Jean C Emond1, Nathan P Goodrich, James J Pomposelli, Talia B Baker, Abhinav Humar, David R Grant, Peter Abt, Chris E Friese, Robert A Fisher, Igal Kam, Averell H Sherker, Brenda W Gillespie, Robert M Merion. 1. 1 Department of Surgery, Columbia University Medical Center, New York, NY. 2 Arbor Research Collaborative for Health, Ann Arbor, MI. 3 Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA. 4 Department of Surgery, Northwestern University, Chicago, IL. 5 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. 6 Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. 7 Department of Surgery, University of Pennsylvania, Philadelphia, PA. 8 Department of Surgery, University of California at San Francisco, San Francisco, CA. 9 Department of Transplant Surgery, Virginia Commonwealth University, Richmond, VA. 10 Department of Transplant Surgery, Beth Israel Deaconess Department of Surgery, Harvard University, Boston, MA. 11 Department of Surgery, University of Colorado, Denver, CO. 12 Liver Diseases Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. 13 Department of Biostatistics, University of Michigan, Ann Arbor, MI. 14 Department of Surgery, University of Michigan, Ann Arbor, MI.
Abstract
OBJECTIVE: A principal aim of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study was to study hepatic blood flow and effect of portal flow modulation on graft outcomes in the setting of increasing use of smaller and left lobe grafts. METHODS: Recipients of 274 living donor liver transplant were enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, including 233 (85.0%) right lobes, 40 (14.6%) left lobes, and 1 (0.5%) left lateral section. Hepatic hemodynamics were recorded after reperfusion. A total of 57 portal flow modulations were performed on 52 subjects. RESULTS: Modulation lowered portal pressure in 68% of subjects with inconsistent effects on hepatic arterial and portal flow. A higher rate of graft dysfunction was observed in modulated vs. unmodulated subjects (31% vs. 18%; P = 0.03); however, graft survival in modulated subjects was not different from unmodulated subjects at 3 years. CONCLUSIONS: These results suggest the need for a study using a prespecified portal flow modulation protocol with defined indications to better define the effects of these interventions.
OBJECTIVE: A principal aim of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study was to study hepatic blood flow and effect of portal flow modulation on graft outcomes in the setting of increasing use of smaller and left lobe grafts. METHODS: Recipients of 274 living donor liver transplant were enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, including 233 (85.0%) right lobes, 40 (14.6%) left lobes, and 1 (0.5%) left lateral section. Hepatic hemodynamics were recorded after reperfusion. A total of 57 portal flow modulations were performed on 52 subjects. RESULTS: Modulation lowered portal pressure in 68% of subjects with inconsistent effects on hepatic arterial and portal flow. A higher rate of graft dysfunction was observed in modulated vs. unmodulated subjects (31% vs. 18%; P = 0.03); however, graft survival in modulated subjects was not different from unmodulated subjects at 3 years. CONCLUSIONS: These results suggest the need for a study using a prespecified portal flow modulation protocol with defined indications to better define the effects of these interventions.
Authors: Kim M Olthoff; Jean C Emond; Tempie H Shearon; Greg Everson; Talia B Baker; Robert A Fisher; Chris E Freise; Brenda W Gillespie; James E Everhart Journal: Liver Transpl Date: 2014-10-06 Impact factor: 5.799
Authors: Kim M Olthoff; Robert M Merion; Rafik M Ghobrial; Michael M Abecassis; Jeffrey H Fair; Robert A Fisher; Chris E Freise; Igal Kam; Timothy L Pruett; James E Everhart; Tempie E Hulbert-Shearon; Brenda W Gillespie; Jean C Emond Journal: Ann Surg Date: 2005-09 Impact factor: 12.969
Authors: T Kiuchi; M Kasahara; K Uryuhara; Y Inomata; S Uemoto; K Asonuma; H Egawa; S Fujita; M Hayashi; K Tanaka Journal: Transplantation Date: 1999-01-27 Impact factor: 4.939
Authors: J C Emond; J F Renz; L D Ferrell; P Rosenthal; R C Lim; J P Roberts; J R Lake; N L Ascher Journal: Ann Surg Date: 1996-10 Impact factor: 12.969