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Kaldas FM, Horwitz JK, Noguchi D, Korayem IM, Markovic D, Ebaid S, Agopian VG, Yersiz H, Saab S, Han SB, El Kabany MM, Choi G, Shetty A, Singh J, Wray C, Barjaktarvic I, Farmer DG, Busuttil RW. The Evolution of Redo Liver Transplantation Over 35 Years: Analysis of 654 Consecutive Adult Liver Retransplants at a Single Center. Ann Surg 2023; 278:441-451. [PMID: 37389564 DOI: 10.1097/sla.0000000000005962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To examine liver retransplantation (ReLT) over 35 years at a single center. BACKGROUND Despite the durability of liver transplantation (LT), graft failure affects up to 40% of LT recipients. METHODS All adult ReLTs from 1984 to 2021 were analyzed. Comparisons were made between ReLTs in the pre versus post-model for end-stage liver disease (MELD) eras and between ReLTs and primary-LTs in the modern era. Multivariate analysis was used for prognostic modeling. RESULTS Six hundred fifty-four ReLTs were performed in 590 recipients. There were 372 pre-MELD ReLTs and 282 post-MELD ReLTs. Of the ReLT recipients, 89% had one previous LT, whereas 11% had ≥2. Primary nonfunction was the most common indication in the pre-MELD era (33%) versus recurrent disease (24%) in the post-MELD era. Post-MELD ReLT recipients were older (53 vs 48, P = 0.001), had higher MELD scores (35 vs 31, P = 0.01), and had more comorbidities. However, post-MELD ReLT patients had superior 1, 5, and 10-year survival compared with pre-MELD ReLT (75%, 60%, and 43% vs 53%, 43%, and 35%, respectively, P < 0.001) and lower in-hospital mortality and rejection rates. Notably, in the post-MELD era, the MELD score did not affect survival. We identified the following risk factors for early mortality (≤12 months after ReLT): coronary artery disease, obesity, ventilatory support, older recipient age, and longer pre-ReLT hospital stay. CONCLUSIONS This represents the largest single-center ReLT report to date. Despite the increased acuity and complexity of ReLT patients, post-MELD era outcomes have improved. With careful patient selection, these results support the efficacy and survival benefit of ReLT in an acuity-based allocation environment.
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Affiliation(s)
- Fady M Kaldas
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Julian K Horwitz
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Daisuke Noguchi
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Islam M Korayem
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Daniela Markovic
- Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Samer Ebaid
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vatche G Agopian
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Hasan Yersiz
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sammy Saab
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven B Han
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Mohamad M El Kabany
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Gina Choi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Akshay Shetty
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jasleen Singh
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Christopher Wray
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Igor Barjaktarvic
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Douglas G Farmer
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ronald W Busuttil
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Horwitz JK, Kaldas FM. CAQ Corner: Technical considerations in liver transplantation (101 for hepatologists). Liver Transpl 2023; 29:217-225. [PMID: 36055761 DOI: 10.1002/lt.26556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/30/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Julian K Horwitz
- Division of Liver and Pancreas Transplantation, Department of Surgery , David Geffen School of Medicine at the University of California Los Angeles , Los Angeles , California , USA
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Intensive care management of liver transplant recipients. Curr Opin Crit Care 2022; 28:709-714. [PMID: 36226713 DOI: 10.1097/mcc.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Liver transplantation remains the only definitive treatment for advanced liver disease and liver failure. Current allocation schemes utilized for liver transplantation mandate a 'sickest first' approach, thus most liver transplants occur in patients with severe systemic illness. For intensive care providers who care for liver transplant recipients, a foundation of knowledge of technical considerations of orthotopic liver transplantation, basic management considerations, and common complications is essential. This review highlights the authors' approach to intensive care management of the postoperative liver transplant recipient with a review of common issues, which arise in this patient population. RECENT FINDINGS The number of centers offering liver transplantation continues to increase globally and the number of patients receiving liver transplantation also continues to increase. The number of patients with advanced liver disease far outpaces organ availability and, therefore, patients undergoing liver transplant are sicker at the time of transplant. Outcomes for liver transplant patients continue to improve owing to advancements in surgical technique, immunosuppression management, and intensive care management of liver disease both pretransplant and posttransplant. SUMMARY Given a global increase in liver transplantation, an increasing number of intensive care professionals are likely to care for this patient population. For these providers, a foundational knowledge of the common complications and key management considerations is essential.
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Bağci N, Doğan R. The relationship between pain beliefs and pain severity in liver transplant patients. Transpl Immunol 2022; 72:101564. [DOI: 10.1016/j.trim.2022.101564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/26/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022]
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Laique SN, Eghtesad B, Lindenmeyer CC. Surgical Considerations Regarding Transplantation for the Patient With Acute-on-Chronic Liver Failure. Clin Liver Dis (Hoboken) 2022; 19:93-96. [PMID: 35355839 PMCID: PMC8958245 DOI: 10.1002/cld.1189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Audio Recording.
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Affiliation(s)
- Sobia Nasir Laique
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH
| | - Bijan Eghtesad
- Department of General Surgery, Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH
| | - Christina C. Lindenmeyer
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery InstituteCleveland ClinicClevelandOH
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Cannella R, Dasyam A, Miller FH, Borhani AA. Magnetic Resonance Imaging of Liver Transplant. Magn Reson Imaging Clin N Am 2021; 29:437-450. [PMID: 34243928 DOI: 10.1016/j.mric.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
MR imaging increasingly has been adopted for follow-up imaging post-liver transplantation and for diagnosis of its complications. These include vascular and biliary complications as well as post-transplant malignancies. Interpretation of postoperative MR imaging should take into account the surgical technique and expected post-transplant changes. Contrast-enhanced MR imaging has high sensitivity for identification of vascular complications. MR cholangiopancreatography on the other hand is the most accurate noninvasive method for evaluation of biliary complications.
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Affiliation(s)
- Roberto Cannella
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital "Paolo Giaccone", Via del Vespro 129, Palermo 90127, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, Palermo 90127, Italy
| | - Anil Dasyam
- Department of Radiology, Abdominal Imaging Division, University of Pittsburgh School of Medicine, 200 Lothrop Street, UPMC Presbyterian Suite 200, Pittsburgh, PA 15213, USA
| | - Frank H Miller
- Department of Radiology, Body Imaging Section, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Chicago, IL 60611, USA
| | - Amir A Borhani
- Department of Radiology, Abdominal Imaging Division, University of Pittsburgh School of Medicine, 200 Lothrop Street, UPMC Presbyterian Suite 200, Pittsburgh, PA 15213, USA; Department of Radiology, Body Imaging Section, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Chicago, IL 60611, USA.
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Morochnik S, Niemeyer MM, Lipnik AJ, Gaba RC. Immediate postoperative inferior vena cava stenting to improve hepatic venous outflow following orthotopic liver transplantation. Radiol Case Rep 2020; 16:224-229. [PMID: 33304431 PMCID: PMC7708766 DOI: 10.1016/j.radcr.2020.11.032] [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: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
Orthotopic liver transplantation can be a surgically complex undertaking, with hepatic venous outflow obstruction occurring at a rate of 1%-6% due to inferior vena cava (IVC) torsion, compression, or anastomotic stenosis. In this report, we present 2 cases of immediate postoperative hepatic venous outflow obstruction in the setting of Budd-Chiari syndrome successfully treated with immediate IVC stenting. Although IVC stenting has been reported for management of long-term IVC anastomotic stenosis after orthotopic liver transplantation, use of stenting to address immediate postoperative caval outflow obstruction is less commonly described. We describe the potential utility of immediate stenting to improve outflow from the transplanted liver and highlight the value of this approach in addressing early postsurgical IVC pathology
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Affiliation(s)
| | - Matthew M Niemeyer
- Department of Radiology, Division of Interventional Radiology, University of Illinois at Chicago, 1740 West Taylor Street MC 931, Chicago, IL 60612, USA
| | - Andrew J Lipnik
- Department of Radiology, Division of Interventional Radiology, University of Illinois at Chicago, 1740 West Taylor Street MC 931, Chicago, IL 60612, USA
| | - Ron C Gaba
- Department of Radiology, Division of Interventional Radiology, University of Illinois at Chicago, 1740 West Taylor Street MC 931, Chicago, IL 60612, USA
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Cahalane AM, Mojtahed A, Sahani DV, Elias N, Kambadakone AR. Pre-hepatic and pre-pancreatic transplant donor evaluation. Cardiovasc Diagn Ther 2019; 9:S97-S115. [PMID: 31559157 DOI: 10.21037/cdt.2018.09.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Innovations in surgical techniques coupled with advances in medical and pharmacological management in the past few decades have enabled organ transplantation to become integral to the management of end stage organ failure. In this review article, we will review the role of the radiologist in the work up of liver and pancreas donors during evaluation of their donor candidacy. The critical role of imaging in assessing the parenchymal, biliary and vascular anatomy in liver donor candidates will be reviewed, as well as highlighting the anatomical findings that may pose a contraindication to transplantation. The limited role of imaging in pancreas donor evaluation is also covered, as well as a brief overview of the surgical techniques available and how the radiologist's findings influence operative technique selection.
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Affiliation(s)
- Alexis M Cahalane
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amirkasra Mojtahed
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dushyant V Sahani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nahel Elias
- Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Avinash R Kambadakone
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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10
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Fakhar N, Nikeghbalian S, Kazemi K, Shamsayeefar AR, Gholami S, Kasraianfard A, Malek-Hosseini SA. Transplantation of Deceased Donor Livers With Elevated Levels of Serum Transaminases at Shiraz Transplant Center. HEPATITIS MONTHLY 2016; 16:e40140. [PMID: 27882068 PMCID: PMC5116126 DOI: 10.5812/hepatmon.40140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/14/2016] [Accepted: 09/27/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The current organ shortage has prompted the use of marginal organs. We conducted this retrospective study to present our experience with transplanting deceased donor livers with elevated levels of serum transaminases and to explain whether elevated levels of serum transaminases in donors affect allograft function and survival of the recipients. METHODS Data of deceased donor livers and patients, who underwent liver transplantation from March 2013 to March 2015 at Shiraz center for organ transplantation, was reviewed. Liver donors with aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) level of more than 500 IU/l and their related recipients were considered as the case group (n = 24) and the others were considered as the control group (n = 834). RESULTS In the case group, the medians of levels of serum AST and ALT of donors were 834 ± 425 IU/L (range: 250 - 2285) and 507 ± 367 IU/L (range: 100 - 1600), respectively. Recipients were followed for a median of 13.6 ± 9 months (range: 7 - 28.4). Post-transplant complications were acute rejection (n = 5), infection (n = 3), portal vein thrombosis (n = 3), bile duct stricture (n = 1), and hepatic artery stenosis (n = 1). The one-year survival rate of the patients was 91.7%. Demographics, post-transplant complications and one-year survival rates were not significantly different between the two study groups. CONCLUSIONS Transplanting deceased donor livers with markedly elevated liver enzymes may be an acceptable choice for expanding the donor pool.
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Affiliation(s)
- Nasir Fakhar
- Department of Surgery, Shiraz Center for Organ Transplantation, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Saman Nikeghbalian
- Department of Surgery, Shiraz Center for Organ Transplantation, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Kourosh Kazemi
- Department of Surgery, Shiraz Center for Organ Transplantation, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Ali Reza Shamsayeefar
- Department of Surgery, Shiraz Center for Organ Transplantation, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Siavash Gholami
- Department of Surgery, Shiraz Center for Organ Transplantation, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Amir Kasraianfard
- Department of Surgery, Hamadan University of Medical Sciences, Hamadan, IR Iran
- Corresponding Author: Amir Kasraianfard, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, IR Iran. Tel: +98-9123175338, E-mail:
| | - Seyed Ali Malek-Hosseini
- Department of Surgery, Shiraz Center for Organ Transplantation, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Abstract
Liver transplantation (LT) is an important component in the therapeutic armamentarium of managing end-stage liver disease. In North American children, biliary atresia remains the most common indication for LT compared to hepatitis C in adults, while hepatoblastoma is the most common liver tumor requiring LT, versus Hepatocellular carcinoma in adults. Rejection, lymphoproliferative disease, renal insufficiency, metabolic syndrome, recurrent disease, 'de novo' autoimmune hepatitis and malignancy require careful surveillance and prompt action in adults and children after LT. In children, specific attention to EBV viremia, growth, development, adherence and transition to the adult services is also required. Antibody mediated rejection and screening for donor specific antibodies is becoming important in managing liver graft dysfunction. Biomarkers to identify and predict tolerance are being developed. Machine perfusion and stem cells (iPS) to synthesize organs are generating interest and are a focus for research.
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Affiliation(s)
- Nanda Kerkar
- a Keck School of Medicine, Medical Director Liver/Intestinal and Hepatology Transplant Program, Children's Hospital of Los Angeles , University of Southern California , Los Angeles , CA , USA
| | - Arathi Lakhole
- b Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Los Angeles , University of Southern California , Los Angeles , CA , USA
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12
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Milan Z. Analgesia after liver transplantation. World J Hepatol 2015; 7:2331-5. [PMID: 26413222 PMCID: PMC4577640 DOI: 10.4254/wjh.v7.i21.2331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/26/2015] [Accepted: 09/02/2015] [Indexed: 02/06/2023] Open
Abstract
This article addresses postoperative analgesia in patients with end-stage liver disease who have undergone liver transplantation (LT). Postoperative analgesia determines how patients perceive LT. Although important, this topic is underrepresented in the current literature. With an increased frequency of fast tracking in LT, efficient intra- and postoperative analgesia are undergoing changes. We herein review the current literature, compare the benefits and disadvantages of the therapeutic options, and make recommendations based on the current literature and clinical experience.
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Affiliation(s)
- Zoka Milan
- Zoka Milan, King's College Hospital, SE5 9RS London, United Kingdom
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Jafarian A, Kasraianfard A, Nassiri-Toosi M. Revision liver transplant for persistent infection and localized aspergillosis after hepatic artery thrombosis. EXP CLIN TRANSPLANT 2014; 12:381-3. [PMID: 24417778 DOI: 10.6002/ect.2013.0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Early hepatic artery thrombosis after liver transplant may be complicated by aggressive aspergillosis and bacterial infections that may cause morbidity and mortality. The definitive treatment of hepatic artery thrombosis is revision transplant. However, sepsis may be a contraindication to revision transplant. A 37-year-old man developed hepatic artery thrombosis at 3 days after liver transplant. During the treatment of hepatic artery thrombosis, he developed multiple biliary, bacterial, and fungal infections. Evaluation showed aspergillosis with multiple intrahepatic abscesses. He was treated with antibiotic and antifungal drugs. Despite active sepsis, revision transplant was performed and the infection resolved. Although sepsis may be a contraindication for transplant surgery, revision transplant was successful, probably because the primary transplanted liver was the source of infection.
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Affiliation(s)
- Ali Jafarian
- Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran
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Miller C, Diago Uso T. The liver transplant operation. Clin Liver Dis (Hoboken) 2013; 2:192-196. [PMID: 30992860 PMCID: PMC6448650 DOI: 10.1002/cld.232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/15/2013] [Indexed: 02/04/2023] Open
Affiliation(s)
- Charles Miller
- Cleveland Clinic, Liver Transplant Program, Department of General Surgery Cleveland, OH
| | - Teresa Diago Uso
- Cleveland Clinic, Liver Transplant Program, Department of General Surgery Cleveland, OH
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Current concepts in transplant surgery: liver transplantation today. Langenbecks Arch Surg 2008; 393:245-60. [PMID: 18309513 DOI: 10.1007/s00423-007-0262-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 12/06/2007] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The discipline of liver transplantation (LTx) has been developed over the past decades, and LTx is now considered the gold standard for the treatment of patients with end-stage liver diseases and early liver tumors in cirrhotic livers. This procedure is now performed routinely in many transplant centers, and it has provided an enormous technical innovation to the field of hepatobiliary surgery. Allocation decision of liver organs is based on medical need and timing. MATERIALS AND METHODS The Mayo Model for End Stage Liver Disease based on patient-specific criteria was developed and applied to prioritize patients on the waiting list. From the donor aspects of LTx, sources of organ, excluding xenotransplantation, can be brain-dead donors, living donors, and non-heart-beating donors. Today, the majority of livers are procured from cadaveric donors. In addition to the conventional LTx, other types are living-donor LTx, reuse of grafts as domino transplantation, ex situ as well as in situ split LTx, and reduced-size LTx. The transplantation procedure consists of several steps including donor selection and management, liver procurement and preservation, back-table preparation, recipient operation with liver implantation, postoperative care, immunosuppression, and follow-up. RESULTS The postoperative complications are divided into surgical, non-surgical, and multifactorial complications. Surgical complications account about 34% of morbidities after LTx and are mainly categorized to vascular and biliary complications. The main medical ones are non-surgical bleeding and infections. The multifactorial complications include primary non- or poor function and small-for-size syndrome. The pretransplant outcome predictors of LTx can be divided into donor, recipient, operative, and postoperative factors. CONCLUSION LTx is now considered a safe and standardized procedure with a substantially improved graft and patient survival and acceptable morbidity rates. However, the new problems, including recurrence of hepatitis C or hepatocellular carcinoma, chronic biliary complications, opportunistic infections, and development of de-novo malignancies are the major problems affecting the long-term outcome of transplanted patients.
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Abstract
Liver transplantation in pediatrics has become an accepted modality of treatment in end-stage liver disease and irreversible acute liver failure. Biliary atresia is the most common indication requiring liver transplantation in children. The diagnosis and causes of acute liver failure in children differ from those in adults. Growth and development require special consideration in children. Regular surveillance of Epstein-Barr virus by polymerase chain reaction and appropriate therapy may reduce the incidence of post-transplant lymphoproliferative disease after transplantation. Adherence to the prescribed medical regimen is essential for good graft function. A multidisciplinary approach is the key to success in liver transplantation in children.
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Affiliation(s)
- Nanda Kerkar
- Division of Pediatric Hepatology, Department of Pediatrics, Mount Sinai School of Medicine, Box 1104, New York, NY 10029, USA
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Mehrabi A, Fonouni H, Wente M, Sadeghi M, Eisenbach C, Encke J, Schmied BM, Libicher M, Zeier M, Weitz J, Büchler MW, Schmidt J. Wound complications following kidney and liver transplantation. Clin Transplant 2007; 20 Suppl 17:97-110. [PMID: 17100709 DOI: 10.1111/j.1399-0012.2006.00608.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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Egawa H, Tanaka K, Kasahara M, Takada Y, Oike F, Ogawa K, Sakamoto S, Kozaki K, Taira K, Ito T. Single center experience of 39 patients with preoperative portal vein thrombosis among 404 adult living donor liver transplantations. Liver Transpl 2006; 12:1512-8. [PMID: 17004256 DOI: 10.1002/lt.20777] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) involves technical difficulty. The aim of this research was to analyze their preoperative diagnosis of PVT, operative procedures, and postoperative courses of patients with preoperative PVT. Thirty-nine patients of 404 adult patients (9.7%) undergoing LDLT in our hospital from 1996 June to 2004 December had PVT at their transplantation. Twenty-nine patients had intractable ascites, 21 had gastrointestinal bleeding, and 18 had encephalopathy. The thrombus was located in the portal trunk in 23, in the portal trunk and superior mesenteric vein (SMV) in 7, and developed into the SMV and the splenic vein in 8. The occlusive grade was partial in 29, and complete in 10 patients. The thrombus was removed by a simple technique, and eversion and/or incision technique, or total removal of the portal vein (PV). The PV was reconstructed with the thrombectomized native PV, with an interposed vein graft, or porto-caval hemitransposition. Advanced PVT had a significant impact on blood loss and hospital mortality. Three out of 10 patients with residual PVT required radiological and/or surgical intervention after transplantation. In conclusion, thorough planning is essential for a successful LDLT outcome for patients with preexisting PVT.
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Affiliation(s)
- Hiroto Egawa
- Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
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19
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Abstract
Diagnostic imaging and interventional radiology play key roles in the evaluation and management of patients who are being evaluated for potential liver transplantation (LTX) and of those who have received a transplanted liver. Technical advances in imaging equipment and technique allow more accurate assessment and often obviate unnecessary or nontherapeutic surgery or invasive techniques such as catheter angiography.
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Affiliation(s)
- Omar Almusa
- Abdominal Imaging Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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20
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Chan SC, Fan ST. Right liver adult-to-adult live donor liver transplantation in Hong Kong. Transplant Rev (Orlando) 2006. [DOI: 10.1016/j.trre.2006.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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