{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T20:22:33Z","timestamp":1770754953290,"version":"3.50.0"},"reference-count":47,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T00:00:00Z","timestamp":1670544000000},"content-version":"vor","delay-in-days":69,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Portal inflow modulation (PIM) aimed at reducing portal hyperperfusion is commonly used in living donor liver transplantation (LDLT) to reduce the risk of small\u2010for\u2010size syndrome (SFSS). Many different techniques, both pharmacological and surgical have been used for this purpose. There is, however, little consensus on the best method of PIM, its exact role in preventing SFSS and on early post\u2010LDLT recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To identify whether modifications of portal pressures and flows enhance recovery after LDLT and to provide international expert panel recommendations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. PROSPERO ID: CRD42021260997.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five hundred and ninety four articles were identified through databases\u2019 search. Of the 24 included for a final review by the working group (WG), there were five randomized control trials, four prospective studies and 15 retrospective series. Six outcome measures which were likely to influence early recovery after LDLT, especially in small\u2010for\u2010size grafts (SFSG) were shortlisted. These included acute kidney injury, SFSS, morbidity including sepsis, length of ICU and hospital stay, morbidity of the PIM technique and overall mortality. The WG noted that PIM in this subset of LDLT recipients had a beneficial effect on all the outcomes measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Considering all decision domains, the panel recommends pre\u2010 and intraoperative actual graft weight validation, portal pressure\/flow measurements, and a comprehensive donor evaluation for the determination of potentially small\u2010for\u2010size\/ small\u2010for\u2010flow grafts as mandatory. <jats:bold>(Quality of Evidence: Moderate | Grade of Recommendation: Strong)<\/jats:bold> Pharmacological PIM helps improve early renal function in LDLT recipients. <jats:bold>(Quality of Evidence: High | Grade of Recommendation: Strong)<\/jats:bold> In selected patients with SFSG, PIM helps reduce SFSS\/EAD and sepsis. <jats:bold>(Quality of Evidence: Moderate | Grade of Recommendation: Strong)<\/jats:bold> PIM in the form of splenectomy has increased morbidity compared to splenic artery ligation (SAL). <jats:bold>(Quality of Evidence: Low | Grade of Recommendation: Strong)<\/jats:bold> In LDLT recipients with SFSG, PIM may help reduce morbidity\/mortality. <jats:bold>(Quality of Evidence: Low | Grade of Recommendation: Strong)<\/jats:bold> In LDLT recipients with SFSG, modification of portal pressures and flows enhances recovery after LDLT. <jats:bold>(Quality of Evidence: Moderate | Grade of Recommendation: Strong<\/jats:bold>)<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14657","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T19:39:51Z","timestamp":1648496391000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Does modification of portal pressure and flow enhance recovery of the recipient after living donor liver transplantation? A systematic review of literature and expert panel recommendations"],"prefix":"10.1111","volume":"36","author":[{"given":"Ashwin","family":"Rammohan","sequence":"first","affiliation":[{"name":"Institute of Liver Disease &amp; Transplantation Dr. Rela Institute &amp; Medical Centre Bharath Institute of Higher Education &amp; Research  Chennai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Rela","sequence":"additional","affiliation":[{"name":"Institute of Liver Disease &amp; Transplantation Dr. Rela Institute &amp; Medical Centre Bharath Institute of Higher Education &amp; Research  Chennai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong\u2010Sik","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery Korea University College of Medicine  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5539-9280","authenticated-orcid":false,"given":"Yuji","family":"Soejima","sequence":"additional","affiliation":[{"name":"Department of Surgery Shinshu University School of Medicine  Matsumoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mureo","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center National Center for Child Health and Development  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Ikegami","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery Department of Surgery The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Spiro","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine Royal Free Hospital  London UK"},{"name":"Clinical Service of HPB Surgery and Liver Transplantation Royal Free Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitri","family":"Aristotle Raptis","sequence":"additional","affiliation":[{"name":"Clinical Service of HPB Surgery and Liver Transplantation Royal Free Hospital  London UK"},{"name":"Division of Surgery &amp; Interventional Science University College London, London  UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhinav","family":"Humar","sequence":"additional","affiliation":[{"name":"Thomas E. 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