Clinical study on splanchnic hemodynamic changes after living donor liver transplantation for patients with portal hypertension        JIANG Shui-ming, ZHOU Guang-wen, SHEN Chuan, et al. Department of Surgery, Shanghai Institute of Digestive  Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Corresponding author ：ZHOU Guang-wen, E-mail：gw_vrai@yahoo.com.cn
Abstract    Objective    To study the splanchnic hemodynamic changes after living donor liver transplantation (LDLT). At same time, the effect of such changes on collateral circulation and postoperative liver function was evaluated too. Methods    Between 2006 and 2008, in 18 patients with portal hypertension underwent LDLT, the following parameters were measured preoperatively and postoperative days 1, 3, 5, 7; and 1, 3 months after LDLT with Color Doppler sonography: portal blood flow volume (PBF), portal blood flow mean velocity (PBV), hepatic artery resistance indexes (HA-RI). The same parameters were measured in 18 living donors as contrast. Postoperative graft and spleen volume were estimated by computed tomography. Results    In recipient group, portal venous pressure was decreased, but was higher than normal value after LDLT. PBF and PBV increased and achieved peak value in first day after LDLT (from 1081±278 mL/min to 2171±613 mL/min and from 15±5.7 cm/s to 56±22.1 cm/s, respectively, P<0.01). Although a progressive reduction of PBF and PBV was observed during the follow-up, until 3 months after LDLT, PBF and PBV were significantly greater than donor group (P<0.05). In donor group, although PBF had no change after LDLT, PBV increased (from 23.7±7.2 cm/s to 30.7±7.5 cm/s, P<0.05), and returned to normal after 1 month. Graft and residual liver regenerated rapidly after LDLT. Graft and residual liver volume reached 1426.2±203.4mL and 1139.3±153.1mL respectively. A clear and rapid improvement in splenomegaly was presented in recipient group, whereas spleen size increased postoperative in donor group. Conclusions    A high portal flow was present in cirrhosis with portal hypertension after LDLT.The possible causes for this can be persistence of considerable splenomegaly. Splenic artery is effective management modality for preventing portal hyperperfusion injury.