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Umemura A, Nitta H, Takahara T, Hasegawa Y, Katagiri H, Kanno S, Takeda D, Sasaki A. Pure laparoscopic left lateral graft procurement with removing segment 3 employing Glissonean approach, indocyanine green fluorescence imaging and in situ splitting for a small infant. J Minim Access Surg 2023; 19:165-167. [PMID: 36722543 PMCID: PMC10034808 DOI: 10.4103/jmas.jmas_290_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 02/03/2023] Open
Abstract
We report on a pure laparoscopic left lateral graft procurement with removing segment 3 that employs the Glissonean approach, indocyanine green (ICG) fluorescence imaging and in situ splitting. We first mobilised the liver and confirmed the root of the left hepatic vein (LHV). We then encircled the left Glissonean pedicle, and the segment 3 Glissonean pedicle (G3) was also individually encircled. We performed parenchymal transection of the left lateral segmentectomy using Pringle's manoeuvre. We clipped G3 and confirmed the demarcation line using ICG fluorescence imaging. The inflow in the S2 area was confirmed via intraoperative sonography, and we split segment 3 (S3) from the left lateral sector graft in situ. The left hepatic artery, left portal vein and left hepatic duct were also encircled and divided. The LHV was transected using a linear stapler, and the S2 monosegment liver graft and removed S3 were procured. Our technique reasonably prevents graft-related complications.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | | | | | | | - Shoji Kanno
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Daiki Takeda
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Yahaba, Japan
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Okada N, Kawahara Y, Sanada Y, Hirata Y, Otomo S, Niijima H, Tanaka A, Morimoto A, Lefor AK, Urahashi T, Yasuda Y, Mizuta K, Sakuma Y, Sata N. Successful living donor liver transplantation for liver failure due to maternal T cell engraftment following cord blood transplantation in X-linked severe combined immunodeficiency disease: Case report. Am J Transplant 2021; 21:3184-3189. [PMID: 33793086 DOI: 10.1111/ajt.16588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 01/25/2023]
Abstract
Maternal T cells from perinatal transplacental passage have been identified in up to 40% of patients with severe combined immunodeficiency (SCID). Although engrafted maternal T cells sometimes injure newborn tissue, liver failure due to maternal T cells has not been reported. We rescued a boy with X-linked SCID who developed liver failure due to engrafted maternal T cell invasion following living donor liver transplantation (LDLT) following unrelated umbilical cord blood transplantation (UCBT). After developing respiratory failure 3 weeks postpartum, he was diagnosed with X-linked SCID. Pathological findings showed maternal T cells engrafted in his liver and hepatic fibrosis gradually progressed. He underwent UCBT at 6 months, but hepatic function did not recover and liver failure progressed. Therefore, he underwent LDLT using an S2 monosegment graft at age 1.3 years. The patient had a leak at the Roux-en-Y anastomosis, which was repaired. Despite occasional episodes of pneumonia and otitis media, he is generally doing well 6 years after LDLT with continued immunosuppression agents. In conclusion, the combination of hematopoietic stem cell transplantation (HSCT) and liver transplantation may be efficacious, and HSCT should precede liver transplantation for children with X-linked SCID and liver failure.
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Affiliation(s)
- Noriki Okada
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Yukihiro Sanada
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yuta Hirata
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Shinya Otomo
- Pharmacy, Jichi Medical University Hospital, Tochigi-ken, Japan
| | - Hitomi Niijima
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Akira Tanaka
- Department of Pathology, Jichi Medical University, Tochigi-ken, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Alan K Lefor
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Taizen Urahashi
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yoshikazu Yasuda
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Koichi Mizuta
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yasunaru Sakuma
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Naohiro Sata
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
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Balci D, Bingol-Kologlu M, Kirimker EO, Ergun E, Kansu A, Kuloglu Z, Kirsaclioglu CT, Fitoz S, Can O, Kendirli T, Karayalcin K. 3D-reconstruction and heterotopic implantation of reduced size monosegment or left lateral segment grafts in small infants: A new technique in pediatric living donor liver transplantation to overcome large-for-size syndrome. Surgery 2021; 170:617-622. [PMID: 34052026 DOI: 10.1016/j.surg.2021.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Monosegmental grafts and reduced left lateral segment grafts have been introduced to overcome the problems of large-for-size grafts in pediatric living donor liver transplantation. Here, we introduce a new method of reduced size monosegment or left lateral segment grafts transplanted in the right diaphragmatic fossa heterotopically in small infants. METHODS There were 4 infants who underwent living donor liver transplantation with heterotopically implanted reduced monosegmental or left lateral segment grafts at our center. The demographic, operative, postoperative, and follow-up data of these infants were collected from our prospectively designed database and reviewed. Technical details of the donor and recipient operation are shared and a supplemental provided. RESULTS The mean recipient age was 7.5 ± 0.9 months (range: 5-10 months), and body weight was 5.9 ± 0.7 kg (range: 4.6-7.8). Primary diagnoses of the recipients were biliary atresia (n:3) and progressive familial intrahepatic cholestasis (n:1). Mean graft-recipient weight ratio was 3.3 ± 0.2. Reduced monosegment III grafts were used in 2 cases, and reduced left lateral segment grafts were used in the other 2 patients. Bile duct reconstruction was done by Roux-en-Y hepaticojejunostomy in 3 patients and duct-to-duct anastomosis in the remaining patient. All patients recovered from the liver transplantation operation and are doing well at a mean follow-up of 8 months. CONCLUSION Living donor liver transplantation with heterotopically implanted reduced monosegmental or left lateral segment seems feasible for the treatment of neonates and extremely small infants. Further accumulation of cases and long-term follow-up are necessary to collect data for the establishment of this treatment modality.
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Affiliation(s)
- Deniz Balci
- Department of Surgery, Ankara University School of Medicine, Turkey.
| | | | | | - Ergun Ergun
- Department of Pediatric Surgery, Ankara University School of Medicine, Turkey
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University School of Medicine, Turkey
| | - Zarife Kuloglu
- Department of Pediatric Gastroenterology, Ankara University School of Medicine, Turkey
| | | | - Suat Fitoz
- Department of Radiology, Ankara University School of Medicine, Turkey
| | - Ozlem Can
- Department of Anesthesiology, Ankara University School of Medicine, Turkey
| | - Tanil Kendirli
- Department of Pediatric Intensive Care, Ankara University School of Medicine, Turkey
| | - Kaan Karayalcin
- Department of Surgery, Ankara University School of Medicine, Turkey
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Monosegment Liver Allografts for Liver Transplantation in Infants Weighing Less Than 6 kg: An Initial Indian Experience. Transplant Proc 2021; 53:1670-1673. [PMID: 33573816 DOI: 10.1016/j.transproceed.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/04/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Living donor liver transplantation in small infants is a significant challenge. Liver allografts from adults may be large in size. This is accompanied by problems of graft perfusion, dysfunction, and the inability to achieve primary closure of the abdomen. Monosegment grafts are a way to address these issues. METHODS Two recipients in our cohort weighed less then 6 kg. The prospective left lateral segments from their donors were large for size. Therefore, monosegment 2 liver grafts were harvested. Data regarding the preoperative, intraoperative, and postoperative events in the donor and the recipient were recorded. RESULTS We were able to achieve significant reduction in the sizes of the grafts harvested. The donors underwent surgery and hospital stay uneventfully. The recipients had normal graft perfusion and no graft dysfunction, and we could achieve primary abdominal closure. One recipient had self-limiting bile leak postoperatively. CONCLUSIONS Monosegment 2 liver allografts are safe and effective for use in living donor liver transplantation in small infants weighing less than 6 kg.
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Grimaldi C, Spada M, Maggiore G. Liver Transplantation in Children: An Overview of Organ Allocation and Surgical Management. Curr Pediatr Rev 2021; 17:245-252. [PMID: 34086551 DOI: 10.2174/1573396317666210604111538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/22/2022]
Abstract
Liver transplantation is the standard treatment for children with end-stage liver disease, primary hepatic neoplasms, or liver-localized metabolic defects. Perioperative mortality is almost absent, and long-term survival exceeds 90%. Organ shortage is managed thanks to advances in organ retrieval techniques; living donation and partial liver transplantation almost eliminated waiting list mortality, thus leading to expanding indications for transplantation. The success of pediatric liver transplantation depends on the prompt and early referral of patients to transplant Centers and on the close and integrated multidisciplinary collaboration between pediatricians, hepatologists, surgeons, intensivists, oncologists, pathologists, coordinating nurses, psychologists, and social workers.
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Affiliation(s)
- Chiara Grimaldi
- Hepatobiliopancreatic and Abdominal Transplant Surgery, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
| | - Marco Spada
- Hepatobiliopancreatic and Abdominal Transplant Surgery, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
| | - Giuseppe Maggiore
- Hepatogastroenterology and Nutrition, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
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Namgoong JM, Hwang S, Song GW, Kim DY, Ha TY, Jung DH, Park GC, Ahn CS, Kim KM, Oh SH, Kwon H, Kwon YJ. Pediatric liver transplantation with hyperreduced left lateral segment graft. Ann Hepatobiliary Pancreat Surg 2020; 24:503-512. [PMID: 33234754 PMCID: PMC7691208 DOI: 10.14701/ahbps.2020.24.4.503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
Backgrounds/Aims To prevent large-for-size graft-related complications in small infant patients, the size of a left lateral segment (LLS) graft can be reduced to be a hyperreduced LLS (HRLLS) graft. Methods This study was intended to describe the detailed techniques for harvesting and implanting HRLLS grafts developed in a high-volume liver transplantation (LT) center. Results The mean recipient age was 4.0±1.7 months (range: 3-6) and body weight was 5.3±1.4 kg (range: 4.1-6.9). Primary diagnoses of the recipients were progressive familial intrahepatic cholestasis in 2 and biliary atresia in 1. The types of LT were living donor LT in 1 and split deceased donor LT in 2. Non-anatomical size reduction was performed to the transected LLS grafts. The mean weight of the HRLLS grafts was 191.7±62.1 g (range: 120-230) and graft-recipient weight ratio was 3.75±1.57% (range: 2.45-5.49). Widening venoplasty was applied to the graft left hepatic vein outflow orifice. Vein homograft interposition was used in a case with portal vein hypoplasia. Types of the abdomen wound closure were one case of primary repair, one of two-staged closure with a mesh, and one of three-staged repair with a silo and a mesh. All three patients recovered uneventfully from the LT operation and are doing well to date for more than 6 years after transplantation. Conclusions Making a HRLLS graft through non-anatomical resection during living donor LT and split deceased donor LT can be a useful option for treating small infant patients.
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Affiliation(s)
- Jung-Man Namgoong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Yeon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seak Hee Oh
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunhee Kwon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Jae Kwon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hirata Y, Agarwal S, Varma S, Balradja I, Verma S, Naganathan S, Gupta S. Impact of Medial Reduction of the Left Lateral Segment: A Novel Technique for Living Donor Liver Transplantation for Small Pediatric Recipients. Liver Transpl 2020; 26:1534-1538. [PMID: 32471006 DOI: 10.1002/lt.25808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/22/2020] [Accepted: 05/07/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Yoshihiro Hirata
- Centre for Liver and Biliary Science, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Shaleen Agarwal
- Centre for Liver and Biliary Science, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Sharat Varma
- Centre for Liver and Biliary Science, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Inbaraj Balradja
- Centre for Liver and Biliary Science, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Sapana Verma
- Centre for Liver and Biliary Science, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Selvakumar Naganathan
- Centre for Liver and Biliary Science, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Subhash Gupta
- Centre for Liver and Biliary Science, Max Super Speciality Hospital, Saket, New Delhi, India
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Namgoong JM, Hwang S, Kim DY, Song GW, Ahn CS, Kim KM, Oh SH. Pediatric split liver transplantation using a hyperreduced left lateral segment graft in an infant weighing 4 kg. KOREAN JOURNAL OF TRANSPLANTATION 2020; 34:204-209. [PMID: 35769065 PMCID: PMC9187033 DOI: 10.4285/kjt.2020.34.3.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/04/2022] Open
Abstract
We present a case of successful split liver transplantation (LT) using a hyperreduced left lateral segment (LLS) graft in a 106-day-old female infant patient weighing 4 kg. The patient was diagnosed with progressive familial intrahepatic cholestasis. Her general condition and liver function deteriorated progressively and she was finally allocated for a split LT under status 1. The deceased donor was a 20-year-old female weighing 63.7 kg. We performed in situ liver splitting and in situ size reduction sequentially. The weight of the hyperreduced LLS graft was 225 g, with a graft-recipient weight ratio of 5.5%. We performed recipient hepatectomy and graft implantation according to the standard procedures for pediatric living-donor LT. Since the graft was too large for primary abdomen closure, the abdominal wall was closed in three stages to make a prosthetic silo, temporary closure with a xenograft sheet, and final primary repair over 2 weeks. The patient has been doing well for more than 6 years after transplantation. In conclusion, split LT using a hyperreduced LLS graft can be a useful option for treating small infants. However, large-for-size graft-related problems, particularly in terms of graft thickness, still remain to be solved.
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Affiliation(s)
- Jung-Man Namgoong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Yeon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seak Hee Oh
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Okada N, Sanada Y, Onishi Y, Urahashi T, Ihara Y, Yamada N, Hirata Y, Katano T, Imai T, Ushijima K, Ogaki K, Otomo S, Mizuta K. The Causes and Outcomes of Early Relaparotomy Following Pediatric Living Donor Liver Transplantation. Liver Transpl 2019; 25:1066-1073. [PMID: 30865366 DOI: 10.1002/lt.25446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
Early relaparotomy of adult recipients after living donor liver transplantation (LDLT) is significantly associated with poor prognosis. However, there are few reports focusing on pediatric recipients after LDLT. The aim of this study is to clarify the causes and outcomes of early relaparotomy after pediatric LDLT. A total of 265 pediatric recipients (272 LDLTs) transplanted from May 2001 to October 2015 were retrospectively analyzed. Early relaparotomy was defined as surgical intervention performed within 3 months after LDLT. Early relaparotomy was performed 49 times for 33 recipients (12.5%). The recipient and graft survival rates in the early relaparotomy group were significantly lower than those in the nonearly relaparotomy group, respectively (75.0% and 63.6% versus 96.6% and 95.8%; both P < 0.001). Left lateral segment grafts were used significantly more frequently in the nonrelaparotomy group (P = 0.01). According to the multivariate analysis, the preoperative Pediatric End-Stage Liver Disease (PELD)/Model for End-Stage Liver Disease (MELD) score of the early relaparotomy group was significantly higher than that of the nonearly relaparotomy group (13.7 versus 6.3; P = 0.04). According to the receiver operating characteristic curve, the preoperative PELD/MELD score cutoff point was 17.2. Early relaparotomy due to infectious causes led to significantly poorer graft survival than that due to noninfectious causes (P = 0.04). In conclusion, the recipient and graft survival rates of the early relaparotomy group were significantly lower than those of the nonearly relaparotomy group. A high preoperative PELD/MELD score was a risk factor for early relaparotomy. In particular, early relaparotomy due to infection showed a poor prognosis.
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Affiliation(s)
- Noriki Okada
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Yukihiro Sanada
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Yasuharu Onishi
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Taizen Urahashi
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Yoshiyuki Ihara
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Naoya Yamada
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Yuta Hirata
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Takumi Katano
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Toshimi Imai
- Pharmacology, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Kentaro Ushijima
- Pharmacology, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Keiko Ogaki
- Pharmacy, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Shinya Otomo
- Pharmacy, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
| | - Koichi Mizuta
- Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan
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Oliveira RA, Mancero JMP, Faria DF, Poveda VDB. A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation. Prog Transplant 2019; 29:144-149. [DOI: 10.1177/1526924819835831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. Methods: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. Results: We enrolled 156 recipients’ medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum β-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (≥487 minutes) and differences in body mass index between donor and recipient (≥1.3 kg/m2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia ≥175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). Conclusions: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.
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Affiliation(s)
- Ramon Antônio Oliveira
- Graduate Program in Adult Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | - Jorge Marcelo Padilla Mancero
- Liver Transplantation Department, Hospital Santa Casa of São Jose dos Campos, São José dos Campos, São Paulo, Brazil
| | - Dalila Fernanda Faria
- Liver Transplantation Department, Hospital Santa Casa of São Jose dos Campos, São José dos Campos, São Paulo, Brazil
| | - Vanessa de Brito Poveda
- Graduate Program in Adult Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
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Najah H, Ammar H, Gupta R, Hamdoun M, Morjane A, Mighri MM, Sassi S. Segmental branching pattern of the left portal vein: Anatomical characteristics and clinical implications. Clin Anat 2017; 31:1122-1128. [PMID: 29082657 DOI: 10.1002/ca.23009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/14/2017] [Accepted: 10/25/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Haythem Najah
- Department of General and Digestive SurgeryHôpital Léon Binet, Route de ChalautreProvins France
| | - Houssem Ammar
- Department of General SurgeryHôpital Ibn JazzarKairouan Tunisia
| | - Rahul Gupta
- Synergy Institute of Medical SciencesDehradun India
| | - Moncef Hamdoun
- Department of Forensic MedicineHôpital Charles NicolleTunis Tunisia
- Université Tunis‐ El Manar, Faculté de Médecine de Tunis, 15 Rue Djebel Lakhdhar La RabtaTunis Tunisia
| | | | - Mohamed Mongi Mighri
- Université Tunis‐ El Manar, Faculté de Médecine de Tunis, 15 Rue Djebel Lakhdhar La RabtaTunis Tunisia
- Department of General SurgeryHôpital Mohamed Taher MaamouriNabeul Tunisia
| | - Sadok Sassi
- Université Tunis‐ El Manar, Faculté de Médecine de Tunis, 15 Rue Djebel Lakhdhar La RabtaTunis Tunisia
- Department of General SurgeryHôpital Mohamed Taher MaamouriNabeul Tunisia
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