Impact of Splenic Artery Ligation in LDLT for Patients With Portal Hypertension
- Conditions
- Living Donor Liver Transplantation
- Interventions
- Procedure: No interventionProcedure: splenic artery ligation
- Registration Number
- NCT04988100
- Lead Sponsor
- Assiut University
- 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 .
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 30
- 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 .
- Patients who have Portal Venous Pressure (PVP) > 15 mm Hg after reperfusion.
- Patients who had splenectomy.
- Patients who have splenic artery aneurysm.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description No splenic artery ligation No intervention If inclusion criteria are met, these group of patients will not undergo splenic artery ligation. Patients who undergo Splenic artery ligation splenic artery ligation If inclusion criteria are met, these group of patients will undergo splenic artery ligation .
- Primary Outcome Measures
Name Time Method Incidence of early graft dysfunction first postoperative month Number of patients who develop early graft dysfunction in each group
Time to normalisation of INR first postoperative month time to normalisation of INR (in days)
Time to normalisation of bilirubin first postoperative month time to normalisation of bilirubin (in days)
Time to normalisation of ascites output first postoperative month time to normalisation of ascites output (in days)
- Secondary Outcome Measures
Name Time Method Mortality first postoperative month death
ICU stay first postoperative month Duration of ICU stay (in days)
Morbidity first postoperative month Morbidity as per Clavein Dindo classification
Total hospital stay first postoperative month duration of total stay in hospital after liver transplantation (in days)