Almost all adult recipients who undergo LDLT develop liver cirrhosis with long-term portal hypertension. Portal hypertension results in vascular dilatation and collateral pathways. Thus, various alterations in systemic hemodynamics and splanchnic circulation occur, and adult recipients often present characteristic hemodynamics before LDLT. A research group from Kyoto University Hospital, Japan (Hori T, Yagi S, Iida T, Uemoto S), non-invasively investigated systemic hemodynamics and splanchnic circulation after LDLT in 30 adult recipients with liver cirrhosis who underwent LDLT (2003-2006), and their research has been published on the November issue 28 of World Journal of Gastroenterology. The article ascertained the correlation between systemic hemodynamics and splanchnic circulation, and clarified how systemic hemodynamic state impacts on local graft circulation. Interestingly, the results of splanchnic circulatory parameters in their current study reveal systemic hemodynamics correlate well with splanchnic circulation, and that subtle disorders of optimal systemic hyperdynamic state easily influence portal venous flow rather than hepatic arterial flow. Moreover, they also identify what hemodynamic state is necessary for excellent clinical outcomes corresponding to good graft functions. Dr. Hori demonstrated the persistence of characteristic systemic hyperdynamic state is indispensable for cirrhotic recipients, even after LDLT, by using a device that can non-invasively analyze the kinetics of indocyanine green, and he is doing further study now at Kyoto University Hospital. Since portal venous flow has been shown to have a large influence on liver regeneration after LDLT, successful clinical outcomes in cirrhotic LDLT recipients are attributed to optimal stability of systemic hyperdynamic state yielding sufficient portal venous flow.
|Contact: You-De Chang|
World Journal of Gastroenterology