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High-resolution MR imaging with gadoxetate disodium for the comprehensive evaluation of potential living liver donors. Liver Transpl 2023; 29:497-507. [PMID: 36738083 DOI: 10.1097/lvt.0000000000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/21/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Several major transplantation centers have used composite multimodality evaluation for the preoperative evaluation of potential living liver donors. This approach can be time-consuming and, although rare, can cause complications. We aimed to demonstrate the clinical feasibility of our comprehensive preoperative MR protocol for the preoperative assessment of living liver donor candidates instead of composite multimodality evaluation. MATERIALS AND METHODS Thirty-five consecutive living liver donor candidates underwent multiphasic liver CT and comprehensive donor protocol MR examinations for preoperative evaluation in a single large-volume liver transplantation (LT) center. Three blinded abdominal radiologists reviewed the CT and MR images for vascular and biliary variations. The strength of agreement between CT and MR angiography was assessed using the kappa index. The detection rate of biliary anatomical variations was calculated. The sensitivity and specificity for detecting significant steatosis (>5%) were calculated. The estimated total volume and right lobe volumes measured by MR volumetry were compared with the corresponding CT volumetry measurements using the intraclass correlation coefficient (ICC). RESULTS Among the 35 patients, 26 underwent LT. The measurement of agreement showed a moderate to substantial agreement between CT and MR angiography interpretations (kappa values, 0.47-0.79; p < 0.001). Combining T2-weighted and T1-weighted MR cholangiography techniques detected all biliary anatomical variations in 9 of the 26 patients. MR-proton density fat fraction showed a sensitivity of 100% (3/3) and a specificity of 91.3% (21/23) for detecting pathologically determined steatosis (>5%). MR volumetry reached an excellent agreement with CT volumetry (reviewers 1 and 2: ICC, 0.92; 95% CI, 0.84-0.96). CONCLUSION Our one-stop comprehensive liver donor MR imaging protocol can provide complete information regarding hepatic vascular and biliary anatomies, hepatic parenchymal quality, and liver volume for living liver donor candidates and can replace composite multimodality evaluation.
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Akdur A, Ayvazoğlu Soy HE, Karakaya E, Yıldırım S, Moray G, Haberal M. Living and Deceased Liver Donation Criteria of Baskent University. EXP CLIN TRANSPLANT 2022; 20:80-87. [DOI: 10.6002/ect.donorsymp.2022.o16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lee O, Kim JM, Kim SJ, Rhu J, Choi GS, Joh JW. Healthy Spouses can be Considered as Living Liver Donors. World J Surg 2022; 46:1474-1484. [PMID: 35316397 DOI: 10.1007/s00268-022-06518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spousal donors have gradually been accepted as an alternative living liver donors to alleviate the organ shortage and prevent donations from children. No information is available regarding the effects of spousal donation on donor safety and recipient outcomes. Our purpose in this study was to determine how spousal liver grafts in living donor liver transplantation (LDLT) affect donor safety and recipient outcomes compared with those of LDLT from children. METHODS We retrospectively analyzed 656 patients, including spouses and children, who underwent a right or extended right hepatectomy for living liver donation between January 2009 and December 2018. RESULTS Spouses represented 18.8% (n = 123) of living liver donors. Female donors comprised 78.9% (n = 97) of spousal donors, and the proportion of male donors in the children group was 72.6% (n = 387). The mean donor operation time of the spousal group was shorter than that of the children group (330 min vs. 358 min; P = 0.011), and the complication rate in the spousal group was lower than that in the children group (12.2% vs. 22.9%; P = 0.006). However, there were no differences in severe complication rates, hospitalization, or liver function tests between the 2 groups at 3 months after donor surgery. The overall survival of recipients in the spousal group was not reduced compared to that of recipients in the children group. CONCLUSION The present study suggests that, with careful selection, spousal donation is feasible and safe in LDLT.
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Affiliation(s)
- Okjoo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Sang Jin Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
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Azoulay D, Feray C, Lim C, Salloum C, Conticchio M, Cherqui D, Sa Cunha A, Adam R, Vibert E, Samuel D, Allard MA, Golse N. A systematic review of auxiliary liver transplantation of small for size grafts in patients with chronic liver disease. JHEP Rep 2022; 4:100447. [PMID: 35310820 PMCID: PMC8927838 DOI: 10.1016/j.jhepr.2022.100447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/14/2022] Open
Abstract
Background & Aims The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic liver disease (CLD) to identify opportunities to develop ALT with SFSGs in patients with CLD. Methods This is a systematic review on ALT using SFSGs in patients with CLD. The review was completed by updates obtained from the authors of the retained reports. Results Heterotopic ALT was performed in 26 cases between 1980 and 2017, none for SFGS stricto sensu, and auxiliary partial orthotopic liver transplantation (APOLT) in 27 cases (from 1999 to 2021), all for SFSG. In APOLT cases, partial native liver resection was performed in most of cases, whereas the second-stage remnant native liver hepatectomy was performed in 9 cases only. The median graft-to-body weight ratio was 0.55, requiring perioperative or intraoperative portal modulation in 16 cases. At least 1 complication occurred in 24 patients following the transplant procedure (morbidity rate, 89%). Four patients (4/27, 15%) died after the APOLT procedure. At the long term, 19 (70%) patients were alive and well at 13 months to 24 years (median, 4.5 years) including 18 with the APOLT graft in place and 1 following retransplantation. Conclusions Despite high postoperative morbidity, and highly reported technical variability, the APOLT technique is a promising technique to use SFSGs in patients with CLD, achieving satisfactory long-term results. The results need to be confirmed on a larger scale, and a standardised technique could lead to even better results. Lay summary At the cost of a high postoperative morbidity, the long-term results of APOLT for small-for-size grafts are good. Standardisation of the procedure and of portal modulation remain needed. Using a small-for-size graft is a risk factor of small-for-size syndrome. Auxiliary liver transplantation can be orthotopic or heterotopic. In auxiliary transplantation, the remnant native liver prevents small-for-size syndrome. Transplantation with a small-for-size graft requires individually tailored portal modulation. Auxiliary liver transplantation might substantially increase the number of available grafts.
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Rajaram RB, Jayaraman T, Yoong BK, Koh PS, Loh PS, Koong JK, Khalil AA, Md Hashim NH, Jamaluddin FH, Mahadeva S. Non-alcoholic fatty liver disease and obesity among adult donors are major challenges to living donor liver transplantation: A single-centre experience. Asian J Surg 2021; 45:441-447. [PMID: 34384674 DOI: 10.1016/j.asjsur.2021.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Obesity and non-alcoholic fatty liver disease (NAFLD) are rampant in South East Asia. There is paucity of data exploring its' impact on donor suitability for living donor liver transplantation (LDLT). We aimed to describe and examine the factors related to non-utilization of potential donors in our LDLT programme. METHODS This is an analysis of prospectively collected data on potential donors for an adult LDLT programme, between January 2017 and December 2019. RESULTS Fifty-five donors for 33 potential recipients were evaluated. The mean age was 31.6 ± 8.5 years, 52.7% were female and the ethnic divisions were: Chinese (50.9%), Indian (25.5%) and Malay (23.6%). The mean body mass index (BMI) among potential donors was 25.1 ± 4.0 kg/m2; 25.5% of donors had normal BMI, 23.6% were overweight and 50.9% were obese. Using the CAP modality of Fibroscan®, we identified the following grades of hepatic steatosis: 36.6% S0, 19.5% S1, 2.4% S2 and 41.5% S3. The non-utilization rate of our donors was 74.5% (41/55) and the main reasons were significant hepatic steatosis and/or obesity. Compared to suitable donors, unsuitable donors had significantly greater mean BMI, mean CAP scores, higher rates of dyslipidaemia and NAFLD. CONCLUSION NAFLD and obesity represent major challenges to an emerging LDLT programme in Malaysia.
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Affiliation(s)
- Ruveena B Rajaram
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Thevaraajan Jayaraman
- Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
| | - Boon-Koon Yoong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Peng-Soon Koh
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pui San Loh
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jun-Kit Koong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Alizan A Khalil
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Fadhil H Jamaluddin
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Kasiske BL, Ahn YS, Conboy M, Dew MA, Folken C, Levan ML, Humar A, Israni AK, Rudow DL, Trotter JF, Massie AB, Musgrove D. Outcomes of living liver donor candidate evaluations in the Living Donor Collective pilot registry. Clin Transplant 2021; 35:e14394. [PMID: 34342054 DOI: 10.1111/ctr.14394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/04/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To gather information on long-term outcomes after living donation, the Scientific Registry of Transplant Recipients (SRTR) conducted a pilot on the feasibility of establishing a comprehensive donor candidate registry. METHODS A convenience sample of 6 US living liver donor programs evaluated 398 consecutive donor candidates in 2018, ending with the March 12, 2020, COVID-19 emergency. RESULTS For 333/398 (83.7%), the donor or program decided whether to donate; 166/333 (49.8%) were approved, and 167/333 (50.2%) were not or opted out. Approval rates varied by program, from 27.0% to 63.3% (median, 46%; intraquartile range, 37.3-51.1%). Of those approved, 90.4% were white, 57.2% were women, 83.1% were < 50 years, and 85.5% had more than a high school education. Of 167 candidates, 131 (78.4%) were not approved or opted out because of: medical risk (10.7%); chronic liver disease risk (11.5%); psychosocial reasons (5.3%); candidate declined (6.1%); anatomical reasons increasing recipient risk (26.0%); recipient-related reasons (33.6%); finances (1.5%); or other (5.3%). CONCLUSIONS A comprehensive national registry is feasible and necessary to better understand candidate selection and long-term outcomes. As a result, the US Health Resources and Services Administration asked SRTR to expand the pilot to include all US living donor programs.
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Affiliation(s)
- Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Yoon Son Ahn
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Michael Conboy
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christian Folken
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Macey L Levan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abhi Humar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ajay K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - James F Trotter
- Department of Medicine, Baylor University Medical Center, Dallas, Texas, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donald Musgrove
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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7
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Emamaullee J, Conrad C, Kim M, Goldbeck C, Kwon Y, Singh P, Niemann CU, Sher L, Genyk Y. Assessment of the global practice of living donor liver transplantation. Transpl Int 2021; 34:1914-1927. [PMID: 34165829 DOI: 10.1111/tri.13960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 02/06/2023]
Abstract
Criteria that drive the selection and utilization of living liver donors are limited. Herein, the global availability of living donor liver transplantation (LDLT) and components of donor selection and utilization were assessed via an international survey. There were 124 respondents representing 41 countries, including 47 from Asia/Middle East (A/ME), 20 from Europe, and 57 from the Americas. Responses were obtained from 94.9% of countries with ≥10 LDLT cases/year. Most centers (82.3%) have defined donor age criteria (median 18-60 years), while preset recipient MELD cutoffs (median 18-30) were only reported in 54.8% of programs. Overall, 67.5% of programs have preset donor BMI (body mass index) ranges (median 18-30), and the mean acceptable macrosteatosis was highest for A/ME (20.2 ± 9.2%) and lowest for Americas (16.5 ± 8.4%, P = 0.04). Americas (56.1%) and European (60.0%) programs were more likely to consider anonymous donors versus A/ME programs (27.7%, P = 0.01). There were no differences in consideration of complex anatomical variations. Most programs (75.9%) perform donor surgery via an open approach, and A/ME programs are more likely to use microscopic arterial reconstruction. Despite variations in practice, key aspects of living donor selection were identified. These findings provide a contemporary reference point as LDLT continues to expand into areas with limited access to liver transplantation.
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Affiliation(s)
- Juliet Emamaullee
- Department of Surgery, University of Southern California, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Claire Conrad
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle Kim
- Department of Surgery, University of Southern California, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Cameron Goldbeck
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Yong Kwon
- Department of Surgery, University of Southern California, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pranay Singh
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Claus U Niemann
- Department of Anesthesiology, University of California-San Francisco, San Francisco, CA, USA.,Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Linda Sher
- Department of Surgery, University of Southern California, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yuri Genyk
- Department of Surgery, University of Southern California, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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8
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Lee S, Kim KW, Kim SY, Seo N, Song GW, Lee SG. Controlled attenuation parameter measured using transient elastography for the noninvasive assessment of macrovesicular steatosis in potential living liver donors. Ultrasonography 2021; 41:164-170. [PMID: 34399042 PMCID: PMC8696135 DOI: 10.14366/usg.21071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/06/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This study aimed to determine the diagnostic performance of the controlled attenuation parameter (CAP) measured using transient elastography (TE) for assessing macrovesicular steatosis (MaS) in potential living liver donors using same-day biopsy as a reference standard. METHODS This retrospective study included 204 living liver donor candidates who underwent TE and liver biopsy on the same day between July 2013 and June 2014. The histologic degree of MaS was determined. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of CAP for diagnosing MaS of >10%, and the optimal cutoff value was identified using the maximal Youden index. RESULTS Based on liver biopsy, 185 subjects had MaS of ≤10% and 19 had MaS of >10%. The CAP value was significantly correlated with the percentage of MaS on liver biopsy (r=0.635, P<0.001), and the median CAP value was significantly higher in subjects with MaS of >10% than in those with MaS of ≤10% (300 dB/m vs. 209 dB/m, P<0.001). The AUROC for diagnosing MaS of >10% by CAP was 0.938 (95% confidence interval, 0.896 to 0.967), and a CAP of >259 dB/m yielded a sensitivity of 84.2% and a specificity of 92.4%. CONCLUSION The CAP measured using TE was significantly correlated with MaS and accurately detected substantial MaS in potential living liver donors. The CAP is a promising tool for the noninvasive diagnosis of MaS and may be used to screen unsuitable living liver donor candidates.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Nieun Seo
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
The authors have analyzed the indications and outcomes after ALPPS procedure considering modern literature data devoted to this surgery in pediatric patients. No data on post-resection liver failure, as well as unclear future liver remnant function make it possible to question the feasibility of such procedures in children.
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Affiliation(s)
- D G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology,Oncology and Immunology, Moscow, Russian Federation
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10
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Karakaya E, Akdur A, Ayvazoglu Soy EH, Harman A, Coskun M, Haberal M. Our Living Donor Protocol for Liver Transplant: A SingleCenter Experience. EXP CLIN TRANSPLANT 2020; 18:689-695. [PMID: 33187462 DOI: 10.6002/ect.2020.0280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The shortage of deceased donor organs is a limiting factor in transplant. The growing discrepancy between the wait list demand versus the supply of deceased donor organs has created an incentive for consideration of living donor liver transplant as an alternative. Here, we describe our evaluation process and donor complications. MATERIALS AND METHODS Since 1988, we have performed 659 (449 living donor and 210 deceased donor) liver transplants. The most important evaluation criteria is the relationship between donor and recipient, and we require thatthe donor must be related to the recipient. The evaluation protocol has 5 stages. Donor complications were defined as simple, moderate, and severe. RESULTS We retrospectively investigated data for 1387 candidates, and 938 (67.7%) were rejected; subsequently, 449 living donor liver transplants were performed. There were no complications in 398 of the donors (88.7%). Total complication rate was 11.3%. Simple complications were seen in 31 patients (6.9%). Moderate complications were seen in 19 patients (4.2%). We had only 1 severe complication, ie, organ failure from unspecified liver necrosis, which resulted in death. CONCLUSIONS The relationship between donor and recipient and donor safety should be the primary focus for living donor liver transplant. Donor selection should be made carefully to minimize complications and provide adequately functional grafts.
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Affiliation(s)
- Emre Karakaya
- From the Baskent University Faculty of Medicine, Department of General Surgery, Division of Transplantation, Ankara, Turkey
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11
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Anwar ASMT, Lee JM. A Survey on Awareness and Attitudes Toward Organ Donation Among Medical Professionals, Medical Students, Patients, and Relatives in Bangladesh. Transplant Proc 2020; 52:687-694. [PMID: 32147027 DOI: 10.1016/j.transproceed.2019.12.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 12/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study assesses the level of knowledge and attitudes toward organ donation among doctors, nurses, medical students, patients, and relatives of patients at Dhaka Medical College Hospital in Dhaka, Bangladesh. METHODS A cross sectional study was conducted at Dhaka Medical College Hospital among doctors, nurses, medical students, patients, and attendants (100 participants in each group). Participants completed a 20-item self-administered questionnaire that assessed levels of knowledge and attitudes regarding organ donation. RESULTS Among the 500 participants, 85% had heard about organ donation, but only 46% of doctors, 33% of nurses, and 41% of medical students could report the names of all the organs that can be donated. One-fourth (25.4%) had agreed to donate their organs (23% of doctors, 17% of nurses, 28% of medical students, 29% of patients, and 30% of attendants), and 26.0% did not agree to donate (17% of doctors, 19% of nurses, 16% of medical students, 42% of patients, and 36% of relatives). Less than half (43.8%) of participants reported that they would donate organs to help someone when they die. Among the entire sample, 16% reported that their family would be upset if they donated organs, and 12.6% reported that it was against their religion. CONCLUSION Although medical professionals have a better understanding of organ donation than nonmedical individuals, their attitudes toward organ donation are similar to that of the general population. A strategic approach should be taken to develop and launch public campaigns targeting both medical professionals and the general population to educate and raise awareness about organ donation.
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Affiliation(s)
| | - Jae-Myeong Lee
- Korea University College of Medicine, Seoul, South Korea.
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12
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El-Meteini M, Shorub E, Mahmoud DAM, Elkholy H, El-Missiry A, Hashim R. Psychosocial profile and psychiatric morbidity among Egyptian patients after living donor liver transplantation. MIDDLE EAST CURRENT PSYCHIATRY 2019. [DOI: 10.1186/s43045-019-0003-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Offspring Versus Nonoffspring to Parent Living Donor Liver Transplantation: Does Donor Relationship Matter? Transplantation 2019; 104:996-1002. [PMID: 31568397 DOI: 10.1097/tp.0000000000002977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Offspring (donor) to parent (recipient) transplant is the most common form of living donor liver transplant in the United States. In kidney transplantation, it has been suggested that female recipients of offspring living donor kidney allografts have inferior outcomes. It is unknown whether such a phenomenon also occurs following living donor liver transplantation. METHODS A retrospective analysis was completed of recipients of a living donor liver transplant from January 1998 to January 2018 in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. Patients were grouped as having received a living donor liver allograft from either an offspring or a nonoffspring, with exactly 3 HLA matches, as would be expected between an offspring and parent. Graft and patient survival were analyzed using Cox proportional hazards modeling. RESULTS A total of 279 offspring to parent and 241 nonoffspring donor liver transplants were included in the analysis. Female recipients of offspring liver allografts had both inferior 10-year graft (52% versus 72%; P < 0.001) and patient survival (52% versus 81%; P < 0.001) compared with female recipients of nonoffspring allografts. No such difference in outcomes was discovered among male recipients. A stratified analysis of sex of offspring donors to female recipients demonstrated that donor male gender was associated with graft failure (HR = 2.87; P = 0.04) and mortality (hazard ratio = 3.89; P = 0.03). Again, this association was not seen with male recipients. CONCLUSIONS Among female recipients, offspring to parent living donor liver transplantation yields inferior long-term graft and patient survival. Furthermore, among offspring donors, male sex was strongly associated with inferior outcomes. These findings have significant implications for donor selection.
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14
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Wang P, Que W, Zhang M, Dai X, Yu K, Wang C, Peng Z, Zhong L. Application of 3-Dimensional Printing in Pediatric Living Donor Liver Transplantation: A Single-Center Experience. Liver Transpl 2019; 25:831-840. [PMID: 30770639 DOI: 10.1002/lt.25435] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
Three-dimensional (3D) printing has been used to support organ transplantations. However, whether it helps remains unclear. This study aimed to present and assess the application of 3D-printed liver models in pediatric living donor liver transplantation (LDLT). The 3D images were printed to touchable liver models with transparent liver parenchyma, specifically colored hepatic vessels, and biliary structures. A total of 30 consecutive recipients were enrolled in the study: 10 were operated on with the support of 3D printing (3D-printing group) and 20 (control group) were operated on without it. Detailed photographs and data of the cases in the 3D-printing group were presented. One patient underwent auxiliary partial orthotopic liver transplantation using the left lobe graft, in which the abdominal cavity model was also printed to test whether the planned graft fit the recipient's abdominal cavity. The 3D-printed models facilitated surgical planning and procedures, particularly in the management of hepatic veins and in the prevention of large-for-size syndrome. The operative time of donors in the 3D-printing group was significantly shorter compared with the control group (2.3 ± 0.4 versus 3.0 ± 0.4 hours; P < 0.001). Inpatient costs for donors in the 3D-printing group were 17.1% lower than those in the control group (34.6 ± 6.6 versus 41.7 ± 10.4 thousand ¥; P = 0.03). In conclusion, in small infants and complicated pediatric LDLT patients, 3D-printed models can help minimize the risk of large-for-size syndrome and graft reduction. The 3D-printed models may be conducive to liver graft procurement and intraoperative assistance in pediatric LDLT.
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Affiliation(s)
- Pusen Wang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weitao Que
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingman Zhang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaoke Dai
- Department of General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Kanru Yu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunguang Wang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihai Peng
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Zhong
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Taran FA, Schöller D, Rall K, Nadalin S, Königsrainer A, Henes M, Bösmüller H, Fend F, Nikolaou K, Notohamiprodjo M, Grasshoff C, Heim E, Zipfel S, Schäffeler N, Bakchoul T, Heyne N, Guthoff M, Krämer B, Reisenauer C, Hoopmann M, Kagan KO, Brännström M, Wallwiener D, Brucker SY. Screening and evaluation of potential recipients and donors for living donor uterus transplantation: results from a single-center observational study. Fertil Steril 2019; 111:186-193. [PMID: 30611405 DOI: 10.1016/j.fertnstert.2018.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To report our experience with the screening and selection of potential recipients and living donors of our uterus transplantation (UTx) program. DESIGN Part of an observational program. SETTING University hospital. PATIENT(S) Patients with absolute uterine factor infertility (AUFI). INTERVENTION(S) Screening by e-mail and telephone, selection during surgical consultation, and preoperative investigations according to a multistep procedure for living donation. MAIN OUTCOME MEASURE(S) Age, cause of AUFI, exclusion reasons, and preoperative workup. RESULT(S) A total of 212 potential recipients expressed interest in participation. Among the 46 potential recipients and 49 directed donors were 4 potential recipients, each with 2 directed donors. Mean (range) age of potential recipients was 29.6 (19-41) years. Of the potential recipients, 39 (84.8%) had congenital AUFI and 7 (17.3%) had acquired AUFI. Ultimately, 15 potential recipients with 16 directed donors were selected for participation, with 1 potential recipient having 2 directed donors. Mean age of included potential recipients was 28.9 (22-35) years, and mean donor age was 51.3 (37-62) years. Fourteen potential recipients (93.3%) had congenital AUFI, and one potential recipient (6.7%) had undergone hysterectomy for obstetric complications. CONCLUSION(S) The number of potential candidates for UTx is not inconsiderable, with congenital AUFI being the leading cause of AUFI in our cohort. However, our findings highlight that large numbers of AUFI patients need to be screened, considering our exclusion rates were >50%, owing to ABO incompatibility, unavailability of a directed donor, and self-withdrawal. Moreover, meticulous preoperative screening, including in-depth psychological assessment, is mandatory to maximize living donor safety and UTx success.
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Affiliation(s)
- Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany.
| | - Dorit Schöller
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Katharina Rall
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral, and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Melanie Henes
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Hans Bösmüller
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | - Falko Fend
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Christian Grasshoff
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
| | - Eckhard Heim
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany
| | - Tamam Bakchoul
- Center for Transfusion Medicine, University of Tübingen, Tübingen, Germany
| | - Nils Heyne
- Department of Endocrinology and Diabetology, Angiology, Nephrology, and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Martina Guthoff
- Department of Endocrinology and Diabetology, Angiology, Nephrology, and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Bernhard Krämer
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Christl Reisenauer
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Karl-Oliver Kagan
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Stockholm IVF, Stockholm, Sweden
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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16
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A Worldwide Survey of Live Liver Donor Selection Policies at 24 Centers With a Combined Experience of 19 009 Adult Living Donor Liver Transplants. Transplantation 2019; 103:e39-e47. [PMID: 30308575 DOI: 10.1097/tp.0000000000002475] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Abu-Gazala S, Olthoff KM. Current Status of Living Donor Liver Transplantation in the United States. Annu Rev Med 2019; 70:225-238. [DOI: 10.1146/annurev-med-051517-125454] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adult-to-adult living donor liver transplantation (LDLT) was introduced in response to the shortage of deceased donor liver grafts. The number of adult living donor transplants is increasing due to improved outcomes and increasing need. Advantages of LDLT include optimization of the timing of transplant, better organ quality, and lower rates of recipient mortality compared to staying on the wait list for deceased donor liver transplant. Donor safety remains the major focus when considering LDLT. Recent advancements have supported the increased use of LDLT to help decrease wait list death and improve long-term survival of transplant recipients.
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Affiliation(s)
- Samir Abu-Gazala
- Transplantation Unit, Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Kim M. Olthoff
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4283, USA
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18
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Predicting Hepatic Steatosis in Living Liver Donors Via Controlled Attenuation Parameter. Transplant Proc 2018; 50:3533-3538. [DOI: 10.1016/j.transproceed.2018.06.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022]
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19
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Sotiropoulos GC, Spartalis E, Machairas N, Paul A, Malagó M, Neuhäuser M. Liver transplantation for hepatocellular carcinoma with live donors or extended criteria donors: a propensity score-matched comparison. Ann Gastroenterol 2018; 31:722-727. [PMID: 30386123 PMCID: PMC6191876 DOI: 10.20524/aog.2018.0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/29/2018] [Indexed: 12/27/2022] Open
Abstract
Background To compare patient survival after liver transplantation (LT) for hepatocellular carcinoma (HCC) from live donors (LD) or extended criteria donors (ECD). Methods Data from consecutive LT procedures for HCC involving either LD or ECD were reviewed. Patient survival was our primary outcome. Re-transplantation (Re-LT), ischemic type bile lesions (ITBL), and tumor recurrence represented secondary outcomes. The primary outcome was statistically analyzed using Kaplan-Meier estimates and Cox proportional hazards regression; logistic regression analyses were used for statistical analysis of the secondary outcomes. Propensity score was calculated based on patient age, sex, hepatitis C viral infection (HCV), laboratory model for end-stage liver disease (labMELD) score, bridging treatment, Milan criteria, α-fetoprotein levels, and tumor grade. Results The study evaluated 109 recipients undergoing LT from either LD (n=57) or ECD (n=52). LT procedure (hazard ratio [HR] 2.349, 95% confidence interval [CI] 1.151-4.794, P=0.0190), age (HR 1.075, 95%CI 1.020-1.133, P=0.0074) and labMELD score (HR 1.082, 95%CI 1.021-1.147, P=0.0075) reached significance by Cox proportional hazards regression. After adjustment with the propensity score (stratification with 5 strata), the LT procedure was still significant (HR 2.401, 95%CI 1.114-5.175, P=0.0253). Tumor grade (odds ratio [OR] 9.628, 95%CI 1.120-82.752, P=0.0391), labMELD score (OR 1.224, 95%CI 1.019-1.471, P=0.0306), and Milan criteria (OR 6.375, 95%CI 1.239-32.796, P=0.0267) gained statistical significance by logistic regression analysis for Re-LT, ITBL, and tumor recurrence, respectively. Conclusions LT for HCC showed superior patient survival with ECD rather than LD grafts. Re-LT, ITBL, and tumor recurrence showed no significant differences between the two groups. However, the diverging criteria for the definition of ECD grafts represent a considerable limitation for the wide application of this policy.
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Affiliation(s)
- Georgios C Sotiropoulos
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany (Georgios C. Sotiropoulos, Andreas Paul, Massimo Malagó).,Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece (Georgios C. Sotiropoulos, Eleftherios Spartalis, Nikolaos Machairas)
| | - Eleftherios Spartalis
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece (Georgios C. Sotiropoulos, Eleftherios Spartalis, Nikolaos Machairas)
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece (Georgios C. Sotiropoulos, Eleftherios Spartalis, Nikolaos Machairas)
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany (Georgios C. Sotiropoulos, Andreas Paul, Massimo Malagó)
| | - Massimo Malagó
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany (Georgios C. Sotiropoulos, Andreas Paul, Massimo Malagó).,Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK (Massimo Malago)
| | - Markus Neuhäuser
- Department of Mathematics and Technology, Koblenz University of Applied Science, Remagen, Germany (Markus Neuhäuser)
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20
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Kim B, Kim SY, Kim KW, Jang HY, Jang JK, Song GW, Lee SG. MRI in donor candidates for living donor liver transplant: Technical and practical considerations. J Magn Reson Imaging 2018; 48:1453-1467. [DOI: 10.1002/jmri.26257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Bohyun Kim
- Department of Radiology; Ajou University Medical Center, Ajou University School of Medicine; Suwon South Korea
| | - So Yeon Kim
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Kyoung Won Kim
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Hye Young Jang
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Jong Keon Jang
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Gi Won Song
- Department of Surgery, Division of Hepatobiliary and Liver Transplantation Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Sung Gyu Lee
- Department of Surgery, Division of Hepatobiliary and Liver Transplantation Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
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21
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Abu-Gazala S, Olthoff KM. Status of Adult Living Donor Liver Transplantation in the United States: Results from the Adult-To-Adult Living Donor Liver Transplantation Cohort Study. Gastroenterol Clin North Am 2018; 47:297-311. [PMID: 29735025 DOI: 10.1016/j.gtc.2018.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This article reviews the Adult-to-Adult Living Donor Liver Transplant Cohort Study (A2ALL). The findings show that the number of adult-to-adult living donor liver transplants is consistently increasing. Living donor liver transplantation has an important benefit for patients with acute liver failure, does not compromise donor safety, and has lower rates of acute cellular rejection in biologically related donor and recipient. The conclusions from the A2ALL consortium have been critical in transplant advancement, supporting increased use to help decrease waitlist death and improve long-term survival of transplant recipients.
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Affiliation(s)
- Samir Abu-Gazala
- Department of Surgery, Transplantation Unit, Hadassah Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
| | - Kim M Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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22
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Benkö T, Sgourakis G, Molmenti EP, Peitgen HO, Paul A, Nadalin S, Schroeder T, Radtke A. Portal Supply and Venous Drainage of the Caudate Lobe in the Healthy Human Liver: Virtual Three-Dimensional Computed Tomography Volume Study. World J Surg 2017; 41:817-824. [PMID: 27822720 DOI: 10.1007/s00268-016-3791-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The venous vascular anatomy of the caudate lobe is exceptional. The purpose of this study was to assess portal inflow and venous outflow volumes of the caudate lobe. METHODS Extrahepatic (provided by the first-order branches) versus intrahepatic (provided by the second- to third-order branches) portal inflow, as well as direct (via Spieghel veins) versus indirect (via hepatic veins) venous drainage patterns were analyzed in virtual 3-D liver maps in 140 potential live liver donors. RESULTS The caudate lobe has a greater intrahepatic than extrahepatic portal inflow volume (mean 55 ± 26 vs. 45 ± 26%: p = 0.0763), and a greater extrahepatic than intrahepatic venous drainage (mean 54-61 vs. 39-46%). Intrahepatic drainage based on mean estimated values showed the following distribution: middle > inferior (accessory) > right > left hepatic vein. CONCLUSIONS Sacrifice of extrahepatic caudate portal branches can be compensated by the intrahepatic portal supply. The dominant outflow via Spieghel veins and the negligible role of left hepatic vein in caudate venous drainage may suggest reconstruction of caudate outflow via Spieghel veins in instances of extended left hemiliver live donation not inclusive of the middle hepatic vein. The anatomical data and the real implication for living donors must be further verified by clinical studies.
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Affiliation(s)
- T Benkö
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - G Sgourakis
- Department of Surgery, Furness General Hospital, Dalton Ln, Barrow-in-Furness, Cumbria, LA14 4LF, UK.
| | - E P Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - H O Peitgen
- MeVis Center for Medical Diagnostic Systems and Visualization, University of Bremen, Bremen, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - S Nadalin
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General, Visceral and Transplant Surgery, University Hospital Tubingen, Tubingen, Germany
| | - T Schroeder
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - A Radtke
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General, Visceral and Transplant Surgery, University Hospital Tubingen, Tubingen, Germany
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23
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Living donor liver transplantation: eliminating the wait for death in end-stage liver disease? Nat Rev Gastroenterol Hepatol 2017; 14:373-382. [PMID: 28196987 DOI: 10.1038/nrgastro.2017.2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adult-to-adult living donor liver transplantation (A2ALDLT), outside of Asia, remains an important yet underutilized gift of life. For patients with end-stage liver disease, A2ALDLT is a proven transplantation option, with lower waiting list mortality and suffering, and equivalent or better allograft and patient survival than deceased-donor liver transplantation (DDLT). The risks to living donors and the benefit to their recipients have been carefully defined with long-term level 1 and 2 evidence-based study. An overview of the development and practice of living donor liver transplant (LDLT), including donor and recipient surgical allograft innovation, is provided. The issues of recipient selection, outcomes and morbidity, including disease-variable study and challenges past and present are presented in comparison with DDLT cohorts, and future insights are described. Central to practice is the careful and concise review of donor evaluation and selection and donor outcome, morbidity, quality of life and present and future strategies for donor advocacy and growth of the technique.
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24
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Nugroho A, Kim OK, Lee KW, Song S, Kim H, Hong SK, Yoon KC, Kim HS, Choi Y, Lee HW, Yi NJ, Suh KS. Evaluation of donor workups and exclusions in a single-center experience of living donor liver transplantation. Liver Transpl 2017; 23:614-624. [PMID: 28294533 DOI: 10.1002/lt.24762] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/27/2017] [Indexed: 02/07/2023]
Abstract
The process of evaluating potential donors in liver transplantation is important to ensure donor safety and provide optimal recipient outcomes. However, there has been no report about donor exclusion rates and reasons for such exclusion in Korea. In this study, we aimed to elucidate the outcomes of potential living liver donor evaluation in a major living donor liver transplantation center. From July 2011 to June 2015, prospectively collected data of 726 potential donors for 588 matched recipients were subsequently evaluated. Among 726 potential donors, 374 potential donors (51.5%) finally reached donation; 352 potential donors (48.5%) were excluded for various reasons. Donor reasons were 29.8%, including medical problems, withdrawal of consent, graft volume issues, and identification of a better suitable donor. Recipient reasons were 20.7%, including recipient death or recovery, allocation to deceased donor, and progressions of hepatocellular carcinoma. A total of 38 (5.2%) potential donors had a fatty liver. Among them, 15 (39.5%) potential donors tried short-term weight reduction and eventually were able to donate. In conclusion, the main reasons for donor exclusion were medical problems and withdrawal of consent. Therefore, thorough medical screening and careful examination for donor voluntarism are important in the donor evaluation process. Liver Transplantation 23 614-624 2017 AASLD.
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Affiliation(s)
- Adianto Nugroho
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ok-Kyung Kim
- Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Sanghee Song
- Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyeyoung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Chul Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Sin Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
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25
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Scatton O, Cauchy F, Conti F, Perdigao F, Massault PP, Goumard C, Soubrane O. Two-stage liver transplantation using auxiliary laparoscopically harvested grafts in adults: Emphasizing the concept of "hypersmall graft nursing". Clin Res Hepatol Gastroenterol 2016; 40:571-574. [PMID: 27156172 DOI: 10.1016/j.clinre.2016.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 03/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Living donor liver transplantation is limited by the donor's risk in case of right liver donation and by the risk of small-for-size syndrome on the recipient in case of left lobe transplantation. This study aimed at evaluating the feasibility and results of two-stage liver transplantation using auxiliary hyper small grafts harvested laparoscopically and discussing relevant technical insights and issues that still need to be overcome. METHODS Retrospective analysis involving two patients operated at a tertiary referral center. The recipients underwent left lateral sectionectomy and then auxillary liver transplantation using laparoscopically harvested left lateral section. The native right liver was transiently left in place to sustain the initially small functional graft functional during its hypertrophy. RESULTS No donor experienced postoperative complication. After 7days, the hypertrophy rate was 112% (105-120). Doppler assessments during the first two postoperative weeks showed progressive portal vein inflow decrease in the right native livers and portal vein inflow increase in the grafts. Liver biopsies on postoperative day 7 showed no lesion of overperfusion. No recipient experienced liver failure or small-for-size syndrome. Second stage hepatectomy of the native liver was undertaken in one patient. In the other patient, biliary stenosis on postoperative day 30 precluded second stage hepatectomy. This patient required retransplantation after one year. CONCLUSIONS AND RELEVANCE The current strategy increases donor safety and may allow increasing the pool of available grafts. Refinements in the management of the native right liver are however required to improve the feasibility rate of this strategy.
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Affiliation(s)
- Olivier Scatton
- Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - François Cauchy
- Department of liver transplantation and HPB surgery, hôpital Beaujon, université Paris 7-Xavier-Bichat, Assistance publique-Hôpitaux de Paris, 92110 Clichy, France
| | - Filomena Conti
- Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Fabiano Perdigao
- Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Pierre Philippe Massault
- Department of digestive surgery, hôpital Cochin, université Paris 5-René-Descartes, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - Claire Goumard
- Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Olivier Soubrane
- Department of liver transplantation and HPB surgery, hôpital Beaujon, université Paris 7-Xavier-Bichat, Assistance publique-Hôpitaux de Paris, 92110 Clichy, France
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26
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Abougergi MS, Rai R, Cohen CK, Montgomery R, Solga SF. Trends in Adult-to-Adult Living Donor Liver Transplant Organ Donation: The Johns Hopkins Experience. Prog Transplant 2016; 16:28-32. [PMID: 16676671 DOI: 10.1177/152692480601600107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adult-to-adult living donor liver transplantation is an increasingly important option for 17000 patients awaiting liver transplantation in the United States. However, adult-to-adult living donor liver transplantation volumes peaked in 2001 (N=518), and have gradually fallen in 2002 (N=362), 2003 (N=321), and 2004 (N=323). Recent concerns about donor safety and ethical considerations have made careful analysis of donor availability and selection criteria critically important. We conducted a retrospective review of our active liver transplant recipient registry (N=251) and compared it to our living donor registry (N=231), which included all potential living donors before the selection process. Fifteen percent of recipients accounted for the majority (53%) of donor evaluations, whereas 42% of recipients did not have even a single donor evaluation. Recipient diagnosis appears to have a significant impact on donor availability, with donors rarely evaluated for patients with alcoholic cirrhosis. Careful and stringent selection criteria rule out 67% of potential donors.
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27
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Segedi M, Dhani G, Ng VL, Grant D. Living Donors for Fulminant Hepatic Failure in Children. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-29185-7_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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28
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Nadalin S, Capobianco I, Panaro F, Di Francesco F, Troisi R, Sainz-Barriga M, Muiesan P, Königsrainer A, Testa G. Living donor liver transplantation in Europe. Hepatobiliary Surg Nutr 2016; 5:159-75. [PMID: 27115011 DOI: 10.3978/j.issn.2304-3881.2015.10.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Living donor liver transplantation (LDLT) sparked significant interest in Europe when the first reports of its success from USA and Asia were made public. Many transplant programs initiated LDLT and some of them especially in Germany and Belgium became a point of reference for many patients and important contributors to the advancement of the field. After the initial enthusiasm, most of the European programs stopped performing LDLT and today the overall European activity is concentrated in a few centers and the number of living donor liver transplants is only a single digit fraction of the overall number of liver transplants performed. In this paper we analyse the present European activities and highlight the European contribution to the advancement of the field of LDLT.
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Affiliation(s)
- Silvio Nadalin
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Ivan Capobianco
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Fabrizio Panaro
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Fabrizio Di Francesco
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Roberto Troisi
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Mauricio Sainz-Barriga
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Paolo Muiesan
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Alfred Königsrainer
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Giuliano Testa
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
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Pamecha V, Mahansaria SS, Bharathy KGS, Kumar S, Sasturkar SV, Sinha PK, Sarin SK. Selection and outcome of the potential live liver donor. Hepatol Int 2016; 10:657-64. [DOI: 10.1007/s12072-016-9715-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/11/2016] [Indexed: 01/21/2023]
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The impact of metabolic syndrome and prevalent liver disease on living donor liver transplantation: a pressing need to expand the pool. Hepatol Int 2015; 10:347-54. [PMID: 26341515 DOI: 10.1007/s12072-015-9664-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Organ shortage has been the ongoing obstacle to expanding liver transplantation worldwide. Living donor liver transplantation (LDLT) is hoped to improve this shortage. The aim of the present study is to analyze the impact of metabolic syndrome and prevalent liver disease on living donations. METHODS From July 2007 to May 2012, 1065 potential living donors were evaluated according to a stepwise evaluation protocol. The age of the worked-up donors ranged from 18 to 45 years. RESULTS Only 190 (18%) were accepted for donation, and 875 (82%) were rejected. In total, 265 (24.9%) potential donors were excluded because of either diabetes or a body mass index >28. Some potential donors were excluded at initial screening because of incompatible blood groups (115; 10.8%), social reasons (40; 3.8%), or elevated liver enzymes (9; 1%). Eighty-five (8%) donors were excluded because of positive hepatitis serology. Steatosis resulted in the exclusion of 84 (8%) donors. In addition, 80 (7.5%) potential donors were rejected because of variations in biliary anatomy, and 20 (2%) were rejected because of aberrant vascular anatomy. Rejection due to biliary-related aberrancy decreased significantly in the second half of our program (11 vs. 4%, p = 0.001). In total, 110 (10.3%) potential donors were rejected because of insufficient remnant volume (<30%) as determined by CT volumetry, whereas 24 (2.2%) were rejected because of a graft-to-recipient body weight ratio less than 0.8%. CONCLUSION Metabolic syndrome and viral hepatitis negatively impacted our living donor pool. Expanding the donor pool requires the implementation of new strategies.
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Akbulut S, Karagul S, Ertugrul I, Aydin C, Yilmaz M, Yilmaz S. Histopathologic Findings of Cholecystectomy Specimens in Patients Who Underwent Donor Hepatectomy for Living Donor Liver Transplantation. Transplant Proc 2015; 47:1466-8. [PMID: 26093744 DOI: 10.1016/j.transproceed.2015.04.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors. METHODS The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers. RESULTS A total of 1009 donors aged 17 to 66 years (31.1 ± 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 ± 9.1 years [16-63 years]) and 422 were female (31.8 ± 9.8 years [18-66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other donors' biochemical tests were within normal ranges. The macroscopic examination of gallbladders revealed mean gallbladder wall thickness, length, and width of 1.82 ± 0.8 mm (1-10 mm), 72 ± 11.4 mm (40-120 mm), and 52.5 ± 14 mm (15-90 mm), respectively. The microscopic gallbladder examination showed that 740 donors had a normal gallbladder, 193 had chronic cholecystitis (1 donor had antral metaplasia and 1 had intestinal metaplasia), 40 had cholesterolosis (1 donor had both tubular adenoma and intestinal metaplasia), 15 had minimal chronic cholecystitis (1 donor had pyloric metaplasia), 14 had cholelithiasis, 2 had adenomyosis, 2 had muscular hypertrophy, 1 had papillary hyperplasia, 1 had microdiverticulitis, and 1 had mucosal lymphatic ectasia. CONCLUSION The results of this study reflect the actual gallbladder pathologies that can be detected in healthy people. Clearer conclusions can be reached about the epidemiological data on gallbladder as the number of living liver donors increases in the future.
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Affiliation(s)
- S Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
| | - S Karagul
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - I Ertugrul
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - C Aydin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - M Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - S Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
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Radtke A, Sgourakis G, Molmenti EP, Beckebaum S, Cicinnati VR, Schmidt H, Peitgen HO, Broelsch CE, Malagó M, Schroeder T. Risk of venous congestion in live donors of extended right liver graft. World J Gastroenterol 2015; 21:6008-6017. [PMID: 26019467 PMCID: PMC4438037 DOI: 10.3748/wjg.v21.i19.6008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 02/01/2015] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV).
METHODS: There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnant-volume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CV-index). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off- RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV.
RESULTS: MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%. Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFS-remnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4% (range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations.
CONCLUSION: MHV procurement should consider individual remnant congestive- and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.
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Yoon JH, Lee JM, Suh KS, Lee KW, Yi NJ, Lee KB, Han JK, Choi BI. Combined Use of MR Fat Quantification and MR Elastography in Living Liver Donors: Can It Reduce the Need for Preoperative Liver Biopsy? Radiology 2015; 276:453-64. [PMID: 25763828 DOI: 10.1148/radiol.15140908] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of magnetic resonance (MR) fat quantification and MR elastography for the assessment of hepatic steatosis and fibrosis in living liver donor candidates. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and the requirement of informed consent was waived. Donors who underwent MR fat quantification and MR elastography at 1.5 T, followed by liver biopsy, were chronologically grouped into test and validation groups. In the test group (n = 362), MR fat fraction and liver stiffness were compared among donors with normal parenchyma (n = 244), simple steatosis (n = 71), steatosis with inflammatory activity (n = 21), nonalcoholic steatohepatitis (n = 17), and fibrosis (n = 9). Diagnostic performance of the two techniques was assessed by using receiver operating characteristic curve analysis for the detection of substantial steatosis (macrovesicular fat ≥ 10%) or fibrosis (≥F1) and was tested in a validation group (n = 34). RESULTS In the test group, donors with steatosis showed significantly higher fat fraction than donors without steatosis (P < .0001), and donors with fibrosis and nonalcoholic steatohepatitis showed significantly higher liver stiffness values than donors without fibrosis (P < .0001). Areas under the curve were 0.93 (cutoff value > 5.8%) for MR fat quantification and 0.85 (cutoff value > 1.94 kPa) for MR elastography. By using those values, the combination of the two techniques could be used to detect substantial steatosis or fibrosis with 100% sensitivity (12 of 12 patients, 95% confidence interval: 73.4%, 100%) and 100% negative predictive value (15 of 15 patients, 95% confidence interval: 78.0%, 100%) in the validation group. CONCLUSION A combination of MR fat quantification and MR elastography can provide sufficient sensitivity to detect substantial steatosis or fibrosis (≥F1) in liver donor candidates.
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Affiliation(s)
- Jeong Hee Yoon
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.)
| | - Jeong Min Lee
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.)
| | - Kyung-Suk Suh
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.)
| | - Kwan-Woong Lee
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.)
| | - Nam-Joon Yi
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.)
| | - Kyung Bun Lee
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.)
| | - Joon Koo Han
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.)
| | - Byung Ihn Choi
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.)
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Ríos A, López-Navas AI, Ayala-García MA, Sebastián MJ, Abdo-Cuza A, Martínez-Alarcón L, Ramírez EJ, Muñoz G, Palacios G, Suárez-López J, Castellanos R, González B, Martínez MA, Díaz E, Ramírez P, Parrilla P. [Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:364-72. [PMID: 25623418 DOI: 10.1016/j.gastrohep.2014.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/29/2014] [Accepted: 12/11/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion. OBJECTIVE To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America. MATERIAL AND METHOD Ten hospitals were selected from the «International Donor Collaborative Project»: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis. RESULTS Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001). CONCLUSIONS Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body.
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Affiliation(s)
- Antonio Ríos
- Proyecto Colaborativo Internacional Donante, Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia. España.
| | - Ana Isabel López-Navas
- Proyecto Colaborativo Internacional Donante, Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, España; Departamento de Psicología, Universidad Católica de San Antonio, Universidad Católica de San Antonio de Murcia, Murcia, España
| | - Marco Antonio Ayala-García
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Hospital General de SubZona n.(o) 10 del Instituto Mexicano del Seguro Social, Delegación Guanajuato, México
| | - María José Sebastián
- Centro de Coordinación de Trasplantes, Unidad Médica de Alta Especialidad, Hospital de Especialidades n.(o) 25 Instituto Mexicano del Seguro Social (IMSS), Monterrey, México
| | | | - Laura Martínez-Alarcón
- Proyecto Colaborativo Internacional Donante, Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - Gerardo Muñoz
- Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, México
| | - Gerardo Palacios
- Centro de Coordinación de Trasplantes, Unidad Médica de Alta Especialidad, Hospital de Especialidades n.(o) 25 Instituto Mexicano del Seguro Social (IMSS), Monterrey, México
| | | | | | - Beatríz González
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Universidad de Guanajuato, Guanajuato, México
| | | | - Ernesto Díaz
- Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Hospital General de SubZona n.(o) 10 del Instituto Mexicano del Seguro Social, Delegación Guanajuato, México
| | - Pablo Ramírez
- Proyecto Colaborativo Internacional Donante, Murcia, España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia. España
| | - Pascual Parrilla
- Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia. España
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Wahab MA, Hamed H, Salah T, Elsarraf W, Elshobary M, Sultan AM, Shehta A, Fathy O, Ezzat H, Yassen A, Elmorshedi M, Elsaadany M, Shiha U. Problem of living liver donation in the absence of deceased liver transplantation program: Mansoura experience. World J Gastroenterol 2014; 20:13607-13614. [PMID: 25309092 PMCID: PMC4188913 DOI: 10.3748/wjg.v20.i37.13607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 04/03/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
We report our experience with potential donors for living donor liver transplantation (LDLT), which is the first report from an area where there is no legalized deceased donation program. This is a single center retrospective analysis of potential living donors (n = 1004) between May 2004 and December 2012. This report focuses on the analysis of causes, duration, cost, and various implications of donor exclusion (n = 792). Most of the transplant candidates (82.3%) had an experience with more than one excluded donor (median = 3). Some recipients travelled abroad for a deceased donor transplant (n = 12) and some died before finding a suitable donor (n = 14). The evaluation of an excluded donor is a time-consuming process (median = 3 d, range 1 d to 47 d). It is also a costly process with a median cost of approximately 70 USD (range 35 USD to 885 USD). From these results, living donor exclusion has negative implications on the patients and transplant program with ethical dilemmas and an economic impact. Many strategies are adopted by other centers to expand the donor pool; however, they are not all applicable in our locality. We conclude that an active legalized deceased donor transplantation program is necessary to overcome the shortage of available liver grafts in Egypt.
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Hennedige T, Anil G, Madhavan K. Expectations from imaging for pre-transplant evaluation of living donor liver transplantation. World J Radiol 2014; 6:693-707. [PMID: 25276312 PMCID: PMC4176786 DOI: 10.4329/wjr.v6.i9.693] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/25/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
Living donor liver transplant (LDLT) is a major surgical undertaking. Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation. Computed tomography (CT) and magnetic resonance imaging (MRI) are currently the imaging modalities of choice in pre-operative evaluation. These cross-sectional imaging techniques can reveal the vascular and biliary anatomy, assess the hepatic parenchyma and perform volumetric analysis. Knowledge of the broad indications and contraindications to qualify as a recipient for LDLT is essential for the radiologist reporting scans in a pre-transplant patient. Similarly, awareness of the various anatomical variations and pathological states in the donor is essential for the radiologist to generate a meaningful report of his/her observations. CT and MRI have largely replaced invasive techniques such as catheter angiography, percutaneous cholangiography and endoscopic retrograde cholangiopancreatography. In order to generate a meaningful report based on these pre-operative imaging scans, it is also mandatory for the radiologist to be aware of the surgeon’s perspective. We intend to provide a brief overview of the common surgical concepts of LDLT and give a detailed description of the minimum that a radiologist is expected to seek and report in CT and MR scans performed for LDLT related evaluation.
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Radiographic Features of Potential Donor Livers That Precluded Donation. AJR Am J Roentgenol 2014; 202:W343-8. [DOI: 10.2214/ajr.13.10677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hwang I, Lee JM, Lee KB, Yoon JH, Kiefer B, Han JK, Choi BI. Hepatic steatosis in living liver donor candidates: preoperative assessment by using breath-hold triple-echo MR imaging and 1H MR spectroscopy. Radiology 2014; 271:730-8. [PMID: 24533869 DOI: 10.1148/radiol.14130863] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of both breath-hold T2*-corrected triple-echo spoiled gradient-echo water-fat separation magnetic resonance (MR) imaging (triple-echo imaging) and high-speed T2-corrected multiecho hydrogen 1 ((1)H) MR spectroscopy in the assessment of macrovesicular hepatic steatosis in living liver donor candidates by using histologic assessment as a reference standard. MATERIALS AND METHODS The institutional review board approved this retrospective study with waiver of the need to obtain informed consent. One hundred eighty-two liver donor candidates who had undergone preoperative triple-echo imaging and single-voxel (3 × 3 × 3 cm) MR spectroscopy performed with a 3.0-T imaging unit and who had also undergone histologic evaluation of macrovesicular steatosis were included in this study. In part 1 of the study (n = 84), the Pearson correlation coefficient was calculated. Receiver operating characteristic (ROC) curve analysis was performed to detect substantial (≥10%) macrovesicular steatosis. In part 2 of the study, with a different patient group (n = 98), diagnostic performance was evaluated by using the diagnostic cutoff values determined in part 1 of the study. RESULTS The correlation coefficients of triple-echo MR imaging and MR spectroscopy with macrovesicular steatosis were 0.886 and 0.887, respectively. The areas under the ROC curve for detection of substantial macrovesicular steatosis were 0.959 and 0.988, with cutoff values of 4.93% and 5.79%, respectively, and without a significant difference (P = .328). In the part 2 study group, sensitivity and specificity were 90.9% (10 of 11) and 86.2% (75 of 87) for triple-echo MR imaging and 90.9% (10 of 11) and 86.2% (75 of 87) for MR spectroscopy, respectively. CONCLUSION Either breath-hold triple-echo MR imaging or MR spectroscopy can be used to detect substantial macrovesicular steatosis in living liver donor candidates. In the future, this may allow selective biopsy in candidates who are expected to have substantial macrovesicular steatosis on the basis of MR-based hepatic fat fraction.
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Affiliation(s)
- Inpyeong Hwang
- From the Department of Radiology (I.H., J.M.L., J.H.Y., J.K.H., B.I.C.), Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), and Department of Pathology (K.B.L.), Seoul National University Hospital, 28 Yeongon-dong, Jongno-gu, Seoul 110-744, Korea; and Siemens Healthcare, Erlangen, Germany (B.K.)
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Oliver JB, Peters S, Bongu A, Beidas AK, Dikdan G, Brown L, Koneru B. Prerecovery liver biopsy in the brain-dead donor: a case-control study of logistics, safety, precision, and utility. Liver Transpl 2014; 20:237-44. [PMID: 24382833 DOI: 10.1002/lt.23786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/27/2013] [Indexed: 02/07/2023]
Abstract
Prerecovery liver biopsy (PLB) can potentially to decrease futile recovery and increase utilization of marginal brain-dead donor (BDD) livers. A case-control study was conducted to examine the logistics, safety, histological precision, and liver utilization associated with PLB in BDDs. Twenty-three cases between January 2008 and January 2013 were compared to 2 groups: 48 sequential and 69 clinically matched controls. Compared to the sequential controls, the cases were older (53 versus 46 years), heavier (30.2 versus 25.8 kg/m2), had higher prevalences of hypertension (78.3% versus 44.7%) and alcohol use (56.5% versus 23.4%), and a lower United Network for Organ Sharing expected organ yield (0.73 versus 0.81 livers/donor; P < 0.05 for all). Baseline characteristics were similar between cases and clinical controls. Donor management time was longer for the cases (22.4 hours) versus sequential controls (16.5 hours, P = 0.01) and clinical controls (15.9 hours, P = 0.01). Complications for cases (8.7%) were not different from either group of controls (18.8% for sequential controls, P = 0.46; 17.4% for clinical controls, P = 0.50). The agreement between the donor hospital and study pathologists was substantial regarding evaluation of steatosis (κ = 0.623) and fibrosis (κ = 0.627) and moderate regarding inflammation (κ = 0.495). The proportions of livers that were transplanted were similar for the cases and the clinical controls (60.9% versus 59.4%). In contrast, the proportion of donors for whom liver recovery was not attempted was higher (30.4% versus 8.7%), and the proportion of attempted liver recoveries that did not result in transplantation was lower (8.7% versus 31.9%). These differences were significant at P = 0.009. Overall, PLB is logistically feasible with only a minimal delay and is safe, its interpretation at donor hospitals is reproducible, and it appears to decrease futile liver recovery.
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El-Meteini M, Dabbous H, Sakr M, Ibrahim A, Fawzy I, Bahaa M, Abdelaal A, Fathy M, Said H, Rady M, El-Dorry A. Donor rejection before living donor liver transplantation: causes and cost effective analysis in an egyptian transplant center. HEPATITIS MONTHLY 2014; 14:e13703. [PMID: 24497879 PMCID: PMC3909637 DOI: 10.5812/hepatmon.13703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/10/2013] [Accepted: 12/08/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the living donor liver transplant setting, the preoperative assessment of potential donors is important to ensure the donor safety. OBJECTIVES The aim of this study was to identify causes and costs of living liver-donors rejection in the donation process. MATERIALS AND METHODS From June 2010 to June 2012, all potential living liver donors for 66 liver transplant candidates were screened at the Ain Shams Center for Organ Transplantation. Potential donors were evaluated in 3 phases, and their data were reviewed to determine the causes and at which phase the donors were rejected. RESULTS One hundred and ninety two potential living liver donors, including 157 (81.7%) males, were screened for 66 potential recipients. Of these, 126 (65.6%) were disqualified for the donation. The causes of rejection were classified as surgical (9.5 %) or medical (90.5 %). Five donors (3.9 %) were rejected due to multiple causes. Factor V Leiden mutation was detected in 29 (23 %) rejected donors (P = 0.001), 25 (19.8 %) donors had positive results for hepatitis serology (P = 0.005), and 16 (12.7 %) tested positive for drug abuse. Portal vein trifurcation (n = 9, 7.1%) and small size liver graft estimated by CT volumetric analysis (n = 6, 4.8 %) were the main surgical causes which precluded the donation. CONCLUSIONS Among potential Egyptian living liver donors, Factor V Leiden mutation was a significant cause for live donor rejection. A stepwise approach to donor assessment was found to be cost-effective.
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Affiliation(s)
| | - Hany Dabbous
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
- Corresponding Author: Hany Dabbous, Ain Shams Center for Organ Transplant (ASCOT), 33 Golf Street, Maadi, Cairo, Egypt. Tel: +2-23809247, Fax: +2-23809997, E-mail:
| | - Mohammad Sakr
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
| | - Amany Ibrahim
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
| | - Iman Fawzy
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
| | - Mohamed Bahaa
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
| | - Amr Abdelaal
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
| | - Mohamed Fathy
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
| | - Hany Said
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
| | - Mohamed Rady
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
| | - Ahmed El-Dorry
- Ain Shams Center for Organ Transplant (ASCOT), Cairo, Egypt
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Jennings T, Grauer D, Rudow DL. The role of the independent donor advocacy team in the case of a declined living donor candidate. Prog Transplant 2013; 23:132-6. [PMID: 23782660 DOI: 10.7182/pit2013299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many controversies arise when living donor candidates present themselves for consideration as donors for urgent liver transplants. Nonparent living donors for urgent pediatric transplant recipients are a unique donor candidate population with specific considerations that need to be acknowledged and addressed by the independent donor advocacy team. Such a team educates about donation, identifies potential contraindications, examines the distant relationships between donor and recipient, and considers ethical issues about the ability to make an informed decision in an urgent situation. A center for living donation dealt with such ethical issues when a donor candidate with a distant relationship was evaluated for living donation. Multiple relative contraindications were identified, and the donor candidate was declined. Careful management by the independent donor advocacy team is necessary to ensure the psychosocial safety and to provide needed psychosocial support and intervention for donor candidates with psychological contraindications to donation. Standard follow-up protocols need to be developed for declined donor candidates.
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Affiliation(s)
- Tiane Jennings
- UCSF Medical Center, San Francisco, California 94143, USA.
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Donor selection for adult-to-adult living donor liver transplantation: well begun is half done. Transplantation 2013; 95:501-6. [PMID: 23128999 DOI: 10.1097/tp.0b013e318274aba1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Donor selection criteria for adult-to-adult living donor liver transplantation vary with the medical center of evaluation. Living donor evaluation uses considerable resources, and the nonmaturation of potential into actual donors may sometimes prove fatal for patients with end-stage liver disease. On the contrary, a thorough donor evaluation process is mandatory to ensure safe outcomes in otherwise healthy donors. We aimed to study the reasons for nonmaturation of potential right lobe liver donors at our transplant center. METHODS A retrospective data analysis of all potential living liver donors evaluated at our center from 1998 to 2010 was done. RESULTS Overall, 324 donors were evaluated for 219 potential recipients, and 171 (52.7%) donors were disqualified. Common reasons for donor nonmaturation included the following: (1) donor reluctance, 21%; (2) greater than 10% macro-vesicular steatosis, 16%; (3) assisted donor withdrawal, 14%; (4) inadequate remnant liver volume, 13%; and (5) psychosocial issues, 7%, and thrombophilia, 7%. Ten donors (6%) were turned down because of anatomic variations (8 biliary and 2 arterial anomalies). Donors older than 50 years and those with body mass index of more than 25 were less likely to be accepted for donation. CONCLUSIONS We conclude that donor reluctance, hepatic steatosis, and assisted donor withdrawal are major reasons for nonmaturation of potential into actual donors. Anatomic variations and underlying medical conditions were not a major cause of donor rejection. A system in practice to recognize these factors early in the course of donor evaluation to improve the efficiency of the selection process and ensure donor safety is proposed.
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Akbulut S, Yilmaz M, Eris C, Kutlu R, Yilmaz S. Living-donor liver transplant using the right hepatic lobe without the right hepatic vein: solving the drainage problem. EXP CLIN TRANSPLANT 2013; 11:278-82. [PMID: 23767945 DOI: 10.6002/ect.2012.0060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although rare, major congenital defects of the hepatic veins are detectable at autopsy, advanced, noninvasive imaging techniques such as Doppler ultrasonography and multislice computed tomography can accurately define these anomalies. One of these anomalies is congenital absence of the main right hepatic vein. We present a 21-year-old woman living-liver donor candidate with congenital absence of the right hepatic vein who underwent an extended right donor hepatectomy. She was tested for transplant compatibility with her 45-year-old brother, who had chronic liver failure secondary to hepatitis B. Multislice computed tomography revealed an absence of the right hepatic vein, and the right hepatic lobe was drained by 4 inferior hepatic veins with diameters ranging from 4 to 8.4 mm. An extended right-donor hepatectomy was performed. A common-large opening drainage reconstruction model that included all of the inferior hepatic veins and middle hepatic vein was created using the saphenous vein and an aortic homograft. There were no postoperative complications related to hepatic venous drainage thanks to the common-large opening model. We demonstrate that a right donor hepatectomy is feasible in congenital absence of the right hepatic vein solving the drainage problem using common-large opening reconstruction technique.
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Affiliation(s)
- Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
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A retrospective evaluation of causes of exempting living liver donors in an Egyptian centre. Arab J Gastroenterol 2013; 14:10-3. [DOI: 10.1016/j.ajg.2013.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 11/23/2012] [Accepted: 01/30/2013] [Indexed: 01/21/2023]
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Computer-assisted surgical planning in adult-to-adult live donor liver transplantation: how much does it help? A single center experience. Transplantation 2013; 94:1138-44. [PMID: 23222737 DOI: 10.1097/tp.0b013e31826e5970] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative imaging and donor selection are cardinal components of adult-to-adult live donor liver transplantation (ALDLT). The purpose of this study was to evaluate our three-dimensional (3D) computed tomography image-derived computer-assisted surgical planning (3D CASP) in ALDLT. METHODS Eighty-three consecutive ALDLTs (71 right and 12 left) were planned with 3D CASP. Graft, remnant, and total liver volume compliance were calculated and compared with actual intraoperative values. Computed risk analysis encompassing territorial liver mapping, functional (safely drained) volumes, and outflow congestion volumes in grafts and remnants allowed for the individualized management of the middle hepatic vein (MHV). RESULTS Graft volume compliance was 13.5%±4.4%. Three small-for-size (SFS) grafts with lethal SFS syndrome (SFSS) had nonsignificant volume compliance with maximal graft volume-body weight ratios of less than 0.83. Seven SFS grafts with reversible or absent SFSS showed maximal graft volume-body weight ratios of 0.9 to 1.16. Significant differences were identified for (a) virtual graft and remnant congestion volumes of risky versus nonrisky MHV types (49%±6% and 34%±7% vs. 29%±8% and 33%±12%, P<0.001 and P<0.02, respectively) and (b) virtual mean functional versus surgical volumes of grafts (527±119 vs. 963±176 mL, P<0.0001) and remnants (419±182 vs. 640±213 mL, P<0.001). CONCLUSIONS CASP allowed for (a) prevention of SFSS in extremely small grafts by predicting donor liver plasticity and (b) individualized MHV management for both donors and recipients based on functional graft/remnant volume analysis.
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Hegab B, Abdelfattah MR, Azzam A, Mohamed H, Al Hamoudi W, Alkhail FA, Bahili HA, Khalaf H, Sofayan MA, Sebayel MA. Day-of-surgery rejection of donors in living donor liver transplantation. World J Hepatol 2012; 4:299-304. [PMID: 23293715 PMCID: PMC3536836 DOI: 10.4254/wjh.v4.i11.299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 10/31/2012] [Accepted: 11/07/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To study diagnostic laparoscopy as a tool for excluding donors on the day of surgery in living donor liver transplantation (LDLT). METHODS This study analyzed prospectively collected data from all potential donors for LDLT. All of the donors were subjected to a three-step donor evaluation protocol at our institution. Step one consisted of a clinical and social evaluation, including a liver profile, hepatitis markers, a renal profile, a complete blood count, and an abdominal ultrasound with Doppler. Step two involved tests to exclude liver diseases and to evaluate the donor's serological status. This step also included a radiological evaluation of the biliary anatomy and liver vascular anatomy using magnetic resonance cholangiopancreatography and a computed tomography (CT) angiogram, respectively. A CT volumetric study was used to calculate the volume of the liver parenchyma. Step three included an ultrasound-guided liver biopsy. Between November 2002 and May 2009, sixty-nine potential living donors were assessed by open exploration prior to harvesting the planned part of the liver. Between the end of May 2009 and October 2010, 30 potential living donors were assessed laparoscopically to determine whether to proceed with the abdominal incision to harvest part of the liver for donation. RESULTS Ninety-nine living donor liver transplants were attempted at our center between November 2002 and October 2010. Twelve of these procedures were aborted on the day of surgery (12.1%) due to donor findings, and eighty-seven were completed (87.9%). These 87 liver transplants were divided into the following groups: Group A, which included 65 transplants that were performed between November 2002 and May 2009, and Group B, which included 22 transplants that were performed between the end of May 2009 and October 2010. The demographic data for the two groups of donors were found to match; moreover, no significant difference was observed between the two groups of donors with respect to hospital stay, narcotic and non-narcotic analgesia requirements or the incidence of complications. Regarding the recipients, our study clearly revealed that there was no significant difference in either the incidence of different complications or the incidence of retransplantation between the two groups. Day-of-surgery donor assessment for LDLT procedures at our center has passed through two eras, open and laparoscopic. In the first era, sixty-nine LDLT procedures were attempted between November 2002 and May 2009. Upon open exploration of the donors on the day of surgery, sixty-five donors were found to have livers with a grossly normal appearance. Four donors out of 69 (5.7%) were rejected on the day of surgery because their livers were grossly fatty and pale. In the laparoscopic era, thirty LDLT procedures were attempted between the end of May 2009 and October 2010. After the laparoscopic assessment on the day of surgery, twenty-two transplantation procedures were completed (73.4%), and eight were aborted (26.6%). Our data showed that the levels of steatosis in the rejected donors were in the acceptable range. Moreover, the results of the liver biopsies of rejected donors were comparable between the group A and group B donors. The laparoscopic assessment of donors presents many advantages relative to the assessment of donors through open exploration; in particular, the laparoscopic assessment causes less pain, requires a shorter hospital stay and leads to far superior cosmetic results. CONCLUSION The laparoscopic assessment of donors in LDLT is a safe and acceptable procedure that avoids unnecessary large abdominal incisions and increases the chance of achieving donor safety.
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Affiliation(s)
- Bassem Hegab
- Bassem Hegab, Mohamed Rabei Abdelfattah, Ayman Azzam, Hazem Mohamed, Waleed Al Hamoudi, Faisal Aba Alkhail, Hamad Al Bahili, Hatem Khalaf, Mohammed Al Sofayan, Mohammed Al Sebayel, Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
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Abstract
1. Expertise in hepatobiliary surgery. 2. Donor selection criteria. 3. Selective liver biopsy in donors. 4. Accurate determination of hepatic volumes and anatomy. 5. Extent of donor hepatectomy. 6. Donor psychosocial evaluation. 7. Catastrophic events. 8. Long-term follow up.
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Affiliation(s)
- Mary Ann Simpson
- Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA
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Garcia-Valdecasas JC. European approach to increasing organ donation: European Union donor card, presumed consent, and other innovations. Liver Transpl 2012; 18 Suppl 2:S8-9. [PMID: 22899323 DOI: 10.1002/lt.23538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
1. Liver transplantation has become the standard of care for terminal liver disease. 2. Unfortunately, liver transplantation has become the victim of its own success because the number of available donors is not meeting the growing demand for organs.
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Affiliation(s)
- Juan C Garcia-Valdecasas
- Department of Surgery, Hospital Clinic of Barcelona, University of Barcelona, Villaroel 170, Barcelona, Spain.
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Dew MA, Zuckoff A, DiMartini AF, DeVito Dabbs AJ, McNulty ML, Fox KR, Switzer GE, Humar A, Tan HP. Prevention of poor psychosocial outcomes in living organ donors: from description to theory-driven intervention development and initial feasibility testing. Prog Transplant 2012; 22:280-92; quiz 293. [PMID: 22951506 DOI: 10.7182/pit2012890] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Although some living donors experience psychological, somatic, and interpersonal difficulties after donation, interventions to prevent such outcomes have not been developed or evaluated. OBJECTIVE To (1) summarize empirical evidence on psychosocial outcomes after donation, (2) describe a theoretical framework to guide development of an intervention to prevent poor outcomes, and (3) describe development and initial evaluation of feasibility and acceptability of the intervention. METHODS Based on a narrative literature review suggesting that individuals ambivalent about donation are at risk for poor psychosocial outcomes after donation, the intervention targeted this risk factor. Intervention structure and content drew on motivational interviewing principles in order to assist prospective donors to resolve ambivalence. Data were collected on donors' characteristics at our institution to determine whether they constituted a representative population in which to evaluate the intervention. Study participants were then recruited to assess the feasibility and acceptability of the intervention. They were required to have scores greater than 0 on the Simmons Ambivalence Scale (indicating at least some ambivalence about donation). RESULTS Our population was similar to the national living donor population on most demographic and donation-related characteristics. Eight individuals who had been approved to donate either a kidney or liver segment were enrolled for pilot testing of the intervention. All successfully completed the 2-session telephone-based intervention before scheduled donation surgery. Participants' ratings of acceptability and satisfaction were high. Open-ended comments indicated that the intervention addressed participants' thoughts and concerns about the decision to donate. CONCLUSIONS The intervention is feasible, acceptable, and appears relevant to donor concerns. A clinical trial to evaluate the efficacy of the intervention is warranted.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Radtke A, Sgourakis G, Molmenti EP, Schroeder T, Cicinnati VR, Beckebaum S, Peitgen HO, Broelsch CE, Malagó M. The "carving" liver partitioning technique for graft hepatectomy in live donor liver transplantation: a single-center experience. Surgery 2012; 153:189-99. [PMID: 22884089 DOI: 10.1016/j.surg.2012.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 06/14/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND In adult live donor liver transplantation, postoperative venous congestion of graft and remnant livers can lead to life-threatening complications. The purpose of this study was to evaluate the safety and benefits of our 3-dimensional, computed tomographic, computer-assisted donor hepatectomy using the "carving" partitioning technique. METHODS Eighty-three consecutive adult live donor liver transplantations were performed based on data obtained from individualized preoperative 3-dimensional, computed tomographic reconstructions and virtual graft hepatectomies. RESULTS There were 71 right and 12 left grafts. Small grafts (graft volume body weight ratio, <1.0) were used in 20 cases. We observed no clinically important differences in postoperative function between right and left grafts. Four recipients developed lethal small-for-size syndrome. Reversible small-for-size syndrome was observed in a right graft recipient and in 2 right graft donors. CONCLUSION Preoperative 3-dimensional, computed tomographic, computer-assisted planning using virtual liver partitioning allowed for: (1) an individualized carving technique based on specific donor anatomic characteristics, (2) donor safety based on individualized patterns of venous outflow, and (3) optimized drainage of the medial area of the graft based on the preferential inclusion of the middle hepatic vein.
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Affiliation(s)
- Arnold Radtke
- Department of General, Thoracic, and Transplant Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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