51
|
|
52
|
Abstract
Whole-liver transplantation is an accepted and successful method of treating end-stage liver disease. As a result of the shortage of cadaveric livers, split-liver transplantation and living donor liver transplantation are becoming more commonplace. Ultrasonography (US) is the initial imaging modality of choice for detection and follow-up of early and delayed complications from all types of liver transplantation. Vascular complications include thrombosis and stenosis of the hepatic artery, portal vein, or inferior vena cava, as well as hepatic artery pseudoaneurysms and celiac artery stenosis. Biliary complications include leaks, strictures, stones or sludge, dysfunction of the sphincter of Oddi, and recurrent disease. Neoplastic disease in the transplanted liver may represent recurrent neoplasia or posttransplantation lymphoproliferative disorder. Parenchymal disease may take the form of a focal mass or a diffuse parenchymal abnormality. Perihepatic fluid collections and ascites are common after liver transplantation. Knowledge of the surgical technique of liver transplantation and awareness of the normal US appearance of the transplanted liver permit early detection of complications and prevent misdiagnosis.
Collapse
Affiliation(s)
- Jane D Crossin
- Department of Diagnostic Imaging, Toronto General Hospital, University of Toronto, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4
| | | | | |
Collapse
|
53
|
|
54
|
Yao FY, Bass NM, Nikolai B, Merriman R, Davern TJ, Kerlan R, Ascher NL, Roberts JP. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver Transpl 2003; 9:684-92. [PMID: 12827553 DOI: 10.1053/jlts.2003.50147] [Citation(s) in RCA: 213] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since our interim report of the intention-to-treat outcome of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC), we have performed a follow-up analysis of an expanded cohort of 70 patients to further assess whether the observed pattern and predictors of dropout are consistent with the rationale behind current HCC-adjusted Model for End Stage Liver Disease (MELD) organ allocation scheme. All except one patient had pretransplantation staging meeting our proposed expanded criteria-a single lesion < or =6.5 cm, or three or fewer lesions none >4.5 cm and total tumor diameter < or =8 cm. Thirty-eight patients received OLT. The cumulative probabilities of dropout at 6, 12, and 18 months were 7.2%, 37.8%, and 55.1%, respectively. The respective dropout probabilities would have been 11.0%, 57.4%, and 68.7% if the United Network for Organ Sharing (UNOS) criteria for exclusion (single lesion < or =5 cm or three or fewer lesions none >3 cm) were applied. Predictors of dropout with either criteria included three tumor nodules and a single lesion >3 cm at initial presentation, whereas preoperative chemoembolization or ablation therapies were associated with a lower risk for dropout only when applying the UNOS criteria for patient exclusion. In the subgroup with two or three lesions or a solitary tumor >3 cm, the cumulative probabilities of dropout were nine-fold higher than those with a single lesion < or =3 cm (P =.004). In conclusion, the low dropout rate in the first 6 months and the differing dropout risks based on tumor characteristics support further refinements in the HCC-adjusted MELD organ allocation scheme.
Collapse
Affiliation(s)
- Francis Y Yao
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco 94143, USA.
| | | | | | | | | | | | | | | |
Collapse
|
55
|
Jawan B, Luk HN, Chen YS, Wang CC, Cheng YF, Huang TL, Eng HL, Liu PP, Chiu KW, Chen CL. The effect of liver graft-body weight ratio on the core temperature of pediatric patients during liver transplantation. Liver Transpl 2003; 9:760-3. [PMID: 12827566 DOI: 10.1053/jlts.2003.50131] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The left lateral segment of the liver from an adult living donor sometimes is relatively too large for a small pediatric recipient. It currently is unknown whether a high graft-recipient body weight ratio (GRWR) has a significant effect on core temperature during the anhepatic and reperfusion phases of living donor liver transplantation (LDLT). Seventy-two pediatric patients undergoing LDLT were divided into two groups according to body weight. Group I (GI) consisted of patients with a body weight greater than 10 kg, and group II (GII), less than 10 kg. Core temperature, measured as nasopharyngeal temperature (NT), was compared between groups at induction of anesthesia, hourly during the following 6 hours, as the lowest core temperature at the anhepatic phase, 5 and 30 minutes after reperfusion, and the last 2 hours before the end of the operation. Mild hypothermia of 35.8 degrees C +/- 0.7 degrees C and 35.9 degrees C +/- 0.4 degrees C for GI and GII was noted after induction of anesthesia, respectively; this increased +/- 1 degrees C in the following 6 hours. In the anhepatic and reperfusion phases, a sudden and significant decrease in NT was observed in both groups. This decrease in NT was significantly greater in GII than GI. In conclusion, a sudden decrease in core temperature was observed during the anhepatic and reperfusion phases of LDLT in pediatric patients, likely caused by placement of the cold liver graft, which is flushed with 4 degrees C lactated Ringer's solution during vessel reconstruction, in the anhepatic phase and return of venous blood through the cold preserved liver in the reperfusion phase. Core temperatures of pediatric patients with a body weight less than 10 kg in GII, who received grafts with a high GRWR, were more affected than those in GI.
Collapse
Affiliation(s)
- Bruno Jawan
- First Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan, ROC.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
56
|
Icoz G, Kilic M, Zeytunlu M, Celebi A, Ersoz G, Killi R, Memis A, Karasu Z, Yuzer Y, Tokat Y. Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations. Liver Transpl 2003; 9:575-80. [PMID: 12783398 DOI: 10.1053/jlts.2003.50129] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biliary complications appear to be the leading cause of postoperative complications after living donor liver transplantation (LDLT). The aim of this study is to analyze the complications, treatment modalities, and outcomes of biliary anastomoses in a series of 50 consecutive right-lobe LDLTs. Median patient age was 45 years, and median right-lobe graft volume was 740 g. Graft-recipient weight ratio was 0.69 to 1.80. Median follow-up time was 15 months (range, 2 to 38 months). Eleven of 50 patients died, resulting in an overall allograft and patient survival rate of 78%. In biliary reconstruction, a duct-to-duct (D-D) anastomosis or a standard Roux-en-Y (R-Y) anastomosis was performed. Twenty-nine grafts (58%) had a single duct for anastomosis. Seventeen grafts (34%) had two bile duct orifices, and four grafts (8%) had three bile duct orifices. A D-D anastomosis was performed in 36 cases (72%), whereas R-Y reconstruction was preferred in 14 cases (28%). The overall incidence of biliary anastomotic complications was 30% in this series. Five patients developed biliary leaks, presumably from the cut surface, and all of them healed spontaneously. Two bilomas were drained percutaneously. Anastomotic strictures occurred in 8 patients (16%) and were significantly greater than in the R-Y group (P =.03). Although strictures seemed to develop more frequently in allografts with multiple bile ducts, this did not reach statistical significance (P =.05). All strictures were managed by nonsurgical measures initially. Restenosis occurred in 2 patients, both of whom had an R-Y anastomotic stricture. These anastomoses were revised surgically, giving a reoperation rate of 4% for biliary problems. No graft or patient was lost because of biliary problems. Our data suggest that D-D anastomosis is a safe and feasible method of biliary reconstruction in LDLT by preserving physiological bilioenteric continuity and allowing easy access through endoscopic techniques.
Collapse
Affiliation(s)
- Gokhan Icoz
- Department of Surgery, Ege University Medical School, Izmir, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
57
|
Settmacher U, Steinmüller TH, Schmidt SC, Heise M, Pascher A, Theruvath T, Hintze R, Neuhaus P. Technique of bile duct reconstruction and management of biliary complications in right lobe living donor liver transplantation. Clin Transplant 2003; 17:37-42. [PMID: 12588320 DOI: 10.1034/j.1399-0012.2003.02058.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
From December 1999 to January 2002, 50 right lobe living donor liver transplantations were performed. The donor operations included an intraoperative cholangiography to elicit variations in bile duct anatomy. The biliary reconstruction was done whenever possible as an end-to-end microanastomosis of the donor right hepatic duct with the recipient's bile duct. As a result of the early segmental branching of the donor biliary tree, two segment bile ducts had to be anastomosed in 20 patients and three segment bile ducts in three patients. In 12 patients, a Roux-en-Y hepaticojejunostomy was performed. All anastomoses were drained externally. We observed two leakages at the resection surface which could be treated successfully by an external drainage. Six leaks occurred at the site of end-to-end biliary anastomoses. Twice the problem could be conservatively solved placing a stent percutaneously. In two patients a hepaticojejunostomy was performed after a bile duct necrosis. In two patients with an anastomotic leak, occurring 3 d, respectively, 3 month after the original transplantation, the bile duct could be directly reconstructed over a T-tube. Two anastomotic stenoses were observed, one in combination with a leak treated by percutaneous stent implantation and the second, 3 month after transplantation which was treated surgically. Biliary reconstruction after living donor liver transplantation requires microsurgical techniques and can be performed as a direct end-to-end anastomosis in most cases. Biliary complications were treated by percutaneous drainage or surgical revision in all cases.
Collapse
Affiliation(s)
- U Settmacher
- Department of General-, Visceral-, and Transplantation Surgery, Charité Berlin, Campus Virchow Klinikum, Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
58
|
Williams RS, Alisa AA, Karani JB, Muiesan P, Rela SM, Heaton ND. Adult-to-adult living donor liver transplant: UK experience. Eur J Gastroenterol Hepatol 2003; 15:7-14. [PMID: 12544688 DOI: 10.1097/00042737-200301000-00003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adult-to-adult living donor liver transplantation (ALDLT) is being adopted widely in the USA and mainland Europe, fueled by the increasing waiting lists for cadaver organs. The present report describes the first UK experience with the procedure in patients from overseas who have the lowest priority for cadaver organ allocation. METHODS The 16 patients seen over the period November 1998 to March 2002 had end-stage cirrhosis from chronic hepatitis C virus (HCV) or hepatitis B virus (HBV) infection (13 cases), with single instances of cryptogenic cirrhosis, secondary biliary cirrhosis and alcoholic liver disease. Grafts were left lobe in the first two recipients and right lobe in the subsequent 14 recipients, donated by nine sons/daughters and seven brothers/sisters. RESULTS Twelve of the 16 recipients did well. The four recipients who died had recurrent sepsis; two of these died following hepatic arterial occlusion, and in three major surgical factors were present before transplantation. Serial computed tomography (CT) measurements in the survivors showed regeneration of the grafted lobe with final volumes reaching in each case the calculated standard liver volume for body size. In the donors, liver function tests had returned to normal by day 7-14, with rapid regeneration of the remaining lobe, although the final size attained that estimated before donation in only four donors. CONCLUSIONS ALDLT, although requiring considerable facilities and organization, can give good results for both recipient and donor. As with cadaver grafts, outcome in the recipient if the larger right lobe is used is dependent on surgical risk factors and the severity of clinical decompensation before transplantation. Measures to ensure the safety of the donors remain the main concern.
Collapse
Affiliation(s)
- Roger S Williams
- Liver Unit Cromwell Hospital, University College London Hospitals, London, UK.
| | | | | | | | | | | |
Collapse
|
59
|
Wai CT, Tan LHC, Kaur M, Da Costa M, Quak SH, Tan KC. Pitfalls in interpreting liver biopsy results: the story of the blind men and the elephant. Liver Transpl 2002; 8:1200-1. [PMID: 12474163 DOI: 10.1053/jlts.2002.36843] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
60
|
Ryan CK, Johnson LA, Germin BI, Marcos A. One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation. Liver Transpl 2002; 8:1114-22. [PMID: 12474149 DOI: 10.1053/jlts.2002.36740] [Citation(s) in RCA: 223] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Living donor liver transplantation allows an increasing number of patients with end-stage liver disease the opportunity for effective treatment in the face of a critical shortage of cadaveric organs. Hepatic steatosis decreases functional graft mass and may contribute to graft dysfunction. Screening liver biopsy allows accurate quantitation of hepatic fat, but is an invasive procedure that is not universally employed in the evaluation of living donors. We studied 100 consecutive prospective right lobe living donors, all evaluated with liver biopsy, imaging studies, and various clinical parameters. The accuracy and predictive value of body mass index (BMI) and imaging were compared with biopsy in determining the amount of hepatic fat. There were no complications to biopsy, with 33% showing some degree of steatosis. BMI correlated only weakly with biopsy, with 73% of overweight (BMI > 25) donors having little or no hepatic fat. Imaging was only 12% sensitive to small amounts (5% to 10%) of fat, with increasing sensitivity to more severe steatosis. Imaging diagnosed steatosis in 2 donors without hepatic fat and failed to identify a candidate denied with biopsy-proven 30% steatosis. Conversely, 9% of candidates with BMIs of 25 or less had 10% or greater steatosis. Moreover, three candidates were denied surgery because biopsy detected occult liver disease. Accurate quantification of hepatic fat is not afforded by BMI and imaging studies alone. Screening liver biopsy has a low complication rate and may serve to increase donor safety. Biopsy is essential in identifying donor grafts at risk for poor recipient outcome while maximizing the donor pool.
Collapse
Affiliation(s)
- Charlotte K Ryan
- Department of Pathology and Laboratory Medicine and Division of Transplantation, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
| | | | | | | |
Collapse
|
61
|
Yao FY, Bass NM, Nikolai B, Davern TJ, Kerlan R, Wu V, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl 2002; 8:873-83. [PMID: 12360427 DOI: 10.1053/jlts.2002.34923] [Citation(s) in RCA: 326] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A major obstacle for orthotopic liver transplantation (OLT) as treatment for hepatocellular carcinoma (HCC) is tumor growth resulting in dropout from the waiting list for OLT. There is a paucity of data on survival according to intention-to-treat analysis and the rate of dropout from the waiting list for OLT among patients with HCC. To further evaluate these issues, we analyzed the outcome of 46 consecutive patients with HCC listed for OLT between January 1998 and January 2001. Exclusion criteria for OLT were tumor size greater than 5 cm for one to three lesions or four lesions or greater of any size. Twenty-one patients underwent OLT. There were 11 dropouts because of tumor progression and six deaths, including three deaths after dropout. Kaplan-Meier 1- and 2-year intention-to-treat survival rates were 91.7% and 72.6%, respectively. Monthly dropout rates were 0% from 0 to 3 months, 1.5% from 3 to 6 months, 1.0% from 6 to 9 months, 4.9% from 9 to 12 months, and 5.6% from 12 to 15 months. One dropout occurred beyond 15 months among 4 patients remaining at risk. Cumulative probabilities for dropout at 6, 12, and 24 months were 7.3%, 25.3%, and 43.6%, respectively. Predictors for dropout included two or three tumor nodules or a solitary lesion greater than 3 cm at initial presentation and previous hepatic resection. Our results support recent changes in the scheme of organ allocation aimed at reducing the dropout rate and improving outcome for patients with HCC awaiting OLT.
Collapse
Affiliation(s)
- Francis Y Yao
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, CA 94143-0538, USA.
| | | | | | | | | | | | | | | |
Collapse
|
62
|
Kadry Z, Selzner N, Handschin A, Müllhaupt B, Renner EL, Clavien PA. Living donor liver transplantation in patients with portal vein thrombosis: a survey and review of technical issues. Transplantation 2002; 74:696-701. [PMID: 12352888 DOI: 10.1097/00007890-200209150-00018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Unlike cadaveric liver transplantation, current attitudes in living donor liver transplantation (LDLT) quote increased risk factors in the potential recipient such as retransplantation, multiple previous surgeries, or preexisting recipient portal vein thrombosis (PVT) as absolute or relative contraindications to this procedure. METHODS An international survey was performed to examine the attitude of transplant teams relative to LDLT in the setting of preexisting PVT in the potential recipient. A questionnaire was sent to a total of 80 transplant centers performing LDLT in the United States, Europe, Canada, Japan, Southeast Asia, and Australia. RESULTS A response was obtained from 47 transplant centers (59% response rate). This included 2146 LDLT procedures that combined both left and right lobe allografts. The incidence of acute preexisting recipient PVT was 18 (0.8%) and of chronic PVT was 26 (1.2%). Thrombectomy was performed in 28 (64%), a jump graft in 13 (29.5%), and a combination of both thrombectomy and a jump graft in 2 (4.5%) cases. With reference to the presence of preexisting PVT in the potential recipient, 5 centers considered this to be an absolute contraindication (10.7%), 24 centers as a relative contraindication (51%), and 18 as not being a contraindication (38.3%) to LDLT. CONCLUSIONS The overall response to our questionnaire reflected a cautious attitude within the transplant community. Ethical criteria pertaining to risk undertaken by a healthy donor in situations of higher recipient morbidity risk does seem to impact on the decision to undertake LDLT in this group of patients.
Collapse
Affiliation(s)
- Zakiyah Kadry
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
63
|
Humar A, Khwaja K, Sielaff TD, Lake JR, Payne WD. Technique of split-liver transplant for two adult recipients. Liver Transpl 2002; 8:725-9. [PMID: 12149768 DOI: 10.1053/jlts.2002.34680] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Abhinav Humar
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
| | | | | | | | | |
Collapse
|
64
|
Diaz GC, Renz JF, Mudge C, Roberts JP, Ascher NL, Emond JC, Rosenthal P. Donor health assessment after living-donor liver transplantation. Ann Surg 2002; 236:120-6. [PMID: 12131094 PMCID: PMC1422557 DOI: 10.1097/00000658-200207000-00018] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To elicit donor opinions on liver living donation through use of a survey that protected the anonymity of the respondent and to assay long-term (follow-up > 1 year) donor health by a widely recognized instrument for health assessment. SUMMARY BACKGROUND DATA Living-donor liver transplantation is an accepted technique for children that has recently been extended to adults. Limited donor outcomes data suggest favorable results, but no outcomes data have been reported using an instrument that elicits an anonymous response from the donor or employs a widely recognized health survey. METHODS Forty-one living-donors between June 1992 and June 1999 were identified and included in this study, regardless of specific donor or recipient outcome. Each donor received a 68-question survey and a standard McMaster Health Index. RESULTS Survey response was 80%. All donors were satisfied with the information provided to them before donation. Eighty-eight percent of donors initially learned of living donation only after their child had been diagnosed with liver disease: 44% through the transplant center, 40% by popular media, 12% by their pediatrician, and 4% by their primary care physician. Physical symptoms, including pain and the surgical wound, were recurrent items of concern. Perception of time to "complete" recovery were less than 3 months (74%), 3 to 6 months (16%), and more than 6 months (10%). Donors' return to physical activities was shown by above-mean McMaster physical scores; scores for social and emotional health were not different from population data. There were no reported changes in sexual function or menstruation after donation, and five of six donors procreated. CONCLUSIONS Donors overwhelmingly endorsed living donation regardless of recipient outcome or the occurrence of a complication. Eighty-nine percent advocated "increased" application of living donation beyond "emergency situations," and no donor responded that living donation should be abandoned or that he or she felt "forced" to donate.
Collapse
Affiliation(s)
- Geraldine C Diaz
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
65
|
Fulcher AS, Turner MA, Ham JM. Late biliary complications in right lobe living donor transplantation recipients: imaging findings and therapeutic interventions. J Comput Assist Tomogr 2002; 26:422-7. [PMID: 12016373 DOI: 10.1097/00004728-200205000-00018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this work was to present the imaging findings of late biliary complications in right lobe living donor liver transplantation recipients and to describe radiologic techniques used to treat these complications. METHOD A retrospective review of medical records and imaging examinations was conducted in 5 of 48 right lobe living donor recipients with known biliary obstruction treated with percutaneous biliary drainage (PBD). Two abdominal radiologists reviewed in consensus the MR cholangiopancreatography (MRCP)/MR, ultrasound (US), CT, and PBD images. RESULTS Biliary-enteric anastomotic strictures were detected in all five recipients. In the four recipients who underwent the procedure, MRCP detected obstruction in each. CT detected obstruction in the fifth recipient. US failed to detect obstruction in one of two recipients. PBD catheters were placed without complication and relieved the obstruction in all five recipients. In addition, in three recipients, balloon dilatation of the stricture was performed and resulted in anastomotic patency. CONCLUSION Biliary-enteric anastomotic strictures accounted for all late biliary complications and were detected correctly with MRCP and CT. The strictures were treated successfully with PBD in all instances and balloon dilatation when possible.
Collapse
Affiliation(s)
- Ann Simpson Fulcher
- Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0615, USA.
| | | | | |
Collapse
|
66
|
Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med 2002; 346:1074-82. [PMID: 11932476 DOI: 10.1056/nejmra011629] [Citation(s) in RCA: 371] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- James F Trotter
- Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver 80262, USA.
| | | | | | | |
Collapse
|
67
|
Biggins SW, Beldecos A, Rabkin JM, Rosen HR. Retransplantation for hepatic allograft failure: prognostic modeling and ethical considerations. Liver Transpl 2002; 8:313-22. [PMID: 11965573 DOI: 10.1053/jlts.2002.31746] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Retransplantation already accounts for 10% of all liver transplants performed, and this percentage is likely to increase as patients live long enough to develop graft failure from recurrent disease. Overall, retransplantation is associated with significantly diminished survival and increased costs. This review summarizes the current causes of graft failure after primary liver transplant, prognostic models that can identify the subset of patients for retransplantation with outcomes comparable to primary transplantation, and ethical considerations in this setting, i.e., outcomes-based versus urgency-based approaches.
Collapse
Affiliation(s)
- Scott W Biggins
- Department of Medicine, Portland Veterans Affairs Medical Center and Oregon Health Sciences University, Portland, OR 97207, USA
| | | | | | | |
Collapse
|
68
|
Taber DJ, Dupuis RE, Fann AL, Andreoni KA, Gerber DA, Fair JH, Johnson MW, Shrestha R. Tacrolimus dosing requirements and concentrations in adult living donor liver transplant recipients. Liver Transpl 2002; 8:219-23. [PMID: 11910566 DOI: 10.1053/jlts.2002.30885] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Living donor liver transplantation in adult recipients is becoming increasingly common. The liver metabolizes most drugs, including immunosuppressive agents. Right-lobe grafts used in adult living donor liver transplantation consist of only 50% to 60% of the total liver. The purpose of this study is to determine whether there is a difference between tacrolimus doses and concentrations in patients who received a partial liver transplant from a living donor (LRD) versus those who received a whole-liver transplant from a cadaveric donor (CAD). Thirteen LRD recipients and 13 CAD recipients who underwent transplantation between April 1998 and July 2000 were included in this analysis. A CAD control group matched for age, sex, and race was used for comparison. Tacrolimus doses and concentrations were analyzed weekly for the first 4 weeks, then monthly for 6 months posttransplantation. There was no difference in acute rejection rates, renal and liver function test results, or number of potentially interacting medications administered between groups. LRD recipients required significantly lower doses of tacrolimus compared with CAD recipients at 2 weeks (0.058 v 0.110 mg/kg/d; P <.01), 3 weeks (0.068 v 0.123 mg/kg/d; P <.02), 4 weeks (0.086 v 0.141 mg/kg/d; P <.02), 2 months (0.097 v 0.141 mg/kg/d; P <.03), and 3 months (0.099 v 0.138 mg/kg/d; P <.03). Tacrolimus 12-hour trough concentrations were similar between groups at all times except for 2 weeks posttransplantation, when LRD recipients' concentrations were significantly greater than those of CAD recipients (12.4 v 9.5 ng/mL; P <.03). In addition, in the first month posttransplantation, LRD recipients were more likely to have greater concentrations of tacrolimus (>15 ng/mL; 22.1% v 9.2%; P <.01). In conclusion, LRD recipients have significantly decreased tacrolimus dosing requirements compared with CAD recipients during the first 3 months posttransplantation despite having similar tacrolimus concentrations.
Collapse
Affiliation(s)
- David J Taber
- Department of Pharmacy, University of North Carolina School of Pharmacy and Medicine, Chapel Hill, NC 27599, USA
| | | | | | | | | | | | | | | |
Collapse
|
69
|
Goyen M, Barkhausen J, Debatin JF, Kühl H, Bosk S, Testa G, Malago M, Ruehm SG. Right-lobe living related liver transplantation: evaluation of a comprehensive magnetic resonance imaging protocol for assessing potential donors. Liver Transpl 2002; 8:241-50. [PMID: 11910569 DOI: 10.1053/jlts.2002.30403] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine the practicability and diagnostic accuracy of a magnetic resonance (MR) protocol capable of replacing computed tomography, catheter angiography, and endoscopic retrograde cholangiopancreatography for the presurgical evaluation of potential liver donors before right hepatectomy. MR imaging (MRI) was performed on a 1.5 T scanner using a phased-array torso surface coil for signal reception. The following image sets were collected: axial two-dimensional (2D) T1-weighted fast low angle shot (FLASH), axial 2D T2-weighted half-Fourier acquisition single-shot turbo-spin-echo (HASTE) with fat saturation, coronal MR cholangio-pancreatography (MRCP) based on 2D multisection HASTE and single-section single-shot rapid acquisition with relaxation enhancement (RARE) imaging, dynamic contrast-enhanced three-dimensional (3D) FLASH, and contrast-enhanced T1-weighted FLASH. 3D FLASH data sets were collected before and after an intravenous administration of Multihance (gadobenate dimeglumine, Gd-BOPTA; Bracco, Milano, Italy), 0.2 mmol/kg of body weight. Thirty-eight potential liver donors were assessed by means of MRI. Twenty patients also underwent digital subtraction angiography (DSA). Of these, 16 patients underwent liver harvesting. MR angiography (MRA) data sets correlated with DSA results, and MRCP results correlated with intraoperative findings. Patients were excluded as potential donors based on insufficient liver mass of the left hepatic lobe (n = 5) or presence of hepatic pathological states (n = 9) seen at MRI, such as hemangiomas, focal nodular hyperplasias, or hepatic steatosis. MRCP showed the biliary system to the level of the first hepatic side branch. Dilated ducts were present in 4 patients. MRA depiction of hepatic arterial morphological characteristics correlated with catheter angiography results in all 20 patients: Three left hepatic arteries originating from the left gastric artery, three aberrant right hepatic arteries originating from the superior mesenteric artery, and two aberrant origins of both hepatic arteries and one common hepatic artery originating from the superior mesenteric artery were correctly identified on MRA. Similarly, the portal venous system was fully assessed on MRA. A comprehensive assessment of the hepatic parenchyma, biliary and pancreatic ductal system, and hepatic arterial, portal, and venous systems can be accomplished using the outlined protocol.
Collapse
Affiliation(s)
- Mathias Goyen
- Department of Diagnostic Radiology, University Hospital Essen, Essen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
70
|
Shiffman ML, Brown RS, Olthoff KM, Everson G, Miller C, Siegler M, Hoofnagle JH. Living donor liver transplantation: summary of a conference at The National Institutes of Health. Liver Transpl 2002; 8:174-88. [PMID: 11862598 DOI: 10.1053/jlts.2002.30981] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Living donor liver transplantation for adults was developed only recently in an attempt to increase the pool of donor organs; to reduce morbidity and mortality; and to improve the long-term survival of patients in need of liver transplant. Within a few brief years, this procedure has gained widespread support by both the public and transplant community. The procedure will soon be performed by nearly 80% of all liver transplant programs in the United States. Unfortunately, the long-term risks of the procedure to the recipient and especially the donor remain undefined. In response to the rapid growth and enthusiasm for this procedure, the National Institutes of Health sponsored a workshop, the goals of which were to review the scientific, medical, and nonmedical issues associated with living donor liver transplantation, and to define questions for future basic and clinical investigations which could improve the success and applicability of this procedure.
Collapse
Affiliation(s)
- Mitchell L Shiffman
- Hepatology Section, Virginia Commonwealth University Health System, Richmond, VA, USA.
| | | | | | | | | | | | | |
Collapse
|
71
|
Beavers KL, Sandler RS, Shrestha R. Donor morbidity associated with right lobectomy for living donor liver transplantation to adult recipients: a systematic review. Liver Transpl 2002; 8:110-7. [PMID: 11862585 DOI: 10.1053/jlts.2002.31315] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim if this study is to determine donor morbidity associated with right lobectomy for living donor liver transplantation (LDLT) to adult recipients through a systematic review of the published literature. Data sources were English-language reports on donor outcome after LDLT. MEDLINE (1995 to June 2001) was searched using the MeSH terms "living donors" and "liver transplantation." Limits were set for human only and English language only. Bibliographies of retrieved references were cross-checked to identify additional reports; 211 reports were obtained. Population studies and consecutive and nonconsecutive series were included. All studies reported at least one of the following outcomes specific to living donors (LDs) of right hepatic lobes to adult recipients: surgical and hospital complications, length of hospital stay, readmissions, recovery time, return to predonation occupation, health-related quality of life, or mortality. Abstracts of relevant articles were reviewed independently using predetermined criteria, and appropriate articles were retrieved. Study design and results were summarized in evidence tables. Summary statistics of combined data were performed when possible. Twelve studies met the inclusion criteria. Data on donor morbidity associated with right lobectomy are limited. On the basis of reported data, morbidity associated with LD right lobectomy ranges from 0% to 67%. In conclusion, reported morbidity associated with right lobe donation for LDLT varies widely. Standardized definitions of morbidity and better methods for observing and measuring outcomes are necessary to understand and potentially improve morbidity. Future studies assessing LD outcomes should report donor outcome more explicitly.
Collapse
Affiliation(s)
- Kimberly L Beavers
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7080, USA
| | | | | |
Collapse
|
72
|
Hiroshige S, Nishizaki T, Soejima Y, Hashimoto K, Ohta R, Minagawa R, Shimada M, Honda H, Hashizume M, Sugimachi K. Beneficial effects of 3-dimensional visualization on hepatic vein reconstruction in living donor liver transplantation using right lobe graft. Transplantation 2001; 72:1993-6. [PMID: 11773902 DOI: 10.1097/00007890-200112270-00022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, virtual operation planning and navigation systems have been introduced in the field of neurosurgery and orthopedic surgery. We report here the beneficial effects of 3-dimensional (3D) visualization on hepatic venous reconstruction in living donor liver transplantation (LDLT) using right lobe graft. METHODS 3D-image reconstruction of the liver was rendered with 3-mm slices of helical computed tomography (CT) data using zioM900 (Zio Software Inc., Tokyo, Japan). To understand the anatomy of the donor's vessels and design an operation plan, a picture of the vessels in and around the liver was reconstructed. RESULTS The 3D image demonstrated two short hepatic veins next to the inferior right hepatic vein (IRHV) as well as a large IRHV. The 3D image showed a more precise diameter of the right hepatic vein (RHV) and the IRHV and a more accurate distance between the two hepatic veins than did images measured by 2-dimensional CT. This preoperative information allowed the donor surgeon to dissect the inferior vena cava (IVC) and hepatic veins with reduced blood loss because of reduced risk of injury to the blood vessels. The 3D image revealed that both the RHV and the IRHV branched off at the same angle from the cylindrical IVC. Preoperative planning based on this information secured smooth anastomosis. CONCLUSIONS 3D visualization is useful for hepatic venous reconstruction of the recipient as well as for donor surgery in LDLT using right lobe graft.
Collapse
Affiliation(s)
- S Hiroshige
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. . kyushu-u.ac.jp
| | | | | | | | | | | | | | | | | | | |
Collapse
|
73
|
|
74
|
Belghiti J, Ettorre GM, Durand F, Sommacale D, Sauvanet A, Jerius JT, Farges O. Feasibility and limits of caval-flow preservation during liver transplantation. Liver Transpl 2001; 7:983-7. [PMID: 11699035 DOI: 10.1053/jlts.2001.28242] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As promoters of orthotopic liver transplantation (OLT) with preservation of caval flow, we reviewed our 8-year experience to assess the feasibility and limits of this technique. Preservation of caval flow during OLT, which improves intraoperative hemodynamic stability, was not considered feasible in a significant proportion of transplant recipients. When transient clamping of caval flow is required, causes and consequences of this clamping during all phases of the procedure were not reported. Between 1991 and 1998, a total of 275 OLTs using a whole graft were performed in 259 patients with a policy consisting of a systematic attempt to preserve inferior vena cava (IVC) and caval flow. Preservation of IVC flow was possible in all cases, and no procedure was converted to the conventional technique. Caval flow was maintained throughout the procedure in 246 procedures (90%). Temporary IVC cross-clamping was required in 24 cases during hepatectomy because of difficult dissection and in 5 cases after graft reperfusion because of outflow obstruction; none required the use of a venovenous shunt. IVC cross-clamping during hepatectomy was required more frequently in cases of a large liver, with a mean duration of 11 +/- 4 minutes, but without significant influence on early postoperative risk, including one graft failure (4%) and one postoperative death (4%). Conversely, IVC cross-clamping after reperfusion, with a mean duration of 23 +/- 5 minutes, was associated with four graft failures (80%) and four deaths (80%). We conclude that IVC preservation is feasible in almost all candidates, allowing the use of split livers from cadaveric or living donors independently from their underlying disease. Although preservation of caval flow was possible in the large majority of cases, transient IVC cross-clamping during hepatectomy was well tolerated in contrast to caval clamping after graft reperfusion. Therefore, if necessary, we recommend transient IVC cross-clamping to perform a large cavocaval anastomosis.
Collapse
Affiliation(s)
- J Belghiti
- Department of Digestive Surgery and Transplantation Unit, Paris VII University, Beaujon Hospital, Clichy, France.
| | | | | | | | | | | | | |
Collapse
|
75
|
Cattral MS, Greig PD, Muradali D, Grant D. Reconstruction of middle hepatic vein of a living-donor right lobe liver graft with recipient left portal vein. Transplantation 2001; 71:1864-6. [PMID: 11455273 DOI: 10.1097/00007890-200106270-00028] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Venous outflow problems in right lobe, living-donor liver transplantation are uncommon, but devastating when they occur. We describe the successful use of the recipient's left portal vein as an interposition graft to drain a dominant middle hepatic vein in a right lobe liver transplant. Two weeks after transplantation, the vein graft accounted for 56% of the total venous outflow of the liver.
Collapse
Affiliation(s)
- M S Cattral
- Multiorgan Transplantation Program, Toronto General Hospital, 621 University Avenue, Toronto, Ontario, Canada M5G 2C4.
| | | | | | | |
Collapse
|
76
|
|
77
|
Abstract
Continued discussion over organ allocation and distribution remained a focal point in the field of liver transplantation in the year 2000. Despite the ongoing debate, no significant changes were implemented in the current allocation system. By far, the most widely discussed topic in liver transplantation this year was live donor adult-to-adult liver transplantation. Several authors reported on their initial experience, with both recipient and donor outcomes appearing excellent. As the number of transplant centers performing this procedure increases we look forward to further studies regarding the safety and long-term outcome of this innovative procedure. Studies on viral hepatitis after liver transplantation again focused on the problem of recurrent hepatitis B and hepatitis C. Several small studies found benefit in patients with hepatitis B treated with intramuscular hepatitis B immunoglobulin and lamivudine after transplantation. Although breakthrough replication remains a problem in some patients, these studies offer hope that combination therapy for hepatitis B may provide improved long-term graft survival in these patients. In patients with hepatitis C, several studies focused on identifying risk factors to predict graft recurrence of the virus after liver transplantation. Both cellular rejection and level of viral replication may be important predictors of recurrent hepatitis C virus in the graft. Early treatment reports using interferon and ribavirin suggest that some patients may have a viral response during therapy; however, it is short lived, and tolerance of medication is difficult. Certainly, we look forward to further studies looking at means of prevention and treatment of viral hepatitis in patients undergoing liver transplantation.
Collapse
Affiliation(s)
- K A Brown
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan 48202, USA.
| | | |
Collapse
|
78
|
Azoulay D, Castaing D, Adam R, Savier E, Delvart V, Karam V, Ming BY, Dannaoui M, Krissat J, Bismuth H. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann Surg 2001; 233:565-74. [PMID: 11303140 PMCID: PMC1421287 DOI: 10.1097/00000658-200104000-00013] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify the outcomes and risks of split-liver transplantation (SLT) for two adult recipients to determine the feasibility of more widespread use of this procedure to increase the graft pool for adults. SUMMARY BACKGROUND DATA The shortage of cadaver liver grafts for adults is increasing. Using livers from donors defined as optimal, the authors have been developing techniques for SLT for two adult recipients at their center. METHODS From July 1993 to December 1999, 34 adults have undergone SLT with grafts from optimal donors prepared by ex situ split (n = 30) or in situ split (n = 4), and 88 adults received optimal whole-liver grafts that were not split. Four split-grafts were transplanted at other centers. The outcomes of transplantation with right and left split-liver grafts were compared with those of whole-liver transplants. The main end points were patient and graft survival at 1 and 2 years and the incidence and types of complications. RESULTS For whole-liver, right and left split-liver grafts, respectively, patient survival rates were 88%, 74%, and 88% at 1 year and 85%, 74%, and 64% at 2 years. Graft survival rates were 88%, 74%, and 75% at 1 year and 85%, 74%, and 43% at 2 years. Patient survival was adversely affected by graft steatosis and recipients inpatient status before transplantation. Graft survival was adversely affected by steatosis and a graft-to-recipient body weight ratio of less than 1%. Primary nonfunction occurred in three left split-liver grafts. The rates of arterial (6%) and biliary (22%) complications were similar to published data from conventional transplantation for an adult and a child. SLT for two adults increased the number of recipients by 62% compared with whole-liver transplantation and was logistically possible in 16 of the 104 (15%) optimal cadaver donors. CONCLUSIONS Split-liver transplantation for two adults is technically feasible. Outcomes and complication rates can be improved by rigid selection criteria for donors and recipients, particularly for the smaller left graft, and possibly also by in situ splitting in cadaver donors. Wider use will require changes in the procedures for graft allocation and coordination between centers experienced in the techniques.
Collapse
Affiliation(s)
- D Azoulay
- Centre Hépatobiliaire, UPRES 1596, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Hôpital Paul Brousse, Villejuif, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
79
|
Bassignani MJ, Fulcher AS, Szucs RA, Chong WK, Prasad UR, Marcos A. Use of imaging for living donor liver transplantation. Radiographics 2001; 21:39-52. [PMID: 11158643 DOI: 10.1148/radiographics.21.1.g01ja0739] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Living donor liver transplantation is emerging as an alternative to cadaveric liver transplantation. The authors present multimodality images obtained in 44 cases of living donor liver transplantation. The images in this article were derived from the pre-, intra-, and postoperative imaging protocol for their institutional transplantation program. Preoperative magnetic resonance (MR) imaging in the donor allows detection of focal liver lesions and accurate determination of liver volume. The latter is crucial to ensure adequate postoperative liver function for donors and recipients. MR cholangiography depicts donor biliary anatomy. MR angiography and digital subtraction arteriography are performed to assess vascular anatomy. Intraoperative ultrasonography (US) helps determine the resection plane during donor hepatectomy. Postoperative MR imaging documents liver regrowth. MR imaging, US, and computed tomography help assess complications in donors and recipients.
Collapse
Affiliation(s)
- M J Bassignani
- Department of Radiology, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA, USA.
| | | | | | | | | | | |
Collapse
|
80
|
Testa G, Malagó M, Valentín-Gamazo C, Lindell G, Broelsch CE. Biliary anastomosis in living related liver transplantation using the right liver lobe: techniques and complications. Liver Transpl 2000; 6:710-4. [PMID: 11084056 DOI: 10.1053/jlts.2000.18706] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the introduction of adult-to-adult living donor liver transplantation using the right lobe of the liver, biliary problems have led the list of complications resulting in postoperative morbidity. We report our experience with the first 30 living donor liver transplantations performed in our institution from August 1998 to January 2000. Patients were 21 men and 9 women, with a mean age 45 +/- 16 years. Mean recipient weight was 65.1 +/- 17.9 kg, mean graft weight was 877 +/- 146 g, and the mean graft-recipient weight ratio was 1.5 +/- 0.6. Patient and graft survival rates were 83.3% and 80%, respectively. Biliary anastomosis was either an end-to-end hepaticocholedochostomy with a T-drain or hepaticojejunostomy. Mean follow-up was 217.4 +/- 149.8 days. The overall complication rate was 26.6% (8 of 30 procedures) and was directly correlated to the type of anastomosis and number of bile ducts. Surgical revision was necessary in all cases. Biliary complications were not the primary cause of graft loss. Adult living donor liver transplantation using the right lobe is a successful procedure, with graft and patient survival similar to those in cadaver full-organ transplantation. Postoperative morbidity, mainly caused by biliary leak, was directly related to the number of ducts and type of anastomosis. With increasing experience, we have better defined our plane of transection on the hilar plate, with the goal of obtaining only 1 biliary duct for the anastomosis. We also improved our parenchymal transection technique, which resulted in a decreased incidence of leak at the cut-surface area.
Collapse
Affiliation(s)
- G Testa
- Department General Surgery and Transplantation, University Hospital of Essen, Essen, Germany
| | | | | | | | | |
Collapse
|
81
|
Abstract
Approximately 20% of hepatitis C virus (HCV)-positive liver transplant recipients develop evidence of allograft cirrhosis by year 5. 2. The prevalence of HCV infection in patients undergoing retransplantation has significantly increased since 1990. 3. Retransplantation for recurrent HCV is associated with poor long-term survival. 4. Preoperative hyperbilirubinemia (bilirubin > or =5 mg/dL) and renal failure predict poor outcome after retransplantation. 5. Retransplantation is the only viable option for patients in whom allografts fail because of recurrent HCV disease.
Collapse
Affiliation(s)
- H R Rosen
- Division of Gastroenterology/Hepatology and Liver Transplantation Program, Portland Veterans Affairs Medical Center-Oregon Health Sciences University, Portland, OR 97207, USA.
| |
Collapse
|
82
|
Gundlach M, Broering D, Topp S, Sterneck M, Rogiers X. Split-cava technique: liver splitting for two adult recipients. Liver Transpl 2000; 6:703-6. [PMID: 11084054 DOI: 10.1053/jlts.2000.18503] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Split-liver transplantation for 2 adult recipients is a challenging procedure because of the need to split through the midplane of the donor liver. In applied techniques, usually the middle hepatic vein is retained with the left split and the vena cava retained with the right split graft, particularly to avoid serious venous congestion of the right graft after reperfusion. The indispensable division of the caudate lobe veins lead to uncertain viability of liver segment I, and resection might be necessary. To provide optimal venous drainage of both hemiliver grafts, we developed the split-cava technique. This article describes our new technique of liver splitting, which has been successfully used in 2 in situ harvesting procedures.
Collapse
Affiliation(s)
- M Gundlach
- Department of Hepatobiliary Surgery, University Hospital Eppendorf, Hamburg, Germany.
| | | | | | | | | |
Collapse
|
83
|
Abstract
1. Living donor liver transplantation (LDLT) is increasingly used for adults with end-stage liver disease. 2. Standards for acceptable rates of donor morbidity, and even mortality, must be evaluated in the context of recipient risk of dying while on the waiting list and outcome after transplantation. 3. Use of our current criteria in Colorado for selection of donors and recipients indicated that 15% of recipients could undergo LDLT.
Collapse
Affiliation(s)
- J F Trotter
- Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
| |
Collapse
|