of portal venous flow is crucial for further a higher survival chance in adult liver transplantation. We retrospectively investigated the survival rate, amount of post-operative ascites and period of drain removal, based on Graft Recipient Weight Ratio (GRWR) and intra-operative portal venous pressure (PVP). From April 2006 to March 2008, 106 adult recipients underwent liver transplantation in our institute. Monitoring of PVP was performed in 100 cases. GRWR did not influence upon the survival rate, and did not correlate with both the amount of post-operative ascites and the period of drain removal. Two cases whose PVPs exceeded 20 mmHg showed a poor post-operative course due to portal hypertension, and 1 case finally died. PVPs marginally correlated with post-operative ascites. Unexpectedly, some cases finally died because of severe complications caused by portal hypertension, even in the cases whose PVPs are controlled within the range from 15 to 20 mmHg. Survival rates were higher in those whose PVP was higher than 15 mmHg than in those whose PVP was lower than 15 mmHg. Establishment of intra-operative PVP control is a key for excellent results.