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Marginal donor liver versus standard donor liver: A single center-observational study. Hepatobiliary Pancreat Dis Int 2022; 22:239-244. [PMID: 36323609 DOI: 10.1016/j.hbpd.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The effectiveness and safety of marginal donor livers remain controversial. This study aimed to investigate the clinical efficacy of marginal donor livers in patients with liver transplantation (LT). METHODS This study included 199 liver donors (including 16 split donors) and 206 liver recipients from January 1, 2018 to January 27, 2020, with case follow-up until July 2021. Clinical data of donors and recipients were retrospectively analyzed and were divided into the marginal donor and standard donor groups according to the criteria of marginal donor livers. Indices of liver and kidney functions, complications, and survival curves of the two groups were compared. RESULTS Compared with the standard donor group, the blood creatinine levels were significantly higher in the marginal donor group in the first week after operation (P < 0.05); there were no significant differences in the alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels after LT (all P > 0.05); there was no significant difference in the incidence of complications after LT (P > 0.05); there was also no significant difference in the survival curve (P = 0.335). CONCLUSIONS There were no significant differences in liver and kidney function and survival curve between the standard donor and marginal donor groups. The marginal donor liver appears safe and reliable for LT and may be an important strategy to expand the donor pool and solve the shortage of organs.
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Bekki Y, Myers B, Wang R, Smith N, Zerillo J, Rocha C, Tabrizian P, Moon J, Arvelakis A, Facciuto ME, DeMaria S, Florman S. Postreperfusion syndrome in liver transplantation: Outcomes, predictors, and application for recipient selection. Clin Transplant 2022; 36:e14587. [PMID: 34997798 DOI: 10.1111/ctr.14587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to identify risk factors for postreperfusion syndrome (PRS) and its impact on LT outcomes. METHODS Data analysis was performed in 1021 adult patients undergoing donation after brain death (DBD) LT to identify PRS incidence, the risk factors for PRS development, and its impact on LT outcomes. RESULTS The overall incidence of PRS was 16.1%. Independent risk factors for PRS included donor age (odds ratio (OR) 1.01, p = 0.02), donor body mass index (BMI) (OR 1.04, p = 0.003), moderate macrosteatosis (OR 2.48, p = 0.02), and cold ischemia time (CIT) (OR 1.06, p = 0.02). On multivariable analysis for 30-day graft failure, PRS (hazard ratio (HR) 3.49; p<0.001) and Model for End-stage Liver Disease (MELD) score (HR 1.01; p = 0.05) were independent risk factors. Patients were categorized into 4 distinct groups based on PRS risk groups and MELD groups, which showed different 1-year graft survival (p<0.001). There were comparable outcomes between low PRS risk - high MELD and high PRS risk - low MELD group (p = 0.33). CONCLUSIONS donor age, donor BMI, moderate macrosteatosis, and CIT were identified as risk factors for the development of PRS in LT using DBD grafts. PRS risk evaluation may improve donor-to-recipient matching based on their MELD scores. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuki Bekki
- Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Bryan Myers
- Division of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York City, New York, USA
| | - Ryan Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Natalie Smith
- Department of Anesthesiology, Perioperative and Pain Medicine, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jeron Zerillo
- Department of Anesthesiology, Perioperative and Pain Medicine, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Chiara Rocha
- Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Parissa Tabrizian
- Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jang Moon
- Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Antonios Arvelakis
- Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Marcelo E Facciuto
- Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sander Florman
- Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Valvi D, Shah M, Marti F, Gedaly R. Reply. Liver Transpl 2022; 28:143. [PMID: 34455685 DOI: 10.1002/lt.26284] [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: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Deepa Valvi
- Transplant Center, Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY
| | - Malay Shah
- Transplant Center, Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY
| | - Francesc Marti
- Transplant Center, Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY
| | - Roberto Gedaly
- Transplant Center, Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY
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Bekki Y, Fenig Y. Impact of Donors Who Are Extremely Obese on Early Graft Loss and 30-Day Mortality After Liver Transplantation. Liver Transpl 2022; 28:141-142. [PMID: 34465001 DOI: 10.1002/lt.26283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/18/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Yuki Bekki
- Recanati-Miller Transplantation Institute Division of Abdominal Transplantation Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yaniv Fenig
- Division of Transplantation Department of Surgery, State University of New York Downstate Health Sciences University, Brooklyn, NY
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Peng Y, Li B, Xu H, Chen K, Wei Y, Liu F. Pure Laparoscopic Versus Open Approach for Living Donor Right Hepatectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:832-841. [PMID: 34842460 DOI: 10.1089/lap.2021.0583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Pure laparoscopic liver donor right hepatectomy (LLDRH) remains challenging, and its value is still unclear compared with open liver donor right hepatectomy (OLDRH). Objective: To provide comprehensive evidence about the safety and efficacy of LLDRH. Methods: The MEDLINE, Embase, Web of Science, and Cochrane Library electronic databases were searched from the date of inception to July 2021. A fixed-effects or random-effects model was used to analyze the pooled data by using Review Manager Version 5.3. Results: A total of 1940 patients from 6 studies were enrolled in this meta-analysis. For perioperative outcomes of donors, LLDRH had a longer operative time than OLDRH (weighted mean difference [WMD] = 29.75 [4.23-55.26] minutes, P = .02), but it had lower overall morbidity (odds ratio [OR] = 0.67 [0.45-0.99], P = .04), fewer pulmonary complications (OR = 0.47 [0.29-0.76], P = .002), and shorter hospital stays (WMD = -1, P < .001) than OLDRH. However, major complications, biliary complications, portal vein problems, and intra-abdominal bleeding were comparable between the 2 groups. With regard to the postoperative data of recipients, the risks of biliary problems, hepatic artery problems, portal vein problems, hepatic vein problems, and postoperative liver failure were similar between the 2 groups. Conclusions: LLDRH for living donors is safe and effective, and it offers superior perioperative outcomes to OLDRH.
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Affiliation(s)
- Yufu Peng
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Li
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
| | - Hongwei Xu
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
| | - Kang Chen
- Department of Hepatobiliary and Pancreatic Surgery, People's Hospital of Xichang City, Xichang City, China
| | - Yonggang Wei
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
| | - Fei Liu
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, China
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