101
|
Chen CL, Concejero AM, Wang CC, Wang SH, Liu YW, Yang CH, Yong CC, Lin TS. Inferior vena cava replacement in living donor liver transplantation for hepatocellular carcinoma. Liver Transpl 2009; 15:1637-40. [PMID: 19877261 DOI: 10.1002/lt.21897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
102
|
Lin TS, Chiang YC, Chen CL, Concejero AM, Cheng YF, Wang CC, Wang SH, Liu YW, Yang CH, Yong CC. Intimal dissection of the hepatic artery following transarterial embolization for hepatocellular carcinoma: an intraoperative problem in adult living donor liver transplantation. Liver Transpl 2009; 15:1553-6. [PMID: 19877251 DOI: 10.1002/lt.21888] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this study was to describe the relationship between intimal dissection (ID) in the recipient hepatic artery (HA) and transarterial embolization (TAE) and highlight the reconstructive methods for the different types of ID encountered in living donor liver transplantation (LDLT). Fifty-four patients with hepatocellular carcinoma underwent LDLT. ID was classified as mild, moderate, or severe, and this classification was based on the extent of intimal injury. Mild, moderate, or severe ID were defined as ID that was less than one-quarter of the circumference of the HA, had reached one-half of the circumference of the HA, or was more than one-half of the circumference of the HA or involved the entire vessel wall, respectively. The reconstructive methods were based on the severity of ID encountered. Forty patients underwent TAE before LDLT, and 23 of these patients (57.5%) had ID. Nine patients had mild ID, 6 had moderate ID, and 8 had severe ID. In the 14 patients who did not undergo TAE, 4 had ID (28.6%; 3 mild and 1 severe). The other 10 patients (71.4%) had normal HA. In mild and moderate ID, the native HA was used after trimming of the HA until a healthy segment was encountered. In severe ID, the HA was reconstructed with alternative vessels. Two HA thromboses occurred postoperatively. TAE increased the risk of developing ID 2-fold. There was no graft loss or mortality in this series due to HA complications. In conclusion, ID of the HA is associated with pretransplant TAE among hepatocellular carcinoma patients undergoing LDLT. Intraoperative recognition of this complication and trimming until good vessel quality is encountered or using alternative vessels are important.
Collapse
|
103
|
Chiu NM, Tsai JH, Yong CC. Three index series of electroconvulsive therapy for psychotic depression after orthotopic liver transplantation. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1282-3. [PMID: 19622378 DOI: 10.1016/j.pnpbp.2009.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 07/11/2009] [Accepted: 07/14/2009] [Indexed: 11/17/2022]
|
104
|
Cheng YF, Ou HY, Tsang LLC, Yu CY, Huang TL, Chen TY, Concejero A, Yong CC, Chen CL. Interventional percutaneous trans-splenic approach in the management of portal venous occlusion after living donor liver transplantation. Liver Transpl 2009; 15:1378-80. [PMID: 19790159 DOI: 10.1002/lt.21813] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
105
|
Liu CY, Yong CC, Wu SC, Lin CY, Chen CL, Wang CC. Sister Mary Joseph's nodule associated with hepatocellular carcinoma. Surgery 2009; 147:167-8. [PMID: 19744429 DOI: 10.1016/j.surg.2008.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 08/04/2008] [Indexed: 11/16/2022]
|
106
|
Wang SH, Concejero AM, Chen CL, Wang CC, Lin CC, Liu YW, Yang CH, Yong CC. A simple and inexpensive technique of upper abdominal wall retraction in pediatric liver surgery and transplantation. Pediatr Transplant 2008; 12:150-2. [PMID: 18307663 DOI: 10.1111/j.1399-3046.2007.00818.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In majority of centers, pediatric liver surgery and transplantation involves a team of four at any given time: the surgeon, the first and second assistants, and the instrument nurse. This creates considerable crowding around both operative field and operating table. Mechanical devices have been occasionally employed to solve this problem, but most table-mounted devices are designed for adult patients. Based on our experience with pediatric living donor liver transplantation, we developed a simple, safe, and inexpensive method of upper abdominal wall retraction to facilitate surgical exposure and avoid over-crowding in the sterile field. The key points of this technique are the use of the Mercedes incision for liver transplantation or right subcostal incision with upper abdominal midline extension for hepatic resection and an adult-designed Kent retractor. A pediatric-designed Kent retractor is expensive, unnecessary, and may even cause complications as rib fractures and nerve paralysis. We used this technique in 142 consecutive pediatric living donor liver transplants and 16 major hepatectomies in children without any complication resulting from the exposure. The presented technique is simple, safe, reliable, and inexpensive. It can be used in pediatric liver surgery, as well as general pediatric upper abdominal operations.
Collapse
|
107
|
Wu SC, Wang CC, Yong CC. Partial splenectomy for benign splenic cysts with the aid of a Lin clamp: technical note. World J Surg 2008; 31:2144-7; discussion 2148-9. [PMID: 17896130 DOI: 10.1007/s00268-007-9240-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spleen-preserving procedures deserve every effort by surgeons to reduce the risk of overwhelming postsplenectomy infection. Partial splenectomy at hospitals with restricted sources remains technically demanding. We describe our method of partial splenectomy for benign splenic cysts with the aid of a Lin clamp. PATIENTS AND METHODS Since April 2003 to August 2004, we have performed partial splenectomy with the aid of a Lin clamp on 5 suitable patients with symptomatic cysts. Detailed patient characteristics, operative variables, and outcomes were collected. Following surgery, they were regularly followed up every 6 months. RESULTS All five partial splenectomies were successfully executed without any complications. The mean operating time was 75 minutes, and a mean operative blood loss of 68 ml could be achieved. With a mean follow-up of 34.4 months, no cyst recurrences were detected to date. Postoperative laboratory data, imaging studies, and clinical situations proved that the preserved splenic parenchyma maintained adequate function. CONCLUSIONS Partial splenectomy with the aid of a Lin clamp for benign splenic cysts is a practical method with the advantages of easy application, rapid parenchymal dissection, secure hemostasis, and cost-effectiveness. With encouraging preliminary results, further application of this method to bleeding eccentric parenchymal injuries of the spleen may be warranted.
Collapse
|
108
|
Concejero A, Chen CL, Liang CD, Wang CC, Wang SH, Lin CC, Liu YW, Yong CC, Yang CH, Jawan B, Cheng YF. Atrial septal defect in end-stage liver disease children before and after liver transplantation. Surgery 2008; 143:271-7. [DOI: 10.1016/j.surg.2007.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 08/08/2007] [Accepted: 08/10/2007] [Indexed: 01/10/2023]
|
109
|
Hung KC, Yong CC, Chen YS, Eng HL, Kuo FY, Lin CC, Young TH, Kobayashi E, Chen CL, Wang CC. A surgical model of fulminant hepatic failure in rabbits. Liver Int 2007; 27:1333-41. [PMID: 18036098 DOI: 10.1111/j.1478-3231.2007.01512.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Animal models of fulminant hepatic failure (FHF) have been developed for characterization of disease progression and to evaluate the effectiveness of liver-assist devices, some by treatment with hepatotoxic drugs, viral hepatitis or surgical procedures. We have developed a model in the rabbit by combining resection of the three anterior lobes with ligation of the pedicle of the right lateral lobes, resulting in liver necrosis; the remnant quadrate lobes are left intact. MATERIALS AND METHODS Adult male New Zealand white rabbits (n=16) were used. Six animals were killed to measure the weight of the separate liver lobes. The others (n=10) underwent left neck central line placement to monitor continuous blood pressure and collect blood for laboratory analysis, and a burr hole on the right parietal bone to monitor the intracranial pressure (ICP). Blood laboratory analysis, clinical hepatic encephalopathy and ICP levels were measured in FHF animals (n=6). Animals (n=4) undergoing a sham operation served as controls. RESULTS All FHF animals died between 12 and 26 h after liver surgery from FHF characterized by a progressive increase in liver enzymes, ammonia, total bilirubin, coagulopathy, hepatic encephalopathy and intracranial hypertension. Histological features of the ischaemic lobes showed coagulative necrosis of hepatocytes with absence of nuclei and collapse of cell plates. Brain histology revealed hypoxic cell damage. CONCLUSION We have developed a simple, reproducible model of FHF in rabbits that has a number of features comparable with clinical FHF patients and is well suited for testing experimental bioartificial liver systems and investigating the pathogenesis of FHF.
Collapse
|
110
|
Liu YW, Concejero AM, Chen CL, Cheng YF, Eng HL, Huang TL, Chen TY, Wang CC, Wang SH, Lin CC, Yong CC, Yang CH, Jordan AP, Jawan B. Hepatic pseudotumor in long-standing biliary atresia patients undergoing liver transplantation. Liver Transpl 2007; 13:1545-51. [PMID: 17969188 DOI: 10.1002/lt.21320] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A pseudotumor, giant regenerative nodule, or macroregenerative nodule is an unusual benign hepatic lesion in biliary atresia (BA) patients. This tumor may mimic malignant transformation and may preclude liver transplantation (LT). The clinical and imaging surveillance of patients after the Kasai procedure is therefore an important aspect of management of BA patients. Our objective is to report our experience and describe the incidence, imaging, and pathologic features of pseudotumors in BA patients awaiting LT. From August 1990 to December 2006, 133 LTs for BA were performed. Five (3.8%; 4 female, 1 male) patients were diagnosed with pseudotumor. The patients' records were reviewed. The diagnostic imaging modalities used were abdominal ultrasound (US), computed tomography (CT) scan, and magnetic resonance imaging (MRI). Histologic confirmation of the lesions was obtained in all cases. All underwent the Kasai operation in early infancy. Six of 7 lesions in 4 of 5 patients were demonstrated by pretransplant imaging. Two of 7 tumors were detected by US. Five of 7 lesions were detected by CT, and 5 of 7 lesions were demonstrated by MRI. In 1 patient, the lesion was not seen in the US, CT, or MRI but was found during surgery and confirmed by histology. An additional tumor was found incidentally during histologic examination in a patient previously diagnosed to have 2 tumors by CT and MRI. In another patient diagnosed to have 2 tumors on imaging, pathology revealed only a single tumor. In conclusion, although unusual, pseudotumor should be included in the differential diagnosis of liver masses in BA children.
Collapse
|
111
|
Chen CL, Concejero AM, Wang CC, Wang SH, Liu YW, Yong CC, Yang CH, Jordan AP, Cheng YF. Remodeled saphenous vein as interposition graft for portal vein reconstruction in living donor liver transplantation. Liver Transpl 2007; 13:1472-5. [PMID: 17902136 DOI: 10.1002/lt.21215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
112
|
Concejero A, Chen CL, Liang CD, Wang CC, Wang SH, Lin CC, Liu YW, Yong CC, Yang CH, Lin TS, Jawan B, Huang TL, Cheng YF, Eng HL. Living Donor Liver Transplantation in Children With Congenital Heart Disease. Transplantation 2007; 84:484-9. [PMID: 17713432 DOI: 10.1097/01.tp.0000277599.25079.94] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The occurrence of congenital heart disease (CHD) with congenital biliary disease is uncommon. Our aim is to present our experience in living donor liver transplantation (LDLT) as treatment for end-stage liver disease (ESLD) in children with CHD. METHODS A review of transplant records from June 1994 to December 2004 was performed. Twenty-three LDLT (13 males, 10 females) recipients were diagnosed to have both CHD and ESLD. RESULTS CHD diagnoses were made preoperatively using transthoracic two-dimensional color flow Doppler echocardiography. The mean age was 22.3 months. There were 20 (87%) biliary atresia, two (9%) neonatal hepatitis, and one (4%) glycogen storage disease patients. Isolated CHD associated with ESLD included atrial septal defect (11, 48%), pulmonary stenosis (including 2 Alagille syndrome; 4, 17%), patent foramen ovale (4, 17%), ventricular septal defect (1, 4%), and mitral valve prolapse (1, 4%). Complex CHD included atrial septal defect + patent ductus arteriosus + patent foramen ovale (1, 4%), and atrial septal defect + pulmonary stenosis (1, 4%). The median Child's and Pediatric End-stage Liver Disease scores were 9, and 17, respectively. In all, 70% presented with varying degrees of pulmonary congestion pretransplant. There were no perioperative cardiac complications. Posttransplant, the patent foramen ovale in four recipients and atrial septal defect in four recipients closed spontaneously; and two recipients with pulmonary stenosis had their stenoses resolved spontaneously. The overall rejection rate was 17%. There was no mortality. The overall recipient and graft survivals at 1 and 5 years were both 100%. CONCLUSION LDLT is a safe procedure in a select group of ESLD patients with CHD.
Collapse
|
113
|
Concejero A, Chen CL, Wang CC, Wang SH, Lin CC, Liu YW, Yang CH, Yong CC, Wang MC, Eng HL. Chronic Myeloid Leukemia After Living Donor Liver Transplantation. Transplantation 2007; 83:1521-2. [PMID: 17565329 DOI: 10.1097/01.tp.0000265587.17307.6a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
MESH Headings
- Antibiotics, Antineoplastic/adverse effects
- Antibiotics, Antineoplastic/therapeutic use
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Doxorubicin/adverse effects
- Doxorubicin/therapeutic use
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/chemically induced
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Transplantation/adverse effects
- Living Donors
- Male
- Middle Aged
- Neoplasm Invasiveness
- Postoperative Care
Collapse
|
114
|
Iyer SG, Chen CL, Wang CC, Wang SH, Concejero AM, Liu YW, Yang CH, Yong CC, Jawan B, Cheng YF, Eng HL. Long-term results of living donor liver transplantation for glycogen storage disorders in children. Liver Transpl 2007; 13:848-52. [PMID: 17539004 DOI: 10.1002/lt.21151] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver transplantation (LT) may be indicated in glycogen storage disorders (GSD) when medical treatment fails to control the metabolic problems or when hepatic adenomas develop. We present our institutional experience with living donor LT (LDLT) for children with GSD. A total of 244 patients underwent primary LDLT at our institution from June 1994 to December 2005. A total of 12 (5%) children (8 female and 4 male) were afflicted with GSD and were not responsive to medical treatment. Nine patients had GSD type I and 3 had GSD type III. The median age at the time of transplantation was 7.27 yr (range, 2.4-15.7). All patients presented with metabolic abnormalities, including hypoglycemia, and lactic acidosis. In addition, 4 patients presented with growth retardation. A total of 11 patients received left lobe grafts and 1 received a right lobe graft. The mean graft-to-recipient weight ratio was 1.25 (range, 0.89-1.61). Two patients had hepatic vein stenoses that were treated by balloon dilatation; 1 patient had bile leak, which settled spontaneously. The overall surgical morbidity rate was 25%. Three patients had hepatic adenomas in the explanted liver. There was a single mortality at 2 months posttransplantation due to acute pancreatitis and sepsis. The mean follow up was 47.45 months. The metabolic abnormalities were corrected and renal function remained normal. In patients with growth retardation, catch-up growth was achieved posttransplantation. In conclusion, LDLT is a viable option to restore normal metabolic balance in patients with GSD when medical treatment fails. Long-term follow-up after LT for GSD shows excellent graft and patient survival.
Collapse
|
115
|
Wang SH, Chen CL, Concejero A, Wang CC, Lin CC, Liu YW, Yang CH, Yong CC, Lin TS, Chiang YC, Jawan B, Huang TL, Cheng YF, Eng HL. Living donor liver transplantation for biliary atresia. CHANG GUNG MEDICAL JOURNAL 2007; 30:103-8. [PMID: 17595997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Biliary atresia is the most common cause of chronic cholestasis in infants and children. The incidence is estimated at 3.7:10,000 among Taiwanese infants. Kasai hepatoportoenterostomy helps children survive beyond infancy. Liver transplantation is indicated when the Kasai procedure fails to work or when patients develop progressive deterioration of liver function despite an initially successful Kasai operation. Living donor liver transplantation was developed to alleviate organ shortage from deceased donors. It has decreased the waiting time for transplantation and, therefore, improves patient survival. One hundred living donor liver transplantations have been performed for biliary atresia at Chang Gung Memorial Hospital-Kaohsiung Medical Center with both 98% 1-year and 5-year actual recipient survival.
Collapse
|
116
|
Ibrahim S, Chen CL, Wang SH, Lin CC, Yang CH, Yong CC, Jawan B, Cheng YF. Liver resection for benign liver tumors: indications and outcome. Am J Surg 2007; 193:5-9. [PMID: 17188079 DOI: 10.1016/j.amjsurg.2006.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 04/17/2006] [Accepted: 04/17/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND The indications for intervention in cases of benign liver tumors include symptoms, suspicion of malignancy, or risk of malignant change. METHODS Eighty-four liver resections for benign tumors were performed in our hospital from June 1996 to December 2004. The patient records were reviewed retrospectively. RESULTS The study group (41 females, 43 males; average age, 41.4 +/- 10.5 y) included 46 cavernous hemangiomas, 27 focal nodular hyperplasias, 5 hepatic adenomas, and 6 liver cysts. The indications for resection were inability to rule out malignancy (50 [59.5%]), symptoms (33 [39.3%]), and others (1 [1.2%]). Postoperatively, 28 of the 33 patients had resolution of symptoms. Twenty-nine patients (34.5%) had chronic hepatitis B infection. CONCLUSIONS Liver resection for benign liver tumor is safe, but indications for intervention must be evaluated carefully. The presence of chronic parenchymal liver disease does not increase morbidity in these patients.
Collapse
|
117
|
Cheng YF, Huang TL, Chen TY, Concejero A, Tsang LLC, Wang CC, Wang SH, Sun CK, Lin CC, Liu YW, Yang CH, Yong CC, Ou SY, Yu CY, Chiu KW, Jawan B, Eng HL, Chen CL. Liver graft-to-recipient spleen size ratio as a novel predictor of portal hyperperfusion syndrome in living donor liver transplantation. Am J Transplant 2006; 6:2994-9. [PMID: 17061990 DOI: 10.1111/j.1600-6143.2006.01562.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Portal hyperperfusion in a small-size liver graft is one cause of posttransplant graft dysfunction. We retrospectively analyzed the potential risk factors predicting the development of portal hyperperfusion in 43 adult living donor liver transplantation recipients. The following were evaluated: age, body weight, native liver disease, spleen size, graft size, graft-to-recipient weight ratio (GRWR), total portal flow, recipient portal venous flow per 100 g graft weight (RPVF), graft-to-recipient spleen size ratio (GRSSR) and portosystemic shunting. Spleen size was directly proportional to the total portal flow (p = 0.001) and RPVF (p = 0.014). Graft hyperperfusion (RPVF flow > 250 mL/min/100 g graft) was seen in eight recipients. If the GRSSR was < 0.6, 5 of 11 cases were found to have graft hyperperfusion (p = 0.017). The presence of portosystemic shunting was significant in decreasing excessive RPVF (p = 0.059). A decrease in portal flow in the hyperperfused grafts was achieved by intraoperative splenic artery ligation or splenectomy. Spleen size is a major factor contributing to portal flow after transplant. The GRSSR is associated with posttransplant graft hyperperfusion at a ratio of < 0.6.
Collapse
|
118
|
Ibrahim S, Chen CL, Wang CC, Wang SH, Lin CC, Liu YW, Yang CH, Yong CC, Concejero A, Cheng YF. Small remnant liver volume after right lobe living donor hepatectomy. Surgery 2006; 140:749-55. [PMID: 17084717 DOI: 10.1016/j.surg.2006.02.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 02/02/2006] [Accepted: 02/03/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Right lobe living donor liver transplantation has become a viable option for adult patients with end-stage liver disease, however, the safety of the donor is of paramount importance. One of the key factors in donor safety is ensuring adequate donor remnant liver volume. METHODS We retrospectively examined donors who had less than 30% remnant liver volume after right graft procurement. Eighty-six right lobe living donor transplants were carried out in Chang Gung Memorial Hospital, Kaohsiung Medical Center, from January 1999 to December 2004. RESULTS Eight donors had less than 30% remnant liver volume (Group 1) after graft procurement and 78 donors had remnant liver volume greater than 30% (Group 2). There were no differences in donor characteristics, types of graft, operative parameters, and post-operative liver and renal function as well as liver volume at 6 months post-donation between the 2 groups. The graft weight obtained in Group 1 donors was significantly greater compared with that from Group 2 (P<.005). The overall donor complication rate was 6.98%, and all the complications occurred among group 2 donors. CONCLUSIONS The judicious use of donors with less than 30% remnant liver volume is safe as a last resort.
Collapse
|
119
|
Ibrahim S, Chen CL, Lin CC, Yang CH, Wang CC, Wang SH, Liu YW, Yong CC, Concejero A, Jawan B, Cheng YF. Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy. Liver Transpl 2006; 12:950-7. [PMID: 16721773 DOI: 10.1002/lt.20746] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Complications in a donor are a distressing but inevitable occurrence, since graft procurement is a major undertaking. Although the technique for procurement has some similarities to hepatic resection, a donor is very unlike a patient with malignancy. The risk factors identified in these patients cannot be extrapolated to donors. Donor hepatectomy carried out from June 1995 to March 2005 in Chang Gung Memorial Hospital, Kaohsiung Medical Center was reviewed with the aim of identifying risk factors for complications. There were 204 living donor liver transplants, with 205 donor hepatectomies, as 1 living donor liver transplantation was a dual graft. Ten donors (4.88%) suffered complications. There was no difference in terms of age, gender, body weight, operation, and parenchymal time between those who had complications and those who did not. There was also no difference in liver function tests between the 2 groups of donors, but the total bilirubin was significantly higher in donors with complications. The graft weight and remnant liver volume were also similar. The proportion of donors with fatty liver was the same between the 2 groups. The mean blood loss in donors with complications was 170 +/- 79 mL, and that for donors without complications was 95 +/- 77 mL. There was a statistically significant greater blood loss in donors with complications (P < 0.05). The number of segments removed in donors with complications was also higher compared to donors without complications (P < 0.03). Using multivariate analysis, intraoperative blood loss and the number of segments removed were found to be independent risk factors for donor complications. Intraoperative blood loss during graft procurement must be kept low to minimize complications in donors.
Collapse
|
120
|
Wang CC, Lin CC, Young TH, Chen YS, Yong CC, Kobayashi E, Wu CH, Yang CH, Chen CL, Hung KC. Culture and characterization of human hepatocytes isolated from hepatitis C virus infected liver: Effect of collagen-coated surface and FBS-supplemented medium. Biochem Eng J 2006. [DOI: 10.1016/j.bej.2005.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
121
|
Concejero A, Chen CL, Wang CC, Wang SH, Lin CC, Liu YW, Yang CH, Yong CC, Lin TS, Ibrahim S, Jawan B, Cheng YF, Huang TL. Donor graft outflow venoplasty in living donor liver transplantation. Liver Transpl 2006; 12:264-8. [PMID: 16447205 DOI: 10.1002/lt.20699] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatic venous outflow reconstruction is a key to successful living donor liver transplantation (LDLT) because its obstruction leads to graft dysfunction and eventual loss. Inclusion or reconstruction of most draining veins is ideal to ensure graft venous drainage and avoids acute congestion in the donor graft. We developed donor graft hepatic venoplasty techniques for multiple hepatic veins that can be used in either right- or left-lobe liver transplantation. In left-lobe grafts, venoplasty consisting of the left hepatic vein and adjacent veins such as the left superior vein, middle hepatic vein, or segment 3 vein is performed to create a single, wide orifice without compromising outflow for anastomosis with the recipient's vena cava. In right lobe graft where a right hepatic vein (RHV) is adjacent with a significantly-sized segment 8 vein, accessory RHV, and/or inferior RHV, venoplasty of the RHV with the accessory RHV, inferior RHV, and/or segment 8 vein is performed to create a single orifice for single outflow reconstruction with the recipient's RHV or vena cava. Of 35 venoplasties, 2 developed hepatic venous stenoses which were promptly managed with percutaneous interventional radiologic procedures. No graft was lost due to hepatic venous stenosis. In conclusion, these techniques avoid interposition grafts, are easily performed at the back table, simplify graft-to-recipient cava anastomosis, and avoid venous outflow narrowing.
Collapse
|
122
|
Wang CC, Concejero AM, Yong CC, Chen YS, Wang SH, Lin CC, Liu YW, Yang CH, Lin TS, Hung KC, Jawan B, Cheng YF, Ibrahim S, Chen CL. Improving hepatic and portal venous flows using tissue expander and Foley catheter in liver transplantation. Clin Transplant 2006; 20:81-4. [PMID: 16556159 DOI: 10.1111/j.1399-0012.2005.00431.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Vascular reconstruction is important in liver transplantation because its obstruction causes graft failure and eventual loss. Vascular outflow obstruction may be due to graft malposition. We describe our experience with liver allograft repositioning using tissue expander and Foley catheter to improve hepatic and portal venous outflows. PATIENTS AND METHODS A total of seven patients who received liver transplantation at our institution developed hepatic and/or portal venous obstruction during final graft positioning detected by Doppler ultrasonography (hepatic vein flow <10 cm/s; portal vein flow <12 cm/s). Chart and operative records of these patients were reviewed. Technique of operation, donor-recipient characteristics, use of tissue expander or Foley catheter to improve venous outflow, complications, and outcome were analyzed. RESULTS Hepatic and/or portal venous obstruction were detected after portal reperfusion. We used commercially available tissue expander used in plastic surgery and Foley catheter to reposition the graft. Tissue expanders were used in three recipients (age: 27-46 yr). Foley catheters were used in four recipients (age: 7 months-53 yr). One recipient used both tissue expander and Foley catheter. Expanders were filled with 300-770 mL saline and placed into the right subphrenic space. Foley catheters were filled with 15-75 mL saline. Significant improvements in hepatic and/or portal venous outflow were detected by Doppler ultrasonography post-graft repositioning. Aspiration of expander and Foley catheter contents was started from 6th to 27th postoperative day under sonographic guidance. All expanders and catheters were removed by the 19th-56th postoperative day (mean: 38 d). Complications included chylous ascites (1/7), bile leak (1/7), tube drain infection (2/7), septicemia (2/7). All complications were successfully managed by non-operative interventions. There was no outflow obstruction detected by ultrasonography before and after removal of expanders and catheters. One- and two-year graft and patient survivals were both 100%. CONCLUSION The use of tissue expanders and Foley catheters to improve hepatic and portal venous outflow in malposed liver allografts is a simple and safe method after liver transplantation.
Collapse
|
123
|
Ibrahim S, Chen CL, Wang CC, Wang SH, Lin CC, Liu YW, Yang CH, Yong CC, Concejero A, Cheng YF. Liver Regeneration and Splenic Enlargement in Donors after Living-Donor Liver Transplantation. World J Surg 2005; 29:1658-66. [PMID: 16311869 DOI: 10.1007/s00268-005-0101-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Liver regeneration after donor hepactectomy offers a unique insight into the process of liver regeneration in normal livers. As the liver restores itself, concurrent splenic enlargement occurs. There are many theories about why this phenomenon takes place: some investigators have proposed a relative portal hypertension that leads to splenic congestion or, perhaps, the presence of a common growth factor that induces both the liver and spleen to enlarge. Between the months of June 2001 and May 2004, 112 live donor liver transplants (LDLTs) were performed in Chang Gung Memorial Hospital, Kaohsiung, Taiwan. The total number of donor hepatectomies performed during this period was 113, however, because one of the cases required dual donors. Of our 113 donors, we eventually analyzed the data of 109; 4 patients were lost to follow-up 6 months later and were excluded from our study. The average age of our donor population was 32.32 +/- 8.48 years. The mean liver volume at donation was noted to be 1207.72 +/- 219.95 cm3, and 6 months later, it was 1027.18 +/- 202.41 cm3. Expressed as a percentage of the original volume, the mean liver volume 6 months after hepatectomy was 90.70% +/- 12.47% in this series. For right graft donors, mean liver volume after 6 months was 89.68% +/- 12.37% of the original liver volume, whereas that for left graft donors was 91.99% +/- 12.6%. Only 26 of the 109 (23.85%) donors were able to achieve full regeneration 6 months post-donation. Notably, liver function profiles of all donors were normal when measured 6 months after operation. The average splenic volume at donation as measured by computed tomography (CT) volumetry was 159 +/- 58 cm3, and the splenic volume 6 months post-donation was 213 +/- 85 cm3. There was a mean increment in splenic volume of 35% +/- 28% 6 months after donation. The blood profiles of the donors were monitored; particular attention was given to platelet levels and liver function tests, and these were found to be within normal limits 6 months after operation. Of note, splenic enlargement was significantly greater among right-sided donors than their left-sided counterparts. Greater splenic enlargement was also observed in those donors who achieved full liver regeneration at their evaluation 6 months postoperatively than in those who did not. Although original liver volume was not re-established in most patients 6 months after liver donation, there seemed to have been no untoward effects to the donor. The factors that affect liver regeneration are complex and myriad. Although there is splenic enlargement at 6 months post-donation in donors of LDLT, there are no untoward effects of this enlargement.
Collapse
|
124
|
Yong CC, Chen YS, Wang SH, Lin CC, Liu PP, Liu YW, Yang CH, Hung KC, Chiang YC, Lin TS, Cheng YF, Huang TL, Jawan B, Eng HL, Chen CL, Wang CC. Deceased-donor liver transplantation: 10 years' experience at Change Gung Memorial Hospital-Kaohsiung Medical Center. CHANG GUNG MEDICAL JOURNAL 2005; 28:133-41. [PMID: 15945319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The purpose of this study was to summarize the outcomes we achieved using deceased-donor liver transplantation (DDLT) in the past 10 years at Chang Gung Memorial Hospital-Kaohsiung Medical Center (CGMH-KMC). METHODS Between March 1993 and March 2003, 53 DDLTs were performed at CGMH-KMC. Patients were divided into 2 stages: stage 1 (n = 22) from March 1993 to February 1998, and stage 2 (n = 31) from March 1998 to March 2003. Indications for transplantation, patient demographics, surgical procedures, and long-term outcomes were reviewed. RESULTS Indications for transplantation were biliary atresia (16), post-hepatitis B/C viral cirrhosis with or without hepatocellular carcinoma (21), Wilson's disease (8), primary biliary cirrhosis (3), and miscellaneous (5). Two retransplants were carried out for secondary biliary cirrhosis using primary live-donor liver transplantation (LDLT). Ten patients received grafts from 6 split-liver transplantations. Over-all Kaplan-Meier 1-, 3-, and 5-year survival rates were 88.46%, 83.86%, and 79.87%, respectively. A significant improvement in patient survival was observed in stage 2. The Kaplan-Meier 1- and 5-year patient survival rates in stage 2 were 96.67% and 92.95%, respectively. Fifteen patients developed vascular complications. Nine patients died in this series for an overall mortality rate of 17%. CONCLUSIONS Deceased-donor liver transplantation is well established as the treatment of choice for acute and chronic liver failure in Taiwan. Satisfactory outcomes have been attained in those transplanted to date.
Collapse
|
125
|
Takatsuki M, Chen CL, Chen YS, Wang CC, Lin CC, Yang CH, Yong CC, Liu YW. Impact of late conversion from C0 to C2 monitoring of microemulsified cyclosporine in pediatric living donor liver transplant recipients. Clin Transplant 2004; 18:694-9. [PMID: 15516246 DOI: 10.1111/j.1399-0012.2004.00279.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The efficacy and feasibility of 2-h post-dose level (C2) monitoring of cyclosporine in long-term living donor liver transplantation (LDLT) is not clear. The aim of this study was to investigate the impact of late conversion from conventional trough-level (C0) monitoring to C2 monitoring of a microemulsion form of cyclosporine (Neoral) in pediatric LDLT recipients. From June 1994 to August 2002, we performed 116 LDLTs in 115 patients. Initially, we adapted conventional C0 monitoring of Neoral, which was converted to C2 monitoring starting in January 2002. The 60 patients who were enrolled in the study had the following characteristics: they were younger than or equal to 15 yr at transplantation, and they had survived LDLT, and they had received a Neoral-based immunosuppression regimen, and they underwent conversion to C2 more than 1 month after transplantation. We evaluated the impact of conversion on doses, blood levels, rejection, adverse effects, and patient/graft outcome. In the long-term patients, the mean C2 levels immediately after conversion were higher than the target levels at any time point selected after transplantation; thus, 34 patients (57%) finally required a dose reduction of Neoral. The current mean C2 level was significantly lower than that observed immediately after conversion (584.6 +/- 262.8 ng/ml vs. 893.1 +/- 260.2 ng/ml, mean +/- SD, p < 0.0001) with a mean follow-up period of 7.4 +/- 0.6 months (range: 5-8 months) after conversion. Only one patient encountered rejection after conversion (1.7%), and no de novo infection or adverse effects were observed. Traditional C0 monitoring of Neoral was safely replaced by C2 monitoring without an increase in the rejection rate or any adverse effects in pediatric LDLT patients. C2 monitoring contributed to the dose reduction of Neoral, which may lead to the avoidance of long-term complications due to immunosuppression.
Collapse
|