Does modification of portal pressure and flow enhance recovery of the recipient after living donor liver transplantation? A systematic review of literature and expert panel recommendations.
enhanced recovery after surgery
living donor liver transplantation
morbidity
outcomes
portal flow
portal inflow modulation
portal pressure
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
10 2022
10 2022
Historique:
revised:
11
02
2022
received:
13
01
2022
accepted:
25
03
2022
pubmed:
29
3
2022
medline:
15
12
2022
entrez:
28
3
2022
Statut:
ppublish
Résumé
Portal inflow modulation (PIM) aimed at reducing portal hyperperfusion is commonly used in living donor liver transplantation (LDLT) to reduce the risk of small-for-size syndrome (SFSS). Many different techniques, both pharmacological and surgical have been used for this purpose. There is, however, little consensus on the best method of PIM, its exact role in preventing SFSS and on early post-LDLT recovery. To identify whether modifications of portal pressures and flows enhance recovery after LDLT and to provide international expert panel recommendations. Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. CRD42021260997. Five hundred and ninety four articles were identified through databases' search. Of the 24 included for a final review by the working group (WG), there were five randomized control trials, four prospective studies and 15 retrospective series. Six outcome measures which were likely to influence early recovery after LDLT, especially in small-for-size grafts (SFSG) were shortlisted. These included acute kidney injury, SFSS, morbidity including sepsis, length of ICU and hospital stay, morbidity of the PIM technique and overall mortality. The WG noted that PIM in this subset of LDLT recipients had a beneficial effect on all the outcomes measures. Considering all decision domains, the panel recommends pre- and intraoperative actual graft weight validation, portal pressure/flow measurements, and a comprehensive donor evaluation for the determination of potentially small-for-size/ small-for-flow grafts as mandatory. (Quality of Evidence: Moderate | Grade of Recommendation: Strong) Pharmacological PIM helps improve early renal function in LDLT recipients. (Quality of Evidence: High | Grade of Recommendation: Strong) In selected patients with SFSG, PIM helps reduce SFSS/EAD and sepsis. (Quality of Evidence: Moderate | Grade of Recommendation: Strong) PIM in the form of splenectomy has increased morbidity compared to splenic artery ligation (SAL). (Quality of Evidence: Low | Grade of Recommendation: Strong) In LDLT recipients with SFSG, PIM may help reduce morbidity/mortality. (Quality of Evidence: Low | Grade of Recommendation: Strong) In LDLT recipients with SFSG, modification of portal pressures and flows enhances recovery after LDLT. (Quality of Evidence: Moderate | Grade of Recommendation: Strong).
Sections du résumé
BACKGROUND
Portal inflow modulation (PIM) aimed at reducing portal hyperperfusion is commonly used in living donor liver transplantation (LDLT) to reduce the risk of small-for-size syndrome (SFSS). Many different techniques, both pharmacological and surgical have been used for this purpose. There is, however, little consensus on the best method of PIM, its exact role in preventing SFSS and on early post-LDLT recovery.
OBJECTIVES
To identify whether modifications of portal pressures and flows enhance recovery after LDLT and to provide international expert panel recommendations.
DATA SOURCES
Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.
METHODS
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel.
PROSPERO ID
CRD42021260997.
RESULTS
Five hundred and ninety four articles were identified through databases' search. Of the 24 included for a final review by the working group (WG), there were five randomized control trials, four prospective studies and 15 retrospective series. Six outcome measures which were likely to influence early recovery after LDLT, especially in small-for-size grafts (SFSG) were shortlisted. These included acute kidney injury, SFSS, morbidity including sepsis, length of ICU and hospital stay, morbidity of the PIM technique and overall mortality. The WG noted that PIM in this subset of LDLT recipients had a beneficial effect on all the outcomes measures.
CONCLUSIONS
Considering all decision domains, the panel recommends pre- and intraoperative actual graft weight validation, portal pressure/flow measurements, and a comprehensive donor evaluation for the determination of potentially small-for-size/ small-for-flow grafts as mandatory. (Quality of Evidence: Moderate | Grade of Recommendation: Strong) Pharmacological PIM helps improve early renal function in LDLT recipients. (Quality of Evidence: High | Grade of Recommendation: Strong) In selected patients with SFSG, PIM helps reduce SFSS/EAD and sepsis. (Quality of Evidence: Moderate | Grade of Recommendation: Strong) PIM in the form of splenectomy has increased morbidity compared to splenic artery ligation (SAL). (Quality of Evidence: Low | Grade of Recommendation: Strong) In LDLT recipients with SFSG, PIM may help reduce morbidity/mortality. (Quality of Evidence: Low | Grade of Recommendation: Strong) In LDLT recipients with SFSG, modification of portal pressures and flows enhances recovery after LDLT. (Quality of Evidence: Moderate | Grade of Recommendation: Strong).
Types de publication
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14657Investigateurs
Claus Niemann
(C)
Joerg-Matthias Pollok
(JM)
Marina Berenguer
(M)
Pascale Tinguely
(P)
Carlo Frola
(C)
Jonathan Potts
(J)
Shahroo Makhdoom
(S)
Conrad Shaw
(C)
Informations de copyright
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Ma KW, Wong KHC, Chan ACY, et al.. Impact of small-for-size liver grafts on medium-term and long-term graft survival in living donor liver transplantation: a meta-analysis. World J Gastroenterol. 2019; 25(36): 5559-5568.
Troisi RI, Berardi G, Tomassini F, Sainz-Barriga M. Graft inflow modulation in adult-to-adult living donor liver transplantation: a systematic review. Transplant Rev (Orlando). 2017; 31(2): 127-135.
Masuda Y, Yoshizawa K, Ohno Y, Mita A, Shimizu A, Soejima Y. Small-for-size syndrome in liver transplantation: definition, pathophysiology and management. Hepatobiliary Pancreat Dis Int. 2020; 19(4): 334-341.
Yagi S, Uemoto S. Small-for-size syndrome in living donor liver transplantation. Hepatobiliary Pancreat Dis Int. 2012; 11(6): 570-576.
Kiuchi T, Kasahara M, Uryuhara K, et al.. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation. 1999; 67(2): 321-327.
Reddy MS, Kaliamoorthy I, Rajakumar A, et al. Double-blind randomized controlled trial of the routine perioperative use of terlipressin in adult living donor liver transplantation. Liver Transpl. 2017; 23(8): 1007-1014.
Ikegami T, Balci D, Jung DH, Kim JM, Quintini C. Living donor liver transplantation in small-for-size setting. Int J Surg. 2020; 82S: 134-137.
Orue-Echebarria MI, Lozano P, Olmedilla L, García Sabrido JL, Asencio J. “Small-for-flow” syndrome: concept evolution. J Gastrointest Surg. 2020; 24(6): 1386-1391.
Ikegami T, Onda S, Furukawa K, Haruki K, Shirai Y, Gocho T. Small-for-size graft, small-for-size syndrome and inflow modulation in living donor liver transplantation. J Hepatobiliary Pancreat Sci. 2020; 27(11): 799-809.
Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64(4): 383-394.
Murad MH, Mustafa RA, Schünemann HJ, Sultan S, Santesso N. Rating the certainty in evidence in the absence of a single estimate of effect. Evid Based Med. 2017; 22(3): 85.
Andrews JC, Schünemann HJ, Oxman AD, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength. J Clin Epidemiol. 2013; 66(7): 726-735.
Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013; 66(7): 719-725.
Fayed N, Refaat EK, Yassein TE, Alwaraqy M. Effect of perioperative terlipressin infusion on systemic, hepatic, and renal hemodynamics during living donor liver transplantation. J Crit Care. 2013; 28(5): 775-782.
Troisi RI, Vanlander A, Giglio MC, et al. Somatostatin as inflow modulator in liver-transplant recipients with severe portal hypertension: a randomized trial. Ann Surg. 2019; 269(6): 1025-1033.
Mukhtar A, Salah M, Aboulfetouh F, et al. The use of terlipressin during living donor liver transplantation: effects on systemic and splanchnic hemodynamics and renal function. Crit Care Med. 2011; 39(6): 1329-1334.
Ibrahim N, Hasanin A, Allah SA, et al. The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: a randomised controlled study. Indian J Anaesth. 2015; 59(3): 156-164.
Emond JC, Goodrich NP, Pomposelli JJ, et al. Hepatic hemodynamics and portal flow modulation: the A2ALL experience. Transplantation. 2017; 101(10): 2375-2384.
Ito T, Kiuchi T, Yamamoto H, et al. Changes in portal venous pressure in the early phase after living donor liver transplantation: pathogenesis and clinical implications. Transplantation. 2003; 75(8): 1313-1317.
Troisi R, de Hemptinne B. Clinical relevance of adapting portal vein flow in living donor liver transplantation in adult patients. Liver Transpl. 2003; 9(9): S36-41.
Troisi R, Ricciardi S, Smeets P, et al. Effects of hemi-portocaval shunts for inflow modulation on the outcome of small-for-size grafts in living donor liver transplantation. Am J Transplant. 2005; 5(6): 1397-1404.
Ogura Y, Hori T, El Moghazy WM, et al. Portal pressure. Liver Transpl. 2010; 16(6): 718-728.
Ito K, Akamatsu N, Ichida A, et al. Splenectomy is not indicated in living donor liver transplantation. Liver Transpl. 2016; 22(11): 1526-1535.
Yao S, Kaido T, Uozumi R, et al. Is portal venous pressure modulation still indicated for all recipients in living donor liver transplantation? Liver Transplant. 2018; 24(11): 1578-1588.
Soin AS, Yadav SK, Saha SK, et al. Is portal inflow modulation always necessary for successful utilization of small volume living donor liver grafts? Liver Transpl. 2019; 25(12): 1811-1821.
Wang H, Ikegami T, Harada N, et al. Optimal changes in portal hemodynamics induced by splenectomy during living donor liver transplantation. Surg Today. 2015; 45(8): 979-985.
Uemura T, Wada S, Kaido T, et al. How far can we lower graft-to-recipient weight ratio for living donor liver transplantation under modulation of portal venous pressure? Surgery. 2016; 159(6): 1623-1630.
Miyagi S, Shono Y, Tokodai K, et al. Risks of living donor liver transplantation using small-for-size grafts. Transplant Proc. 2020; 52(6): 1825-1828.
Yoshizumi T, Taketomi A, Soejima Y, et al. The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft. Transpl Int. 2008; 21(9): 833-842.
Ou HY, Huang TL, Chen TY, Tsang LLC, Chen CL, Cheng YF. Early modulation of portal graft inflow in adult living donor liver transplant recipients with high portal inflow detected by intraoperative color Doppler ultrasound. Transplant Proc. 2010; 42(3): 876-878.
Miyagi S, Nakanishi C, Hara Y, et al. Correlation between splenectomy and portal vein complications in living donor liver transplantation. Transplant Proc. 2018; 50(9): 2611-2613.
Gyoten K, Mizuno S, Kato H, et al. A novel predictor of posttransplant portal hypertension in adult-to-adult living donor liver transplantation: increased estimated spleen/graft volume ratio. Transplantation. 2016; 100(10): 2138-2145.
Osman AMA, Hosny AA, El-Shazli MA, Uemoto S, Abdelaziz O, Helmy AS. A portal pressure cut-off of 15 versus a cut-off of 20 for prevention of small-for-size syndrome in liver transplantation: a comparative study. Hepatol Res. 2017; 47(4): 293-302.
Onoe T, Tanaka Y, Ide K, et al. Attenuation of portal hypertension by continuous portal infusion of PGE1 and immunologic impact in adult-to-adult living-donor liver transplantation. Transplantation. 2013; 95(12): 1521-1527.
Lauro A, Diago Uso T, Quintini C, et al. Adult-to-adult living donor liver transplantation using left lobes: the importance of surgical modulations on portal graft inflow. Transplant Proc. 2007; 39(6): 1874-1876.
Yagi S, Iida T, Hori T, et al. Optimal portal venous circulation for liver graft function after living-donor liver transplantation. Transplantation. 2006; 81(3): 373-378.
Miller CM. Ethical dimensions of living donation: experience with living liver donation. Transplant Rev (Orlando). 2008; 22(3): 206-209.
Taketomi A, Kayashima H, Soejima Y, et al. Donor risk in adult-to-adult living donor liver transplantation: impact of left lobe graft. Transplantation. 2009; 87(3): 445-450.
Abecassis MM, Fisher RA, Olthoff KM, et al. Complications of living donor hepatic lobectomy-a comprehensive report. Am J Transplant. 2012; 12(5): 1208-1217.
Rammohan A, Reddy MS, Narasimhan G, et al. Live liver donors: is right still right? World J Surg. 2020; 44(7): 2385-2393.
Roll GR, Parekh JR, Parker WF, et al. Left hepatectomy versus right hepatectomy for living donor liver transplantation: shifting the risk from the donor to the recipient. Liver Transpl. 2013; 19(5): 472-481.
Soejima Y, Taketomi A, Yoshizumi T, et al. Feasibility of left lobe living donor liver transplantation between adults: an 8-year, single-center experience of 107 cases. Am J Transplant. 2006; 6(5 Pt 1): 1004-1011.
Dahm F, Georgiev P, Clavien PA. Small-for-size syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications. Am J Transplant. 2005; 5(11): 2605-2610.
Asencio JM, Vaquero J, Olmedilla L, García Sabrido JL. “Small-for-flow” syndrome: shifting the “size” paradigm. Med Hypotheses. 2013; 80(5): 573-577.
Govil S, Reddy MS, Rela M. Has “Small-for-Size” Reached Its “Sell-By” Date. Transplantation. 2016; 100(11): e119.
Wu TJ, Dahiya D, Lee CS, et al. Impact of portal venous hemodynamics on indices of liver function and graft regeneration after right lobe living donor liver transplantation. Liver Transplant. 2011; 17(9): 1035-1045.
Sainz-Barriga M, Scudeller L, Costa MG, De Hemptinne B, Troisi RI. Lack of a correlation between portal vein flow and pressure: toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation. Liver Transpl. 2011; 17(7): 836-848.