Does the Portal Pressure Changes have an Effect on Liver Functions of Donor Hepatectomy in Living Donor Transplantation

Abstract
Background: Living donor liver transplantation has now became an alternative for cadaveric liver transplantation. Raised portal pressure and over perfusion can injure the remnant liver and leads to hepatic dysfunction. This prospective study evaluates the portal pressure changes that occurs during donor hepatectomy and its effect on liver functions.
Aim of Study: We aimed to study the portal pressure changes during donor hepatectomy and its relation to liver functions.
Patients and Methods: This prospective study included 30 adult living donors who underwent right hepatectomy in Liver Transplantation Unit, Faculty of Medicine, Cairo Uni-versity during the period between June 2015 to October 2016. Portal venous pressure was measured intra-operatively using wide gauge cannula preclamping and postclamping of portal vein during donor hepatectomy. Post-operative liver functions in the form of daily ALT, AST, total bilirubin, direct bilirubin, INR and Albumin were done daily till normalization.
Results: In this study the mean portal pressure before and after clamping of right portal vein was 9.9mmHg and 15.23 mmHg respectively. The mean changes in portal pressure were significant (p<0.001).
The higher the changes in portal pressure the higher were the serum levels of day 1, 3 and 5 ALT, day 3 and 5 AST, day 5 total bilirubin and day 5 albumin. The higher the portal pressure changes gave the longer the duration of normalization of (ALT, AST, bilirubin, and albumin).
Conclusion: This study has demonstrated a significant rise in PVP post clamping of right portal vein. The higher the changes in portal pressure the higher serum levels of post-operative day 1, 3 and 5 ALT, day 3 and 5 AST, day 5 total bilirubin and day 5 albumin, the higher the portal pressure changes gave 'the longer the duration of normalization of (ALT, AST, bilirubin, and albumin). However, the delayed functional regeneration did not proceed to liver failure in non of the cases.