Partial splenic artery embolization (PSE) has been widely used in the treatment of pancytopenia and esophagogastric varices in patients with portal hypertension. We compared the effect of PSE performed before living donor liver transplantation (LDLT) with that performed after LDLT. The spleen volume reduced to 44.1% of pretreatment volume after LDLT in the preoperative PSE group, and to 42.3% in the postoperative PSE group. The ratio of platelet count (the one measured 1 year after PSE + LDLT/that measured before PSE + LDLT)was increased to 3.20 in preoperative PSE group. While, it was had increased only to 1.58 in the postoperative group. In patients with portsystemic shunts, preoperative PSE was supposed to prevent steal of graft's portal blood flow. LDLT with additional PSE appears more effective in the treatment of persistent hypersplenism than LDLT alone. Especially, preoperative PSE seems useful in LDLT of small-for-size graft with portsystemic shunts.

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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.

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[in Japanese]

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[in Japanese]

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The subject of the present study is six children with portal obstruction occurring after living donor liver transplant (LDLT). Disease that required LDLT was biliary atresia in all cases. Five out of six children were transplanted within one year after birth. Only one case showed a clinical symptom (refractory ascites) before diagnosis was made. Although radiological intervention was tried, it failed in all cases. Three cases developed gastrointestinal hemorrhage. Two of them were treated with splenorenal shunt therapy and recovered. One patient who had additional portopulmonary hypertension received re-transplantation, but she died of right cardiac heart failure during surgery. Other three cases including a child who had symptoms during the pre-diagnostic period were well without any clinical symptoms and liver function abnormalities. In conclusion, children with portal obstruction after LDLT were difficult to treat. Therefore, this complication should be detected with serial examination such as Doppler ultrasound before it occurs.

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Portal blood consists of mesenteric and splenic veinous blood. In order to determine which one is more important in maintaining liver functions, canine models of a splenocaval shunt (SC shunt) and small bowel autotransplantation (partial mesocaval shunt, MC shunt) which diverts small bowel venous outflow into the systemic circulation and leaves the gastric, duodenal, pancreatic and colonic venous outflow undisturbed was produced, and metabolic changes of the two models was compared. There was no difference in serum amino acid and ammonia levels between the two models. But amount of hepatic ATP in the MC shunt model is lower compared to the control and the SC shunt model. These data suggest that venous blood supply from the small intestine may be more important in maintaing ATP amount in the liver. Therefore, portal drainage, which reestablishes the physiological route of venous outflow, may be more preferable in small bowel transplantation.

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[in Japanese]

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