• Viniyendra Pamecha, Gattu Tharun, Nilesh Patil, Nihar Mohapatra, Anubhav Kumar, Shalini Thapar, Gaurav Sindwani, Udit Dhingra, and Anil Yadav.
• Liver Transplant and Hepato-Pancreato-Biliary Surgery.
• Ann. Surg. 2024 Jun 6.

ObjectiveThe primary objective was to compare the rates of early allograft dysfunction (EAD) in patients undergoing elective adult live donor liver transplantation (ALDLT) with and without graft portal inflow modulation (GIM) for portal hyper-perfusion. The secondary objectives were to compare time to normalization of bilirubin and International Normalized Ratio (INR), day 14 ascitic output more than 1liter, small-for-size syndrome (SFSS), intensive care unit / high dependency unit and total hospital stay, and 90 day morbidity and mortality.BackgroundGIM can prevent EAD in ALDLT patients with portal hyper-perfusion.MethodsA single-center randomized trial with and without GIM for portal hyper-perfusion by splenic artery ligation (SAL) in ALDLT was performed. After reperfusion, patients with portal venous pressure (PVP)>15 mm Hg with a gradient (PVP - central venous pressure) of ≥ 7 mm Hg and/or portal venous flow (PVF)>250 mL/min/100 grams of liver were randomized into two groups: GIM and No GIM.Results75 of 209 patients satisfied the inclusion criteria, and 38 underwent GIM. Baseline PVF and PVP were comparable between the GIM and no GIM groups. SAL significantly reduced the PVF and PVP (P<0.001). There were no differences in the primary and secondary outcomes between the two groups. In the subgroup analysis, with a Graft to Recipient Weight Ratio (GRWR)≤0.8, there were no significant differences in the primary and secondary outcomes.ConclusionSAL significantly decreased PVP and PVF, but did not decrease rates of EAD in adult LDLT.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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