Management of Established Small-for-size Syndrome in Post Living Donor Liver Transplantation: Medical, Radiological, and Surgical Interventions: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

医学 肝移植 门脉高压 心理干预 外科 并发症 移植 肝功能 重症监护医学 内科学 肝硬化 精神科
作者
Varvara A. Kirchner,Sadhana Shankar,David W. Victor,Tomohiro Tanaka,Nicolás Goldaracena,Roberto Troisi,Kim M. Olthoff,Jong Man Kim,Elizabeth A. Pomfret,Nigel Heaton,Wojciech Polak,Akash Shukla,Ravi Mohanka,Deniz Balcı,R. Mark Ghobrial,Subash Gupta,Daniel G. Maluf,John J. Fung,Susumu Eguchi,John P. Roberts,Bijan Eghtesad,Markus Selzner,Raj Prasad,Mureo Kasahara,Hiroto Egawa,Jan Lerut,Dieter Broering,Marina Berenguer,Mark S. Cattral,Pierre‐Alain Clavien,Chao‐Long Chen,Samir Shah,Zhi‐Jun Zhu,Nancy L. Ascher,Toru Ikegami,Prashant Bhangui,Ashwin Rammohan,Jean C. Emond,Mohamed Rela
出处
期刊:Transplantation [Ovid Technologies (Wolters Kluwer)]
卷期号:107 (10): 2238-2246
标识
DOI:10.1097/tp.0000000000004771
摘要

Small-for-size syndrome (SFSS) following living donor liver transplantation is a complication that can lead to devastating outcomes such as prolonged poor graft function and possibly graft loss. Because of the concern about the syndrome, some transplants of mismatched grafts may not be performed. Portal hyperperfusion of a small graft and hyperdynamic splanchnic circulation are recognized as main pathogenic factors for the syndrome. Management of established SFSS is guided by the severity of the presentation with the initial focus on pharmacological therapy to modulate portal flow and provide supportive care to the patient with the goal of facilitating graft regeneration and recovery. When medical management fails or condition progresses with impending dysfunction or even liver failure, interventional radiology (IR) and/or surgical interventions to reduce portal overperfusion should be considered. Although most patients have good outcomes with medical, IR, and/or surgical management that allow graft regeneration, the risk of graft loss increases dramatically in the setting of bilirubin >10 mg/dL and INR>1.6 on postoperative day 7 or isolated bilirubin >20 mg/dL on postoperative day 14. Retransplantation should be considered based on the overall clinical situation and the above postoperative laboratory parameters. The following recommendations focus on medical and IR/surgical management of SFSS as well as considerations and timing of retransplantation when other therapies fail.
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