1
|
Wang D, Ma Y, Gu B, Li X, Yu Y, Zhang Y, Chen H. Preliminary study of donor volume changes after dual-graft liver transplantation in rats. Front Immunol 2023; 14:1183426. [PMID: 37908343 PMCID: PMC10613707 DOI: 10.3389/fimmu.2023.1183426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023] Open
Abstract
Dual-graft liver transplantation (DGLT) expands the pool of donors, ensures the safety of the donors, and treats a potential small for size syndrome (SFSS). However, some of the recipient graft showed atrophy. The cause and mechanism of the unbalanced proliferation and atrophy of dual grafts after clinical DGLT have not been clarified. We established and optimized the rat model of DGLT to explore the causes of growth unbalance. Continuously and dynamically observed bilateral graft volume and portal vein blood flow change by magnetic resonance imaging (MRI) and ultrasound (US). We detected liver function indexes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL). Liver samples from receptors were obtained for morphology, and apoptosis was measured by RT-PCR and western blot. Optimization of the model improved the 7-day survival rate from former 58.3% to 87.5%, and the 30-day survival rate was 68.8%. The volume of the right graft gradually increased, and the left graft atrophied during the 30-day observation period. The portal blood flow of the left graft gradually decreased until the 30th day (0.13 ± 0.01 ml/s) compared with the sham group (0.63 ± 0.05 ml/s), and the right graft significantly increased on the 30th day (0.75 ± 0.11ml/s). The liver function initially increased and then recovered. The total volume (12.52 ± 1.60 ml vs 4.47 ± 0.08 ml) and weight (12.09 ± 1 g vs 4.91 ± 0.18 g) of the graft increased significantly compared to pre-transplantation and reached the level of the sham operation group on the 30th day. The volume and weight of the right graft increased more than those of the left graft (P < 0.05). There was more inflammatory cell infiltration in the left graft, and the right graft had obvious proliferation of hepatocytes and mature bile duct cells. Left grafts were more prone to apoptosis than right grafts (P < 0.05). In conclusion, growth of the right graft is superior to the left; after double liver transplantation, perfusion blood flow and apoptosis may be the reason contributing to the volume differences in dual grafts.
Collapse
Affiliation(s)
- Dan Wang
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yanling Ma
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Baohong Gu
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xuemei Li
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yang Yu
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ying Zhang
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Hao Chen
- The Department of Tumor Surgery, Second Hospital of Lanzhou University, Lanzhou, China
- The Key Laboratory of The Digestive System Tumors of Gansu Province, Second Hospital of Lanzhou University, Lanzhou, China
| |
Collapse
|
2
|
Khan A, Arkam F, Dar FS, Khan NA, Bhatti ABH. Dual Graft Living Donor Liver Transplantation for High Acuity Patients: A Single-Center Experience. J Clin Exp Hepatol 2023; 13:447-453. [PMID: 37250874 PMCID: PMC10213845 DOI: 10.1016/j.jceh.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/18/2022] [Indexed: 05/31/2023] Open
Abstract
Background The outcomes of dual graft living donor liver transplantation (DGLDLT) in high acuity patients remain underreported. The objective of this study was to report long-term outcomes from a single center in this select group of patients. Methods This was a retrospective review of patients who underwent DGLDLT between 2012 and 2017 (n = 10). High acuity patients were defined as patients with model for end stage liver disease (MELD) ≥30 or Child Pugh score ≥11. We looked at 90-day morbidity and mortality and 5-year overall survival (OS). Results The median MELD score and Child Pugh score were 30 (26.7-35) and 11 (11-11.2). The median recipient weight was 105 (95.2-113.7) and ranged from 82 to 132 kg. Out of 10 patients, 4 (40%) required perioperative renal replacement therapy, and 8 (80%) required hospital admission for optimization. The estimated graft to recipient weight ratio (GRWR) with right lobe graft alone was <0.8 in all patients, between 0.75 and 0.65 in 5 (50%) patients, and <0.65 in 5 (50%) patients. The 90-day mortality was 3/10 (30%), and there were 3/10 (30%) deaths during long-term follow-up. Among 155 high acuity patients, the 1-year OS with standard LDLT, standard LDLT with GRWR <0.8, and DGLDLT was 82%, 76%, and 58%, respectively (P = 0.123). With a median follow-up of 40.6 (1.9-74.4) months, the 5-year OS for DGLDLT was 50%. Conclusion The use of DGLDLT in high acuity patients should be prudent and low GRWR grafts should be considered a viable alternative in selected patients.
Collapse
Affiliation(s)
- Abdullah Khan
- Shifa Tameer-e-Millat University Islamabad, Pakistan
| | - Faraz Arkam
- Shifa Tameer-e-Millat University Islamabad, Pakistan
| | - Faisal S. Dar
- Department of HPB Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Sector H-8/4, Pitras Bukhari Road, Islamabad, Pakistan
| | - Nasir A. Khan
- Department of Anesthesiology, Shifa International Hospital Islamabad, Sector H-8/4, Pitras Bukhari Road, Islamabad, Pakistan
| | - Abu Bakar H. Bhatti
- Shifa Tameer-e-Millat University Islamabad, Pakistan
- Department of HPB Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Sector H-8/4, Pitras Bukhari Road, Islamabad, Pakistan
| |
Collapse
|
3
|
Vinayak N, Ravi M, Ankush G, Rashmi B, Prashantha R, Parul G, Anurag S. Dual graft living donor liver transplantation - a case report. BMC Surg 2019; 19:149. [PMID: 31640624 PMCID: PMC6805583 DOI: 10.1186/s12893-019-0606-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background Living donor liver transplantation (LDLT) has emerged as an equally viable option to deceased donor liver transplant for treating end stage liver disease patients. Optimising the recipient outcome without compromising donor safety is the primary goal of LDLT. Achieving the adequate graft to recipient weight ratio (GRWR) is important to prevent small for size syndrome which is an uncommon but potentially lethal complication of LDLT. Case presentation Here we describe a case of successful dual lobe liver transplant for a 32 years old patient with ethanol related end stage liver disease. A right lobe graft without middle hepatic vein and another left lateral sector graft were transplanted successfully. Recipient and both donors recovered uneventfully. Conclusion Dual lobe liver transplant is a feasible strategy to achieve adequate GRWR without compromising donor safety.
Collapse
Affiliation(s)
- Nikam Vinayak
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Room No- 202, 2nd Floor, Mumbai, Maharashtra, 400012, India.
| | - Mohanka Ravi
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Room No- 202, 2nd Floor, Mumbai, Maharashtra, 400012, India
| | - Golhar Ankush
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Room No- 202, 2nd Floor, Mumbai, Maharashtra, 400012, India
| | - Bhade Rashmi
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Room No- 202, 2nd Floor, Mumbai, Maharashtra, 400012, India
| | - Rao Prashantha
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Room No- 202, 2nd Floor, Mumbai, Maharashtra, 400012, India
| | - Gadre Parul
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Room No- 202, 2nd Floor, Mumbai, Maharashtra, 400012, India
| | - Shrimal Anurag
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Room No- 202, 2nd Floor, Mumbai, Maharashtra, 400012, India
| |
Collapse
|
4
|
Zidan A, Sturdevant M, Alkhail FA, Alabbad S, Boehnert MU, Broering D. The first two cases of living donor liver transplantation using dual grafts in Saudi Arabia. Ann Saudi Med 2019; 39:118-123. [PMID: 30955020 PMCID: PMC6464670 DOI: 10.5144/0256-4947.2019.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The concept of dual-graft liver transplantation was introduced to overcome the discrepancy between liver transplantation demand and liver donation. Dual-graft transplantation also mitigates cumulative family risk by decreasing individual donor risk through minimization of the resected liver volume from each donor. Here, we describe the first two cases performed in Saudi Arabia wherein a dual-graft living donor liver transplantation was facilitated by the use of one left lobe graft and one left lateral segment in both cases. These are the first two cases of dual-graft liver transplantation reported from Saudi Arabia and the Middle East. SIMILAR CASES PUBLISHED: Nine on the same subject in other parts of the world (Korea, Japan, Germany, China, and Brazil).
Collapse
Affiliation(s)
- Ahmed Zidan
- Dr. Ahmed Zidan Liver Transplantation,, King Faisal Specialist Hospital and Research Centre,, PO Box 3544, Riyadh 11211, Saudi Arabia, T: 966550390905, , ORCID: https://orcid.org/00000002-2423-8246
| | | | | | | | | | | |
Collapse
|
5
|
|
6
|
Xu Y, Chen H, Yeh H, Wang H, Leng J, Dong J. Living donor liver transplantation using dual grafts: Experience and lessons learned from cases worldwide. Liver Transpl 2015; 21:1438-48. [PMID: 26336078 DOI: 10.1002/lt.24315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/20/2015] [Accepted: 08/24/2015] [Indexed: 01/10/2023]
Abstract
In living donor liver transplantation (LDLT), insufficient graft volume could result in small-for-size syndrome in recipients, whereas major liver donation predisposes the donor to a high risk of posthepatectomy liver failure. Dual graft LDLT is therefore introduced to obtain combined graft sufficiency. To date, 367 patients have been reported worldwide. We reviewed all the relevant literature, with a special focus on 43 case reports containing enough data to extract and analyze. A simple decision-making algorithm was developed. Dual graft LDLT is indicated when (1) a single donation is unacceptable due to graft-to-recipient size mismatch; (2) the future liver remnant is insufficient in the single donor after major resection; or (3) there is a significant underlying disorder or anatomical variation within the donor liver. The outcome of dual graft LDLT is reported to be comparable with that of single donor LDLT. Unilateral graft atrophy was found in 7 of the 43 patients, predominantly in the right-sided, heterotopic and initially smaller grafts. Technically, the heterotopic implantation and complex vascular reconstruction are the most demanding. Elaborate surgical planning and modification are needed. Ethical concerns about involving a second living donor need to be addressed. In conclusion, dual graft LDLT should be prudently performed in select cases by surgeons of proven expertise when single donation is unacceptable and a second living donor is available. The decision-making criteria need to be standardized. More surgical modification and clinical research are needed.
Collapse
Affiliation(s)
- Yinzhe Xu
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China.,Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hao Chen
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China
| | - Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hongguang Wang
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China
| | - Jianjun Leng
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China
| | - Jiahong Dong
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China.,Beijing Tsinghua Changgung Hospital, Tsinghua University Medical Center, Changping, Beijing, China
| |
Collapse
|
7
|
Jawan B, Wang CH, Chen CL, Huang CJ, Cheng KW, Wu SC, Shih TH, Yang SC. Review of anesthesia in liver transplantation. ACTA ACUST UNITED AC 2014; 52:185-96. [PMID: 25477262 DOI: 10.1016/j.aat.2014.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/26/2014] [Indexed: 01/10/2023]
Abstract
Liver transplantation (LT) is a well-accepted treatment modality of many end-stage liver diseases. The main issue in LT is the shortage of deceased donors to accommodate the needs of patients waiting for such transplants. Live donors have tremendously increased the pool of available liver grafts, especially in countries where deceased donors are not common. The main ethical concern of this procedure is the safety of healthy donors, who undergo a major abdominal surgery not for their own health, but to help cure others. The first part of the review concentrates on live donor selection, preanesthetic evaluation, and intraoperative anesthetic care for living liver donors. The second part reviews patient evaluation, intraoperative anesthesia monitoring, and fluid management of the recipient. This review provides up-to-date information to help improve the quality of anesthesia, and contribute to the success of LT and increase the long-term survival of the recipients.
Collapse
Affiliation(s)
- Bruno Jawan
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chih-Hsien Wang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplant Program, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Jung Huang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kwok-Wai Cheng
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hsiao Shih
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Chun Yang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
8
|
Chen H, Zhang Y, Han YM, Huguet E, Huang DS, Dong JH. Dual liver transplantation. J Zhejiang Univ Sci B 2013; 14:178-84. [PMID: 23463760 DOI: 10.1631/jzus.b1200041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care, and it is time-dependent. Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice. We need to improve upon the problems of low reperfusion rate, non-standardized treatment, and economic burden in STEMI care. This article briefly reviews the current status of reperfusion strategy in STEMI care, and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.
Collapse
Affiliation(s)
- Hao Chen
- Hepatobiliary Surgery Hospital and Institute of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
| | | | | | | | | | | |
Collapse
|
9
|
Zhang Y, He Y, Praseedom RK, Zheng S, Dong J, Chen H. Establishment of animal model of dual liver transplantation in rat. PLoS One 2012; 7:e40818. [PMID: 22829887 PMCID: PMC3400666 DOI: 10.1371/journal.pone.0040818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 06/13/2012] [Indexed: 11/18/2022] Open
Abstract
The animal model of the whole-size and reduced-size liver transplantation in both rat and mouse has been successfully established. Because of the difficulties and complexities in microsurgical technology, the animal model of dual liver transplantation was still not established for twelve years since the first human dual liver transplantation has been made a success. There is an essential need to establish this animal model to lay a basic foundation for clinical practice. To study the physiological and histopathological changes of dual liver transplantation, “Y” type vein from the cross part between vena cava and two iliac of donor and “Y’ type prosthesis were employed to recanalize portal vein and the bile duct between dual liver grafts and recipient. The dual right upper lobes about 45–50% of the recipient liver volume were taken as donor, one was orthotopically implanted at its original position, the other was rotated 180° sagitally and heterotopically positioned in the left upper quadrant. Microcirculation parameters, liver function, immunohistochemistry and survival were analyzed to evaluate the function of dual liver grafts. No significant difference in the hepatic microcirculatory flow was found between two grafts in the first 90 minutes after reperfusion. Light and electronic microscope showed the liver architecture was maintained without obvious features of cellular destruction and the continuity of the endothelium was preserved. Only 3 heterotopically positioned graft appeared patchy desquamation of endothelial cell, mitochondrial swelling and hepatocytes cytoplasmic vacuolization. Immunohistochemistry revealed there is no difference in hepatocyte activity and the ability of endothelia to contract and relax after reperfusion between dual grafts. Dual grafts made a rapid amelioration of liver function after reperfusion. 7 rats survived more than 7 days with survival rate of 58.3.%. Using “Y” type vein and bile duct prosthesis, we successfully established a novel rat model of dual right upper liver lobe transplantation.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Yong He
- Key Laboratory of Combined Multiorgan Transplantation, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Raaj Kumar Praseedom
- Department of General Surgery, NIHR Comprehensive Biomedical Campus, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Shusen Zheng
- Key Laboratory of Combined Multiorgan Transplantation, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiahong Dong
- Hospital & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Hao Chen
- Key Laboratory of Combined Multiorgan Transplantation, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of General Surgery, Zhejiang Province People’s Hospital, Zhejiang, China
- Department of Cardiology, College of Medicine, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| |
Collapse
|
10
|
Dayangac M, Taner C, Akin B, Uraz S, Balci D, Duran C, Ayanoglu O, Killi R, Yuzer Y, Tokat Y. Dual Left Lobe Living Donor Liver Transplantation Using Donors Unacceptable for Right Lobe Donation: A Case Report. Transplant Proc 2010; 42:4560-3. [DOI: 10.1016/j.transproceed.2010.09.149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/30/2010] [Indexed: 02/07/2023]
|
11
|
Song GW, Lee SG, Hwang S, Kim KH, Ahn CS, Moon DB, Ha TY, Kwon SW, Ko GY, Kim KW. Dual living donor liver transplantation with ABO-incompatible and ABO-compatible grafts to overcome small-for-size graft and ABO blood group barrier. Liver Transpl 2010; 16:491-8. [PMID: 20222051 DOI: 10.1002/lt.22016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABO blood group compatibility has been regarded as an essential prerequisite for successful adult living donor liver transplantation (LDLT). Novel strategies for overcoming the ABO blood group barrier, however, have markedly improved the results of ABO-incompatible (ABOi) LDLT. We describe our strategies for dual graft LDLT to cope with ABO-incompatibility and small-for-size graft syndrome in 3 patients who underwent dual graft LDLT with ABOi and ABO-compatible (ABOc) grafts. One patient received a modified right lobe graft from an ABOi living donor and a left lateral section graft from an ABOc deceased donor, whereas the other 2 patients received 2 left lobe or left lateral section grafts from ABOi and ABOc living donors. To overcome the ABO-blood barrier, each patient was treated with preoperative anti-CD20 antibody (rituximab 375 mg/m(2)), perioperative plasma exchange, and hepatic arterial infusion. All 3 patients were males, of mean age 47.7 years (range, 40 approximately 52 years) and mean Model for End-Stage Liver Disease score 12.3 (range, 9 approximately 15). The mean graft-to-recipient weight ratio was 0.99%. All patients remain alive after a mean follow-up period of 9.5 months (range, 8.0 approximately 10.7 months). All 6 grafts have functioned normally. There were no episodes of antibody-mediated rejection or biliary complication. Dual LDLT with ABOi and ABOc grafts can be a feasible solution for simultaneously overcoming both the ABO blood group barrier and small-for-size graft syndrome.
Collapse
Affiliation(s)
- Gi-Won Song
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Shi-Chun L, Meng-Long W, Ning L, Wei L, Ping C, Jin-Ning L, Jun D, Zhen Z, Ju-Shan W, Dong-Dong L, Qing-Liang G, Yue Z. Emergent right lobe adult-to-adult living-donor liver transplantation for high model for end-stage liver disease score severe hepatitis. Transpl Int 2010; 23:23-30. [PMID: 20050081 DOI: 10.1111/j.1432-2277.2009.00935.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to explore the feasibility of emergency right lobe adult-to-adult living-donor liver transplantation (LDLT) for high model for end-stage liver disease (MELD) score severe hepatitis. Consecutive 10 high MELD score severe hepatitis patients underwent emergency right lobe adult-to-adult LDLT in our hospital from April to December 2007. The MELD score was 34.50 +/- 2.088. The outcomes of these recipients were retrospectively analyzed. Among them, eight cases of ABO blood group were identical and two cases compatible, one case was Rh negative. Two recipients died and the rest of the recipients and all donors are safe; perioperative and 2-year survival rate was 80%. The mean graft-recipient weight ratio (GRWR) was 1.27% +/- 0.25%, and graft volume to recipient standard liver volume ratio (GV/ESLVR) was 56.7% +/- 6.75%. Of the 10 patients, three received right lobe grafts with middle hepatic vein (MHV), four without MHV, three without MHV but followed by V and VIII hepatic vein outflow reconstruction. An encouraging outcome was achieved in this group: elevated serum creatinine, serum endotoxin, decreased serum prothrombin activity, and Tbil returned to normal on postoperative days 3, 7, 14, and 28, respectively. One-year survival rate was 80%. Outcomes of emergency right lobe adult-to-adult LDLT for high MELD score severe hepatitis were fairly encouraging and acceptable. Emergency right lobe adult-to-adult LDLT is an effective and life-saving modality for high MELD score acute liver failure patients following severe hepatitis.
Collapse
Affiliation(s)
- Lu Shi-Chun
- Department of Hepatobiliary Surgery & You-an liver transplant center, Beijing You-An Hospital, Capital Medical University, Beijing, China.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Development and validation of a comprehensive new hepatobiliary software. Part II: Segmental liver function. Nucl Med Commun 2009; 30:945-55. [PMID: 19855312 DOI: 10.1097/mnm.0b013e32832ed3ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was undertaken to develop comprehensive new hepatobiliary software to quantify segmental and lobar liver function and to obtain FDA approval. METHODS Hepatobiliary software written on JAVA platform and loaded on to a PC accepts 99mTc-HIDA dicom image data transferred from a gamma camera. Liver boundary was determined by threshold-based auto edge detection and liver height at right midclavicular (RMCL) line. Geometric mean area of the physiologic right lobe, physiologic left lobe and total liver area were measured. Segmental liver function was determined using the 5th minute frame as the default (100%). RESULTS In 24 control participants, mean (+/-SD) liver height at RMCL was 14.7+/-0.12 cm. Geometric mean area of the physiologic right lobe was 116+/-3 cm2, left lobe 96+/-4 cm2, and total liver area 212+/-3 cm. Right upper lobe (segments 7 and 8) contributed 31+/-0.7%, right lower lobe (segments 5 and 6) 34+/-0.6%, left medial (segments 4A and 4B) 24+/-1%, left lateral (segments 2 and 3) 10+/-2%, and caudate lobe (segment 1) 1+/-0.02% of total liver function. In 23 patients, contrast three-dimensional computerized tomographic volume of the right lobe was 1194+/-419 ml, left lobe 434+/-221 ml, and total liver volume 1628+/-490 ml. Right lobe area was 120+/-30 cm2, left lobe (plus caudate) 88+/-29 cm2 with total liver area of 208+/-51 cm. Right upper lobe (segments 7 and 8) contributed 33+/-10%, right lower lobe (segments 5 and 6) 34+/-7%, left medial (segments 4A and 4B) 23+/-6%, left lateral (segments 2 and 3) 9+/-3%, and caudate lobe (segment 1) 1+/-0.4% of total liver function. There was good correlation of RMCL height, and area of right lobe and total liver with computerized tomographic liver volume. Correlation of percentage volume with percentage function was excellent. CONCLUSION New FDA approved software provides quantitative assessment of segmental, lobar, and total liver size and function from a planar 99mTc-HIDA cholescintigraphy and may enable universal standardization in nuclear hepatology. Quantification may aid surgeons in the determination of the amount of tissue resection during liver surgery.
Collapse
|
14
|
|
15
|
Dual grafts in adult-to-adult living donor liver transplantation: A single center experience in Taiwan. Surgery 2009; 145:212-8. [DOI: 10.1016/j.surg.2008.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 09/15/2008] [Indexed: 02/07/2023]
|
16
|
Chen Z, Yan L, Li B, Zeng Y, Wen T, Zhao J, Wang W, Xu M, Yang J. Prevent small-for-size syndrome using dual grafts in living donor liver transplantation. J Surg Res 2009; 155:261-7. [PMID: 19481224 DOI: 10.1016/j.jss.2009.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 11/22/2008] [Accepted: 01/07/2009] [Indexed: 02/05/2023]
Abstract
BACKGROUND The growing gap between the number of patients waiting for transplantation and available organs is still the main issue facing the transplant community. The major limitation of adult-to-adult living donor liver transplantation (LDLT) is the small-for-size problem because of the concern of donor safety. We report preliminary experiences for preventing small-for-size syndrome using dual grafts from one right lobe without the middle hepatic vein and one left lateral segment in adult-to-adult LDLT. METHODS One hundred ten cases of adult-to-adult LDLT were performed in West China Hospital of Sichuan University from January 2002 to August 2007, and there were 16 small-for-size (SFS) grafts in all grafts. Dual grafts LDLT was performed for six patients with end-stage liver disease, consisting of five cases from one right lobe without the middle hepatic vein and one left lateral segment, and one case from two left lobes. RESULTS All living donors underwent a full recovery from the operation without persistent complications. Four recipients died of sepsis, one recipient received re-transplantation, and three recipients received transplenic artery embolization in the recipients with SFS grafts. All recipients with dual grafts displayed good graft function and a majority of grafts showed normal triangular-shape regeneration of their respective liver grafts. Only in one left lateral segment atrophy occurred, graft hepatectomy was not required. CONCLUSION Dual grafts from one right lobe without the middle hepatic vein and one left lateral segment in adult-to-adult LDLT can prevent the small-for-size problem and yet secure the safety of the donors.
Collapse
Affiliation(s)
- Zheyu Chen
- Department of Hepato-bilio-pancreatology Surgery and Division of Liver Transplantation, West China Hospital, West China Medical School of Sichuan University, Chengdu, China
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Ikegami T, Shimada M, Imura S, Arakawa Y, Nii A, Morine Y, Kanemura H. Current concept of small-for-size grafts in living donor liver transplantation. Surg Today 2008; 38:971-82. [PMID: 18958553 DOI: 10.1007/s00595-008-3771-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 02/18/2008] [Indexed: 12/16/2022]
Abstract
The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called "small-for-size (SFS) graft syndrome." The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extension to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by an SFS graft, such as a portosystemic shunt or splenectomy, have been trialed with some positive results. To establish an effective strategy for transplanting SFS grafts and preventing SFS graft syndrome, it is essential to have precise knowledge and tactics to evaluate graft quality and graft volume, when performing these LDLTs with portal pressure control. We reviewed the updated literature on the pathogenesis of and strategies for using SFS grafts.
Collapse
Affiliation(s)
- Toru Ikegami
- Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | | | | | | | | | | | | |
Collapse
|
18
|
Broering DC, Walter J, Braun F, Rogiers X. Current Status of Hepatic Transplantation. Curr Probl Surg 2008; 45:587-661. [DOI: 10.1067/j.cpsurg.2008.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
19
|
Soejima Y, Taketomi A, Ikegami T, Yoshizumi T, Uchiyama H, Yamashita Y, Meguro M, Harada N, Shimada M, Maehara Y. Living donor liver transplantation using dual grafts from two donors: a feasible option to overcome small-for-size graft problems? Am J Transplant 2008; 8:887-92. [PMID: 18294350 DOI: 10.1111/j.1600-6143.2008.02153.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Living donor liver transplantation (LDLT) between adults inevitably implies two potential risks associated with a small-for-size graft for the recipient and small remnant liver for the donor. To overcome these problems, LDLT using dual grafts from two independent donors can be a solution, in which sufficient graft volume can be obtained while preserving donor safety. We present a case of LDLT that was managed successfully by using right and left lobe dual grafts from two donors. The recipient was a large-size male with hepatitis C cirrhosis complicated by multiple hepatocellular carcinomas (HCCs). The first donor donated a right lobe graft and the second donor donated a left lobe plus caudate lobe graft with the middle hepatic vein. Graft function was excellent throughout the course without evidence of small-for-size syndrome. In conclusion, LDLT using dual grafts can be justified in a selected case to avoid small-for-size graft problems without increasing independent donor risks.
Collapse
Affiliation(s)
- Y Soejima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Walter J, Burdelski M, Bröring DC. Chances and risks in living donor liver transplantation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:101-107. [PMID: 19633759 PMCID: PMC2696717 DOI: 10.3238/arztebl.2008.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 10/22/2007] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Liver transplantation is the first-line therapy in treatment of end-stage liver diseases. Due to the mismatch of available donor organs and growing waiting lists in Germany, live donation is of great interest. METHODS Selective literature review. RESULTS AND DISCUSSION Pediatric living donor liver transplantation almost eliminated waiting list mortality in children and achieved excellent short and long term survival. The situation in adult-to-adult living donor liver transplantation is different, due to the need for extensive donor resection and smaller graft volume for the recipient. Careful donor evaluation and defined selection criteria are essential to minimize the donor's risk and to achieve results comparable to whole organ transplantation. Living donor liver transplantation offers the recipient certain advantages such as superior graft quality, but the procedure should be reserved for selected patients. Donor safety is the highest priority in this procedure. Living donor transplantation should remain in the hands of experienced centers.
Collapse
Affiliation(s)
- Jessica Walter
- Klinik für Allgemeine und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Strasse 7, Kiel, Germany
| | | | | |
Collapse
|