A novel predictor of posttransplant portal hypertension in adult-to-adult living donor liver transplantation: increased estimated spleen/graft volume ratio.

Background: In adult living donor liver transplantation (ALDLT), graft-to-recipient weight ratio (GRWR) of less than 0.8 is incomplete for predicting portal hypertension (>20 mmHg) after reperfusion. We aimed to identify preoperative factors contributing to PVP after reperfusion and to predict portal hypertension, focusing on spleen volume to graft volume ratio (SVGVR). Methods: In 73 recipients with ALDLT between 2002 and 2013, first we analyzed survival according to PVP of 20 mmHg as the threshold, evaluating the efficacy of splenectomy. Second, we evaluated various preoperative factors contributing to portal hypertension after reperfusion. Results: All of the recipients with PVP >20 mmHg (n=19) underwent PVP modulation by splenectomy, and their overall survival was favorable compared to 54 recipients who did not need splenectomy (PVP = 20 mmHg). GRWR had no correlation with PVP. Multivariate analysis revealed that estimated graft and spleen volume were significant factors contributing to PVP after reperfusion (p

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