Living Donor Liver Transplantation
Conditions
Brief summary
In this study, the investigators aim to prove that performing splenic artery ligation in living donor liver transplantation for patients with portal hypertension is beneficial for early graft function postoperatively. The investigators will be analyzing trend of LFT's (liver function tests) after surgery, time for normalization of bilirubin, INR (international normalised ratio) and decrease in ascites, morbidity, mortality, ICU (intensive care unit) and total hospital stay.
Detailed description
Liver transplantation (LT) is the principal treatment for end-stage liver diseases and selected cases of liver neoplasms . Living donor liver transplantation (LDLT) serves as a sole source of liver graft in some countries that do not allow donation from deceased donors for cultural, social, or religious reasons. Hyperperfusion plays an important role in liver regeneration after LDLT, but it may induce injury in the graft . After the reperfusion of a partial graft, there is a significant increase in the portal flow, but Hepatic artery flow remains constant . Excessive portal vein flow may induce injuries in grafts and may contribute to poor graft function. For satisfactory graft function early after LT, the portal vein pressure (PVP) value after reperfusion should be \<15 mm Hg. PVP is the most important hemodynamic factor influencing the functional status of the liver and graft regeneration after LT. The use of Splenic Artery Ligation (SAL) as a simple and safe method to modulate portal flow has been reported . The investigators will evaluate that Splenic artery ligation in living donor liver transplantation for patients with Portal hypertension is feasible and efficient technique to improve early graft function and to decrease morbidity and hospital stay and improve outcomes .
Interventions
PROCEDUREsplenic artery ligation
Splenic artery will be ligated just after takeoff from coeliac trunk at the level of body of pancreas
PROCEDURENo intervention
Splenic artery is not ligated despite the presence of portal hyperperfusion
Sponsors
Assiut University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* All patients undergoing Living Donor Liver Transplantation(LDLT) accepted according to hospital protocol. * Patients who have Portal Venous Pressure (PVP) \> 15 mm Hg after reperfusion .
Exclusion criteria
* Patients who have Portal Venous Pressure (PVP) \> 15 mm Hg after reperfusion. * Patients who had splenectomy. * Patients who have splenic artery aneurysm.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to normalisation of bilirubin | first postoperative month | time to normalisation of bilirubin (in days) |
| Incidence of early graft dysfunction | first postoperative month | Number of patients who develop early graft dysfunction in each group |
| Time to normalisation of ascites output | first postoperative month | time to normalisation of ascites output (in days) |
| Time to normalisation of INR | first postoperative month | time to normalisation of INR (in days) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Morbidity | first postoperative month | Morbidity as per Clavein Dindo classification |
| ICU stay | first postoperative month | Duration of ICU stay (in days) |
| Mortality | first postoperative month | death |
| Total hospital stay | first postoperative month | duration of total stay in hospital after liver transplantation (in days) |
Contacts
Primary ContactAbdallah rashad
Outcome results
None listed