The Change Of Portal Venous Hemodynamic And It's Impact To Liver Function And Regeneration During Living Donor Liver Transplantation

Objective:to discuss the change of portal venous pressure and flow after livng donor liver transplantation;to investigate the impact of portal venous pressure and flow on regeneration and graft function after operation.Methods:24 recipients of living donor liver transplantation who were operated by the same surgical team of the Organ Transplant Center in Tianjin First Central Hospital Since January 2009 to December 2009 were included in this study. The actual GRWR is 1.0265%±0.239 (0.7%-1.508%), include 3 graft with actual GRWR<0.8%(0.7-0.767%).Portal venouse pressures were messured before anhepatic phase,after grafts hepaticartery anastomosis and before cavity closure; Portal venouse flow were messured before after graft's hepaticartery anastomosis and before cavity closure,PVFI were calculated by dividing PVF by graft weight..according PVP at the end of operation,recipients were divided into HPVP group with PVP≥15mmHg (n=8,16.75±1.75mmHg,15-19mmHg) and LPVP group with PVP<15mmHg (n=16,11.69±1.82mmHg,8-14mmHg). also according PVFI at the end of operation, patients were divided into HPVFI group (n=12,301.40±31.26ml/min 100g,344.35-263.79ml/min 100g) with PVFI≥260ml/min 100g graft weight and LPVFI group (n=12,194.97±29.29ml/min 100g,176.32-251.26ml/min 100g) with PVFI＜260ml/min 100g graft weight. The ALT,AST,TBIL,PT,APTT,INR were tested on POD1,POD3,POD7,POD14.All patients taked an abdominal enhanced CT scan on POD14,after CT scan,liver volume was measured and liver regeneration rate was calculated by dividing liver volume by recipient,s standard liver volume.All patients, peripheral venous bloods were extracted on POD1,POD3,POD7,POD14, supernatant plasma collected after centrifugation, and assay IL-6 TNFa,TGFa,TGFb,CDK1 level with ELLISA. To verify the correlation between PVP and PVFI after reopenning Of the portal vein with pearson'test;to compare the differetion of liver function indexes(ALT,AST,TBIL,INR,PT,APTT),liver regeneration rate;to compare the differetion of liver regeneration related factors(TGF-α,TNF-α,IL-6,TGF-β,CDK1) with Repeated measures analysis of variance.Results:1,there is no correlativity between PVP and PVFI after reopening of the portal vein (r=0.026, P=0.904).2,the liver function is poorer in HPVP group than in Lpvp group on POD1,3,7,14,but there is no significant difference(P>0.05).The regeneration rate of the Hpvp group on POD 14 is significantly higher than Lpvp group (112.13%±10.35%vs 95.80%±17.08%, P=0.022). Liver regeneration rate was significantly correlated with portal venouse pressure (r=0.445,p=0.029). The concentration of the IL-6,TNF-a,CDK-lis significantly higher in Hpvp group than Lpvp group (F=9.735, P=0.008; F=4.933, P=0.044; F=6.707, P=0.036).3,The TBIL and the PT level is sigineficiently higher in LPVFI group than in HPVFI group on POD 1,7. On POD 3, The INR and the PT level is sigineficiently higher in Lpvp group than in HPVFI group. The TBIL level on POD1,7 is significantly negatively correlated with PVFI (r=-0.505, P=0.012), and the AST level on POD3 is significantly negatively correlated with PVFI (r=-0.405, P=0.049).There is no significant differention on regeneration rate between HPVFI group and LPVFI group on POD14.(P=0.135),but the PVFI is signeficiently correlated with liver regeneration rate (r=0.416, p=0.043). The IL-6,TNFa,TGFa,TGFb,CDK1 level have no significant difference between LPVFI group and HPVFI group.Conclusion:1,PVP and PVFI have no relevance after portal venouse open.2, PVP significantly stimulate sinusoid space to secrete cytokines related to regeneration. Propriety high PVP(15-20mmHg)is beneficial to liver regeneration and make little adverse impact on liver function recovery.3,In the condition of PVFI<200ml/min 100g,the graft function reconversion is poorer. PVFI is significantly correlate with liver function recoveration and liver regeneration.