1
|
You MS, Paik WH, Choi YH, Shin BS, Lee SH, Ryu JK, Kim YT, Suh KS, Lee KW, Yi NJ, Hong SK. Optimal Biliary Drainage for Patients With Biliary Anastomotic Strictures After Right Lobe Living Donor Liver Transplantation. Liver Transpl 2019; 25:1209-1219. [PMID: 30980451 DOI: 10.1002/lt.25472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
Right lobe (RL) living donor liver transplantation (LDLT) usually includes 2 bile duct anastomosis sites, namely, the right anterior and the right posterior segmental ducts. This study aimed to evaluate the optimal treatment for biliary strictures following RL LDLT with respect to unilateral or bilateral drainage techniques. From January 2005 to December 2017, 883 patients at Seoul National University Hospital underwent RL LDLT. Of these, 110 patients were enrolled who had 2 duct-to-duct anastomosis sites and who were considered at risk of developing biliary anastomotic strictures. Unilateral or bilateral biliary drainage during the follow-up period was identified by endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous transhepatic biliary drainage (PTBD). The clinical success, complication, and 180-day mortality rates were compared between the unilateral and bilateral biliary drainage groups according to the initial ERCP findings. The mean age at the time of LDLT was 54.2 ± 8.2 years. The median time from LDLT to initial biliary anastomotic strictures was 177 (interquartile range, 18-1085) days. At the initial ERCP, unilateral drainage was performed in 55 (50.0%) patients, and bilateral drainage was performed in 11 (10.0%) patients. Of the patients who underwent unilateral drainage, 35 (63.6%) patients required conversion to bilateral drainage during follow-up. Overall, 71 (64.5%) patients required bilateral drainage more than once, whereas only 27 (24.5%) patients reached a resolution with unilateral biliary drainage. In this study, most patients required bilateral biliary drainage more than once during follow-up. An active attempt should be made to drain bilaterally in patients with biliary anastomotic strictures following RL LDLT.
Collapse
Affiliation(s)
- Min Su You
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Hoon Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Bang-Sup Shin
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|
2
|
Outcomes of adult patients adopting small-for-size grafts in living donor liver transplantation: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int 2019; 18:206-213. [PMID: 30952435 DOI: 10.1016/j.hbpd.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Small-for-size graft (SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation (LDLT) as a certain graft size is related to recipients' prognosis. Graft-to-recipient weight ratio (GRWR) ≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume (GRWR < 0.8%, SFSG group) and sufficient volume (GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT. DATA SOURCES The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in PubMed, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. RESULTS Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome (SFSS), no significant difference was found in subjects enrolled after year 2010 (before 2010, OR=3.00, 95% CI: 1.69-5.35, P = 0.0002; after 2010, OR=1.23, 95% CI: 0.79-1.90, P = 0.36; P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3- and 5-year overall survival rates between two groups. CONCLUSIONS This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.
Collapse
|
3
|
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
|
4
|
A Worldwide Survey of Live Liver Donor Selection Policies at 24 Centers With a Combined Experience of 19 009 Adult Living Donor Liver Transplants. Transplantation 2019; 103:e39-e47. [PMID: 30308575 DOI: 10.1097/tp.0000000000002475] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
5
|
Abu-Gazala S, Olthoff KM. Current Status of Living Donor Liver Transplantation in the United States. Annu Rev Med 2019; 70:225-238. [DOI: 10.1146/annurev-med-051517-125454] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adult-to-adult living donor liver transplantation (LDLT) was introduced in response to the shortage of deceased donor liver grafts. The number of adult living donor transplants is increasing due to improved outcomes and increasing need. Advantages of LDLT include optimization of the timing of transplant, better organ quality, and lower rates of recipient mortality compared to staying on the wait list for deceased donor liver transplant. Donor safety remains the major focus when considering LDLT. Recent advancements have supported the increased use of LDLT to help decrease wait list death and improve long-term survival of transplant recipients.
Collapse
Affiliation(s)
- Samir Abu-Gazala
- Transplantation Unit, Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Kim M. Olthoff
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4283, USA
| |
Collapse
|
6
|
Hou CT, Chen YL, Lin CC, Chou CT, Lin KH, Lin PY, Hsu YL, Chen CB, Lin HC, Ko CJ, Wang SH, Weng LC, Hsieh CE. Portal venous velocity affects liver regeneration after right lobe living donor hepatectomy. PLoS One 2018; 13:e0204163. [PMID: 30222781 PMCID: PMC6141071 DOI: 10.1371/journal.pone.0204163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/03/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We investigated whether chronological changes in portal flow and clinical factors play a role in the liver regeneration (LR) process after right donor-hepatectomy. MATERIALS AND METHODS Participants in this prospective study comprised 58 donors who underwent right donor-hepatectomy during the period February 2014 to February 2015 at a single medical institution. LR was estimated using two equations: remnant left liver (RLL) growth (%) and liver volumetric recovery (LVR) (%). Donors were classified into an excellent regeneration (ER) group or a moderate regeneration (MR) group based on how their LR on postoperative day 7 compared to the median value. RESULTS Multivariate analysis revealed that low residual liver volume (OR = .569, 95% CI: .367- .882) and high portal venous velocity in the immediate postoperative period (OR = 1.220, 95% CI: 1.001-1.488) were significant predictors of LR using the RLL growth equation; high portal venous velocity in the immediate postoperative period (OR = 1.325, 95% CI: 1.081-1.622) was a significant predictor of LR using the LVR equation. Based on the two equations, long-term LR was significantly greater in the ER group than in the MR group (p < .001). CONCLUSION Portal venous velocity in the immediate postoperative period was an important factor in LR. The critical time for short-term LR is postoperative day 7; it is associated with long-term LR in donor-hepatectomy.
Collapse
Affiliation(s)
- Chen-Tai Hou
- Surgical Critical Unit, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Li Chen
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (CEH); (YLC)
| | - Chia-Cheng Lin
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chen-Te Chou
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taiper, Taiwan
| | - Kuo-Hua Lin
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Yi Lin
- Transplant Medicine & Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan
| | - Ya-Lan Hsu
- Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Bang Chen
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hui-Chuan Lin
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Chih-Jan Ko
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Su-Han Wang
- Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan
| | - Li-Chueh Weng
- Department of Nursing, Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Chia-En Hsieh
- Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (CEH); (YLC)
| |
Collapse
|
7
|
Sato Y, Nakahara K, Shimada M, Hara Y, Takayanagi D, Sawada N, Mukai S, Shimada S, Yamaguchi N, Hidaka E, Takehara Y, Ishida F, Kudo SE. Donor Left-Sided Heptectomy by Use of the Real-Time Moving Windows Method With 8-Centimeter Transverse Skin Incision. Transplant Proc 2016; 48:1083-6. [PMID: 27320563 DOI: 10.1016/j.transproceed.2015.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study, we demonstrated our new device for open donor liver surgery with left-sided heptectomy by use of the real-time moving windows (RTMW) method with 8-cm transverse skin incision for living donors from the viewpoints of cosmetic, economic, and safety procedures. METHODS After the upper abdominal 8-cm transverse skin incision was made, the subcutaneous area was exfoliated and the reverse T-shaped-abdominal incision was made, as in open surgery. After that, the 2 Kent hooks for the upper region and the 2 surgical arms for the lower region were placed. The operative fields of hepatic vein, hepatic hilus, and common hepatic artery were explored, respectively, by use of the RTMW method with the use of the 4 surgical hooks. Hepatic parenchymal dissection was carried out with the use of CUSA and laparosonic coagulating shears. Manipulations of 3 hepatic vessels and the hepatic duct were done by the usual procedure of open surgery. RESULTS This operative procedure could be performed without laparoscopic techniques. The operative time was 7 hours, without blood transfusion. The operative course was uneventful, and the patient was discharged on postoperative day 11. CONCLUSIONS Our RTMW method for donor left-sided hepatectomy is considered to be a useful operative procedure from the viewpoints of donor safety, cosmetic advantage, and cost performance.
Collapse
Affiliation(s)
- Y Sato
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan.
| | - K Nakahara
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - M Shimada
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - Y Hara
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - D Takayanagi
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - N Sawada
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - S Mukai
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - S Shimada
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - N Yamaguchi
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - E Hidaka
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - Y Takehara
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - F Ishida
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| | - S E Kudo
- Digestive Disease Center, Showa University Yokohama Northern Hospital, Yokohama City, Kanagawa Prefecture, Japan
| |
Collapse
|
8
|
Segedi M, Dhani G, Ng VL, Grant D. Living Donors for Fulminant Hepatic Failure in Children. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-29185-7_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
9
|
EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2015.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
10
|
Berardi G, Tomassini F, Troisi RI. Comparison between minimally invasive and open living donor hepatectomy: A systematic review and meta-analysis. Liver Transpl 2015; 21:738-52. [PMID: 25821097 DOI: 10.1002/lt.24119] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/06/2015] [Accepted: 03/14/2015] [Indexed: 12/14/2022]
Abstract
Living donor liver transplantation is a valid alternative to deceased donor liver transplantation, and its safety and feasibility have been well determined. Minimally invasive living donor hepatectomy (MILDH) has taken some time to be accepted because of inherent technical difficulties and the highly demanding surgical skills needed to perform the procedure, and its role is still being debated. Because of the lack of data, a systematic review and meta-analysis comparing MILDH and open living donor hepatectomy (OLDH) was performed. A systematic literature search was performed with PubMed, Embase, Scopus, and Cochrane Library Central. Treatment outcomes, including blood loss, operative time, hospital stay, analgesia use, donor-recipient morbidity and mortality, and donor procedure costs, were analyzed. There were 573 articles, and a total of 11, dated between 2006 and 2014, fulfilled the selection criteria and were, therefore, included. These 11 studies included a total of 608 adult patients. Blood loss [mean difference (MD) = -46.35; 95% confidence interval (CI) = -94.04-1.34; P = 0.06] and operative times [MD = 19.65; 95% CI = -4.28-43.57; P = 0.11] were comparable between the groups, whereas hospital stays (MD = -1.56; 95% CI = -2.63 to -0.49; P = 0.004), analgesia use (MD = -0.54; 95% CI = -1.04 to -0.03; P = 0.04), donor morbidity rates [odds ratio (OR) = 0.62; 95% CI = 0.40-0.98; P = 0.04], and wound-related complications (OR = 0.41; 95% CI = 0.17-0.97; P = 0.04) were significantly reduced in MILDH. MILDH for right liver procurement was associated with a significantly reduced hospital stay (OR = -0.92; 95% CI = 0.17-0.97; P = 0.04). In conclusion, MILDH is associated with intraoperative results that are comparable to results for OLDH and with surgical outcomes that are no worse than those for the open procedure.
Collapse
Affiliation(s)
- Giammauro Berardi
- Department of General Hepatobiliary and Liver Transplantation Surgery, Medical School, Ghent University Hospital, Ghent, Belgium
| | - Federico Tomassini
- Department of General Hepatobiliary and Liver Transplantation Surgery, Medical School, Ghent University Hospital, Ghent, Belgium
| | - Roberto Ivan Troisi
- Department of General Hepatobiliary and Liver Transplantation Surgery, Medical School, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
11
|
Shao Y, Zhang Q, Zhou S, Yan S, Zhou B, Wang W, Zhang M, Shen Y, Zheng S. Complicated hepatic vein reconstruction in living donor liver transplantation: Case report and literature review. SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yi Shao
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
| | - Qiyi Zhang
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
| | - Shuyang Zhou
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
| | - Sheng Yan
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
- Key Laboratory of Combined Multi-Organ Transplantation; Ministry of Public Health; Hangzhou Zhejiang China
- Key Laboratory of Organ Transplantation; Hangzhou Zhejiang China
| | - Bo Zhou
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
| | - Weilin Wang
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
- Key Laboratory of Combined Multi-Organ Transplantation; Ministry of Public Health; Hangzhou Zhejiang China
- Key Laboratory of Organ Transplantation; Hangzhou Zhejiang China
| | - Min Zhang
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
- Key Laboratory of Combined Multi-Organ Transplantation; Ministry of Public Health; Hangzhou Zhejiang China
- Key Laboratory of Organ Transplantation; Hangzhou Zhejiang China
| | - Yan Shen
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
- Key Laboratory of Combined Multi-Organ Transplantation; Ministry of Public Health; Hangzhou Zhejiang China
- Key Laboratory of Organ Transplantation; Hangzhou Zhejiang China
| | - Shusen Zheng
- Department of Surgery; First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
- Key Laboratory of Combined Multi-Organ Transplantation; Ministry of Public Health; Hangzhou Zhejiang China
- Key Laboratory of Organ Transplantation; Hangzhou Zhejiang China
| |
Collapse
|
12
|
EXP CLIN TRANSPLANTExp Clin Transplant 2014; 12. [DOI: 10.6002/ect.2013.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
Du Z, Wei Y, Chen K, Chen X, Zhang Z, Li H, Ma Y, Li B. Risk factors and criteria predicting early graft loss after adult-to-adult living donor liver transplantation. J Surg Res 2014; 187:673-82. [DOI: 10.1016/j.jss.2013.10.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/08/2013] [Accepted: 10/24/2013] [Indexed: 12/11/2022]
|
14
|
A retrospective evaluation of causes of exempting living liver donors in an Egyptian centre. Arab J Gastroenterol 2013; 14:10-3. [DOI: 10.1016/j.ajg.2013.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 11/23/2012] [Accepted: 01/30/2013] [Indexed: 01/21/2023]
|
15
|
Computer-assisted surgical planning in adult-to-adult live donor liver transplantation: how much does it help? A single center experience. Transplantation 2013; 94:1138-44. [PMID: 23222737 DOI: 10.1097/tp.0b013e31826e5970] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative imaging and donor selection are cardinal components of adult-to-adult live donor liver transplantation (ALDLT). The purpose of this study was to evaluate our three-dimensional (3D) computed tomography image-derived computer-assisted surgical planning (3D CASP) in ALDLT. METHODS Eighty-three consecutive ALDLTs (71 right and 12 left) were planned with 3D CASP. Graft, remnant, and total liver volume compliance were calculated and compared with actual intraoperative values. Computed risk analysis encompassing territorial liver mapping, functional (safely drained) volumes, and outflow congestion volumes in grafts and remnants allowed for the individualized management of the middle hepatic vein (MHV). RESULTS Graft volume compliance was 13.5%±4.4%. Three small-for-size (SFS) grafts with lethal SFS syndrome (SFSS) had nonsignificant volume compliance with maximal graft volume-body weight ratios of less than 0.83. Seven SFS grafts with reversible or absent SFSS showed maximal graft volume-body weight ratios of 0.9 to 1.16. Significant differences were identified for (a) virtual graft and remnant congestion volumes of risky versus nonrisky MHV types (49%±6% and 34%±7% vs. 29%±8% and 33%±12%, P<0.001 and P<0.02, respectively) and (b) virtual mean functional versus surgical volumes of grafts (527±119 vs. 963±176 mL, P<0.0001) and remnants (419±182 vs. 640±213 mL, P<0.001). CONCLUSIONS CASP allowed for (a) prevention of SFSS in extremely small grafts by predicting donor liver plasticity and (b) individualized MHV management for both donors and recipients based on functional graft/remnant volume analysis.
Collapse
|
16
|
Spada M, Boggi U, Ricotta C, Pagano D, Gruttadauria S. Left Sectionectomy for Living Donor: Laparoscopic Approach. Updates Surg 2013. [DOI: 10.1007/978-88-470-2664-3_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
17
|
Radtke A, Sgourakis G, Molmenti EP, Schroeder T, Cicinnati VR, Beckebaum S, Peitgen HO, Broelsch CE, Malagó M. The "carving" liver partitioning technique for graft hepatectomy in live donor liver transplantation: a single-center experience. Surgery 2012; 153:189-99. [PMID: 22884089 DOI: 10.1016/j.surg.2012.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 06/14/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND In adult live donor liver transplantation, postoperative venous congestion of graft and remnant livers can lead to life-threatening complications. The purpose of this study was to evaluate the safety and benefits of our 3-dimensional, computed tomographic, computer-assisted donor hepatectomy using the "carving" partitioning technique. METHODS Eighty-three consecutive adult live donor liver transplantations were performed based on data obtained from individualized preoperative 3-dimensional, computed tomographic reconstructions and virtual graft hepatectomies. RESULTS There were 71 right and 12 left grafts. Small grafts (graft volume body weight ratio, <1.0) were used in 20 cases. We observed no clinically important differences in postoperative function between right and left grafts. Four recipients developed lethal small-for-size syndrome. Reversible small-for-size syndrome was observed in a right graft recipient and in 2 right graft donors. CONCLUSION Preoperative 3-dimensional, computed tomographic, computer-assisted planning using virtual liver partitioning allowed for: (1) an individualized carving technique based on specific donor anatomic characteristics, (2) donor safety based on individualized patterns of venous outflow, and (3) optimized drainage of the medial area of the graft based on the preferential inclusion of the middle hepatic vein.
Collapse
Affiliation(s)
- Arnold Radtke
- Department of General, Thoracic, and Transplant Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Jin YJ, Kim KM, Hwang S, Lee SG, Ha TY, Song GW, Jung DH, Kim KH, Yu E, Shim JH, Lim YS, Lee HC, Chung YH, Lee Y, Suh DJ. Exercise and diet modification in non-obese non-alcoholic fatty liver disease: analysis of biopsies of living liver donors. J Gastroenterol Hepatol 2012; 27:1341-7. [PMID: 22554085 DOI: 10.1111/j.1440-1746.2012.07165.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS We evaluated efficacy of exercise and diet modification for steatosis improvement of non-obese non-alcoholic fatty liver disease (NAFLD) patients. METHODS We analyzed retrospectively the clinical and histological parameters of consecutive living liver donors, who experienced repeated liver biopsies due to steatosis and were treated using exercise and diet modification. RESULTS From 1995 to 2009, among a total of 1365 potential living liver donors with NAFLD seen on the initial liver biopsy, 120 consecutive donors with steatosis ≥ 30% or an estimated donor-recipient weight ratio < 0.8, underwent exercise and diet modification and received follow-up liver biopsy at our institution. Median age was 33 years, and median interval between the two consecutive biopsies was 10 weeks (range, 1-39). At the time of initial biopsy, the number of normal body mass index, overweight, and obese donors was 49 (40.8%), 65 (54.2%), and 6 (5.0%), respectively. After lifestyle modification, weight reduction and steatosis improvement were observed in 92 (76.7%) and 103 (85.8%) donors, respectively, at the time of follow-up biopsy. On multivariate analysis, initially higher steatosis (hazard ratio [HR] 1.03, P = 0.02), total cholesterol reduction ≥ 10% (HR 5.59, P = 0.02), and weight reduction ≥ 5% (HR 6.63, P = 0.03) were significantly associated with ≥ 20% steatosis improvement in 120 donors with NAFLD, after exercise and diet modification. CONCLUSIONS Exercise and diet modification were effective in reducing steatosis in potential living liver donors with non-obese NAFLD. Total cholesterol reduction ≥ 10% could be used as a non-invasive predictor for steatosis improvement in liver donors with NAFLD, after exercise and diet modification.
Collapse
Affiliation(s)
- Young-Joo Jin
- Department of Internal Medicine, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Choi HJ, You YK, Na GH, Hong TH, Shetty GS, Kim DG. Single-port laparoscopy-assisted donor right hepatectomy in living donor liver transplantation: sensible approach or unnecessary hindrance? Transplant Proc 2012; 44:347-52. [PMID: 22410013 DOI: 10.1016/j.transproceed.2012.01.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Single-port laparoscopic (SPL) surgery has rapidly gained attention worldwide. Since May 2008, we have propagated the use of SPL surgery, mainly for cholecystectomy and appendectomy. Recently, we have used this modality of minimally invasive surgery for various liver surgeries. We hereby discuss our outcomes of SPL-assisted donor right hepatectomies. METHODS The preoperative workup is the same as for a standard donor hepatectomy. We retrospectively reviewed the data of 150 patients who underwent donor right hepatectomy from October 2008 to May 2011. We divided them into 3 groups depending on the type of surgical procedure. RESULTS Among 150 patients, 20 underwent laparoscopy-assisted donor right hepatectomy (LADRH); 40 underwent single-port laparoscopy-assisted donor right hepatectomy (SPLADRH); and 90 underwent open donor right hepatectomy (ODRH). The donor demographics were comparable among the groups. Postoperative complication and reoperation rates revealed no significant differences. The SPLADRH group showed the lowest level of postoperative pain, thereby leading to a better quality of life postoperatively. CONCLUSIONS SPLADRH seems to be a simple, feasible approach.
Collapse
Affiliation(s)
- H J Choi
- Department of Surgery, Division of Hepatobiliary-Pancreas Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
20
|
Kim BK, Kim SU, Choi GH, Han WK, Park MS, Kim EH, Park JY, Kim DY, Choi JS, Yang SC, Choi EH, Song K, Ahn SH, Han KH, Chon CY. "Normal" liver stiffness values differ between men and women: a prospective study for healthy living liver and kidney donors in a native Korean population. J Gastroenterol Hepatol 2012; 27:781-8. [PMID: 22098121 DOI: 10.1111/j.1440-1746.2011.06962.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Liver stiffness (LS) measurement can distinguish individuals with potential liver disease (LD) from the general population. However, if LS is sex-sensitive, prevalence of LD may be incorrectly estimated when the same reference LS value is applied irrespective of sex. Here, we evaluated whether normal ranges of LS differ between healthy men and women. METHODS LS was measured in a cohort of healthy living liver and kidney donors, none of whom suffered from diabetes mellitus, hypertension, hepatitis B or C virus infection, heart or liver dysfunction, or metabolic syndrome. Patients with abnormal laboratory findings related to potential LD (platelet count < 150 × 10(3) /µL; aspartate aminotransferase > 40 IU/L; alanine aminotransferase [ALT] > 40 IU/L; albumin < 3.3 g/dL; total bilirubin > 1.2 mg/dL; gamma-glutamyl transpeptidase > 54 IU/L; alkaline phosphatase > 115 IU/L) were excluded. RESULTS Among 242 patients analyzed, the mean age was 34.1 for men (n = 121) and 40.5 years for women (n = 121) (P < 0.001). Men had a higher mean LS value than women (5.2 ± 1.2 vs 4.8 ± 1.1 kPa/P < 0.001). Multivariate-linear regression analysis identified sex as the only independent factor for LS values (β = 0.361/P = 0.021). Using the 5th-95th percentiles, we determined normal LS ranges of 3.7-7.0 kPa in men and 3.3-6.8 kPa in women. In subgroups with ALT < 30 IU/L (subgroup-1, n = 216) and ALT < 20 IU/L (subgroup-2, n = 163), men had significantly higher LS values than women (5.2 ± 1.3 vs 4.7 ± 1.1 kPa/P = 0.003 and 5.1 ± 1.2 vs 4.7 ± 1.1 kPa/P = 0.030, respectively), demonstrating an independent sex effect (β = 0.483/P = 0.003 and β = 0.389/P = 0.030, respectively). CONCLUSIONS An independent sex effect on LS values was confirmed. Thus, sex-specific references should be used for effective screening based on LS measurements.
Collapse
Affiliation(s)
- Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Hilmi IA, Planinsic RM. Live liver donors: Are they at a higher risk for post-operative thrombotic complications? World J Transplant 2012; 2:1-4. [PMID: 24175189 PMCID: PMC3812926 DOI: 10.5500/wjt.v2.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 12/20/2011] [Accepted: 02/23/2012] [Indexed: 02/05/2023] Open
Abstract
Live liver donor transplantation to adult recipients is becoming a common practice, increasing the organ pool and providing an alternative to whole cadaveric liver transplantation. These patients are healthy adults without serious medical conditions and typically have normal coagulation profiles preoperatively. Right hepatic lobectomy is usually performed for adult recipients, while left hepatic lobectomy is performed for pediatric recipients. Removal of the whole right lobe from the donors may expose theses patients to multiple intraoperative and postoperative complications. Hypercoagulability has been identified as a serious complication which leads to thromboembolic phenomena with potential fatal consequences. The primary aim of this review is to look at possible changes in post-operative coagulation dynamics that may increase the risk for development of thromboembolic complications in live liver donors. In this article, we stress the importance of addressing the issue that conventional clotting tests (PT, INR, PTT) are unable to detect a hypercoagulable state, and therefore, we should examining alternative laboratory tests to improve diagnosis and early detection of thrombotic complications. Measurement of natural anticoagulant/procoagulant biomarkers combined with conventional coagulation studies and thromboelastography offers a more accurate assessment of coagulation disorders. This allows earlier diagnosis, permitting appropriate intervention sooner, hence avoiding potential morbidity and mortality. Biomarkers that may be evaluated include, but are not limited to: protein C, soluble P-selectin, antithrombin III, thrombin-antithrombin complex, and thrombin generation complex.
Collapse
Affiliation(s)
- Ibtesam Abbass Hilmi
- Ibtesam Abbass Hilmi, Raymond M Planinsic, Department of Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite C-200, Pittsburgh, PA 15213, United States
| | | |
Collapse
|
22
|
Comparative Analysis of Hepatitis C Recurrence and Fibrosis Progression Between Deceased-Donor and Living-Donor Liver Transplantation: 8-Year Longitudinal Follow-Up. Transplantation 2011; 92:453-60. [DOI: 10.1097/tp.0b013e3182259282] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
23
|
Three-dimensional computed tomography analysis of venous collaterals between the middle hepatic vein tributaries and the right hepatic vein in the donor remnant right lobe: report of a case. Surg Today 2011; 41:1266-9. [PMID: 21874428 DOI: 10.1007/s00595-010-4464-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 06/02/2010] [Indexed: 02/06/2023]
Abstract
We report how three-dimensional computed tomography (3D-CT) showed the development of obvious venous collaterals between the middle hepatic vein (MHV) tributaries and the right hepatic vein (RHV) in the remnant right lobe of a donor liver. The donor was a healthy 34-year-old man who donated the left lobe of his liver with the MHV. The 3D-CT calculated that the total drainage of the MHV tributaries was 413 ml, corresponding to 59% of the total remnant liver. The congestion calculated by 3D-CT decreased from 286 ml on postoperative day (POD) 7 to 28 ml on POD 35, corresponding to 36% and 3% of the total remnant liver, respectively. The donor was discharged from hospital with almost normal liver function, and 3D-CT analysis on POD 35 detected obvious venous collaterals between the MHV tributaries and the RHV. These findings suggest that reconstruction of the MHV tributaries in the donor remnant right lobe may not be necessary.
Collapse
|
24
|
Liver allograft outcomes after laparoscopic-assisted and minimal access live donor hepatectomy for transplantation. Am J Surg 2011; 201:450-5. [PMID: 21421098 DOI: 10.1016/j.amjsurg.2010.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND The critical shortage of deceased organ donors has led to live-donor hepatectomy as an alternative donor option for transplantation. Although laparoscopic hepatectomy has been well described for management of liver tumors and can be performed safely, few studies have examined early recipient allograft outcomes after laparoscopic live-donor hepatectomy. We describe our initial experience with laparoscopic-assisted and minimal-access donor hepatectomy and its potential as a safe alternative with graft function comparable with open resection in live-donor liver transplantation. METHODS We performed a retrospective analysis of our past 30 successive live-donor transplants between 2005 and 2009. Fifteen allografts were procured by standard open live-donor (OLD) hepatectomy, and 15 by laparoscopic-assisted (LALD) or minimal-access (MA) live-donor hepatectomy. Left lateral segment grafts were subcategorized and analyzed further. RESULTS Mean donor age, sex, and liver anatomy were comparable between donor groups. Early graft function as measured by peak total bilirubin level, aspartate aminotransferase level, alanine aminotransferase level, and international normalized ratio on postoperative days 2, 7, 30, and 90 were similar between groups, although the international normalized ratio was slightly more increased on postoperative day 7 in LALD grafts (1.75 ± .45 vs 1.28 ± .16; P = .02). Perioperative allograft biliary (2 of 15 vs 0 of 15; P = .48) and vascular (3 of 15 vs 1 of 15; P = .6) complication rates also were comparable between OLD and LALD/MA grafts. One-year graft and patient survival for LALD/MA was 100% compared with 93% for OLD. CONCLUSIONS Our experience shows that LALD or MA live-donor hepatectomy is a safe procedure and produces early graft function comparable with standard OLD hepatectomy. Multicenter, larger-volume experience will determine the widespread application of this technique.
Collapse
|
25
|
Usage of 64-detector-row spiral computed tomography volumetry in preoperative volume prediction in living donor liver transplantation in children. Pediatr Surg Int 2011; 27:445-9. [PMID: 21258936 DOI: 10.1007/s00383-010-2830-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the correlation between the graft volume calculated by 64-detector-row spiral computed tomography (CT) and the graft weight measured during the living donor liver transplantation (LDLT) operation, and try to get an equation to help determine the possible weight of graft before operation. METHODS 23 donors with left lateral lobe LDLT were enrolled to undergo 64-detector-row spiral CT and the imaging data at the hepatic venous phase was used for whole and partial liver volumetric measurement on a dedicated image postprocessing workstation. The resected part of donor liver was weighed during the operation. Statistical analysis with SPSS15.0 was used to analyze the correlation between the estimated liver volume by CT and the actual graft weight. RESULTS The graft volume calculated preoperatively by CT (293.35 ± 53.43 ml) was significantly larger than measured graft weight during the operation (252.82 ± 50.96 g) (P < 0.05). All corresponding pre- and intraoperative data correlated significantly (R = 0.885) (P < 0.001). Intraoperatively expected weight (W (intraop)) in grams and volume calculated preoperatively by CT (V (preop)) in milliliters can be calculated with the equation W (intraop) (g) = 0.844 × V (preop) (ml) + 5.271. CONCLUSION Liver volume calculated by 64-detector-row spiral CT preoperatively can predict the actual graft weight, which is very useful in donor selection in LDLT.
Collapse
|
26
|
Radtke A, Sotiropoulos GC, Sgourakis G, Molmenti EP, Schroeder T, Saner FH, Beckebaum S, Schenk A, Lang H, Broelsch CE, Malagó M. “Anatomical” versus “Territorial” Belonging of the Middle Hepatic Vein: Virtual Imaging and Clinical Repercussions. J Surg Res 2011; 166:146-55. [DOI: 10.1016/j.jss.2009.07.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 06/09/2009] [Accepted: 07/02/2009] [Indexed: 11/26/2022]
|
27
|
Azoulay D, Bhangui P, Andreani P, Salloum C, Karam V, Hoti E, Pascal G, Adam R, Samuel D, Ichai P, Saliba F, Castaing D. Short- and long-term donor morbidity in right lobe living donor liver transplantation: 91 consecutive cases in a European Center. Am J Transplant 2011; 11:101-10. [PMID: 21199351 DOI: 10.1111/j.1600-6143.2010.03284.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The lack of use of a common grading system in reporting morbidity impedes estimation of the true risk to a right lobe living donor (RLLD). We report outcomes in 91 consecutive RLLD's using the validated 5-tier Clavien grading and a quality of life (QOL) questionnaire. The median follow-up was 79 months. The donors were predominantly female (66%), 22 (24%) received autologous blood transfusions. Fifty-three complications occurred in 43 donors (47% morbidity), 19 (37%) were ≥ Grade III, biliary fistula (14%) was the most common. There was no donor mortality. Two intraoperative complications could not be graded and two disfiguring complications in female donors were graded as minor. Two subgroups (first 46 vs. later 45 donors) were compared to study the presence if any, of a learning curve. The later 45 donors had lesser autologous transfusions, lesser rehospitalization and no reoperation and a reduction in the proportion of ≥ Grade III (major) complications (24% vs. 50%; p = 0.06). In the long term, donors expressed an overall sense of well being, but some sequelae of surgery do restrain their current lifestyle. Our results warn against lackadaisical vigilance once RLLD hepatectomy becomes routine.
Collapse
Affiliation(s)
- D Azoulay
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Clavien PA, Oberkofler CE, Raptis DA, Lehmann K, Rickenbacher A, El-Badry AM. What is critical for liver surgery and partial liver transplantation: size or quality? Hepatology 2010; 52:715-29. [PMID: 20683967 DOI: 10.1002/hep.23713] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Pierre-Alain Clavien
- Swiss Hepato-Pancreatico-Biliary and Transplantation Center, Department of Surgery, University of Zurich, Zurich, Switzerland.
| | | | | | | | | | | |
Collapse
|
29
|
Radtke A, Sgourakis G, Sotiropoulos G, Beckebaum S, Molmenti E, Saner F, Schroeder T, Nadalin S, Schenk A, Lang H, Malagó M, Broelsch C. Donor/recipient algorithm for management of the middle hepatic vein in right graft live donor liver transplantation. Am J Surg 2010; 199:708-15. [DOI: 10.1016/j.amjsurg.2009.03.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 03/06/2009] [Accepted: 03/06/2009] [Indexed: 10/19/2022]
|
30
|
Adcock L, Macleod C, Dubay D, Greig PD, Cattral MS, McGilvray I, Lilly L, Girgrah N, Renner EL, Selzner M, Selzner N, Kashfi A, Smith R, Holtzman S, Abbey S, Grant DR, Levy GA, Therapondos G. Adult living liver donors have excellent long-term medical outcomes: the University of Toronto liver transplant experience. Am J Transplant 2010; 10:364-71. [PMID: 20415904 DOI: 10.1111/j.1600-6143.2009.02950.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Right lobe living donor liver transplantation is an effective treatment for selected individuals with end-stage liver disease. Although 1 year donor morbidity and mortality have been reported, little is known about outcomes beyond 1 year. Our objective was to analyze the outcomes of the first 202 consecutive donors performed at our center with a minimum follow-up of 12 months (range 12-96 months). All physical complications were prospectively recorded and categorized according to the modified Clavien classification system. Donors were seen by a dedicated family physician at 2 weeks, 1, 3 and 12 months postoperatively and yearly thereafter. The cohort included 108 males and 94 females (mean age 37.3 +/- 11.5 years). Donor survival was 100%. A total of 39.6% of donors experienced a medical complication during the first year after surgery (21 Grade 1, 27 Grade 2, 32 Grade 3). After 1 year, three donors experienced a medical complication (1 Grade 1, 1 Grade 2, 1 Grade 3). All donors returned to predonation employment or studies although four donors (2%) experienced a psychiatric complication. This prospective study suggests that living liver donation can be performed safely without any serious late medical complications and suggests that long-term follow-up may contribute to favorable donor outcomes.
Collapse
Affiliation(s)
- L Adcock
- Liver Transplant Program, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Radtke A, Sgourakis G, Sotiropoulos GC, Molmenti EP, Nadalin S, Schroeder T, Saner F, Schenk A, Cincinnati VR, Broelsch CE, Lang H, Malagó M. Vascular and biliary anatomy of the right hilar window: its impact on recipient morbidity and mortality for right graft live donor liver transplantation. World J Surg 2009; 33:1941-51. [PMID: 19603222 DOI: 10.1007/s00268-009-0128-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Intrahepatic anatomic variations have been associated with both morbidity and mortality associated with live donor liver transplantation. The aim of our study was to evaluate central hilar and peripheral segmental vascular/biliary anatomy in right graft living donor liver transplantation. METHODS From January 2003 to August 2007, three-dimensional (3D) computed tomography (CT) reconstructions and virtual 3D hepatectomies were performed in 71 consecutive right graft live liver donors. A combined two-level classification system addressing the four possible combinations of normal (N) and abnormal (A) central hilar and peripheral features based on both the existing classification and our own classification for portal (portal vein, PV), arterial (hepatic artery, HA) and biliary (bile duct, BD) systems was defined as follows: type I, N/N; type II, N/A; type III, A/N; and type IV, A/A. RESULTS A simultaneous normal central hilar and peripheral segmental (N/N) anatomy for each system (PV, HA, BD) was found in <50% of grafts. The highest incidence of complex vascular and biliary reconstructions was observed with grafts having abnormal central (type III) or combined abnormal central/peripheral (type IV) anatomy. Central hilar arterial and biliary anomalies were predictors of morbidity by both univariable and multivariable analyses. CONCLUSIONS Our two-level classification and 3D imaging techniques allowed a cautious surgical approach in high-risk cases. Central hilar anatomic variants of the arterial and biliary systems were associated with increased morbidity. Further randomized trials will help determine the precise extent of our observations.
Collapse
Affiliation(s)
- Arnold Radtke
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Selzner M, Kashfi A, Cattral MS, Selzner N, Greig PD, Lilly L, McGilvray ID, Therapondos G, Adcock LE, Ghanekar A, Levy GA, Renner EL, Grant DR. A graft to body weight ratio less than 0.8 does not exclude adult-to-adult right-lobe living donor liver transplantation. Liver Transpl 2009; 15:1776-82. [PMID: 19938139 DOI: 10.1002/lt.21955] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many centers require a minimal graft to body weight ratio (GBWR) >or= 0.8 as an arbitrary threshold to proceed with right-lobe living donor liver transplantation (RL-LDLT), and there is often hesitancy about transplanting lower volume living donor (LD) liver grafts into sicker patients. The data supporting this dogma, based on the early experience with RL-LDLT at Asian centers, are weak. To determine the effect of LD liver volume in the modern era, we investigated the impact of GBWR on the outcome of RL-LDLT with a GBWR as low as 0.6 at the University of Toronto. Between April 2000 and September 2008, 271 adult-to-adult RL-LDLT procedures and 614 deceased donor liver transplants were performed. Twenty-two living donor liver transplantation (LDLT) cases with a GBWR of 0.59 to 0.79 (group A) were compared with 249 LDLT cases with a GBWR >or= 0.8 (group B) and with 66 full-graft deceased donor liver transplants (group C), who were matched 3:1 according to donor and recipient age, Model for End-Stage Liver Disease score, and presence of hepatitis C and hepatocellular carcinoma with the low-GBWR group. Portal vein shunts were not used. Markers of reperfusion injury [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], graft function (international normalized ratio and bilirubin), complications graded by the Clavien score, and graft and patient survival were compared. As expected, LD recipients had a significantly shorter cold ischemia time (94 +/- 43 minutes for A, 96 +/- 57 minutes for B, and 453 +/- 152 minutes for C, P = 0.0001). However, the peak AST, peak ALT, absolute decrease in the international normalized ratio, day 7 bilirubin level, postoperative creatinine clearance, complication rate graded by the Clavien score, and median hospital stay were similar in all groups. The rate of biliary complications was higher with LD grafts than deceased donor grafts (19% for A versus 10% for B and 0% for C, P = 0.2). Patient survival was similar in all groups at 1, 3, and 5 years (91% for A versus 89% for B and 93% for C at 1 year, 87% for A versus 81% for B and 89% for C at 3 years, and 83% for A versus 81% for B and 87% for C at 5 years, P = 0.63). A Cox proportional regression analysis revealed only hepatitis C virus as a risk factor for poorer graft survival and not GBWR as a continuous or categorical variable. In conclusion, we found no evidence of inferior outcomes with smaller size grafts versus larger size LD grafts or full-size deceased donor grafts. Further studies are warranted to examine the factors affecting the function of smaller grafts for living liver donation and thereby define the safe lower limits for transplantation.
Collapse
Affiliation(s)
- Markus Selzner
- Multiorgan Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Lin TS, Concejero AM, Chen CL, Chiang YC, Wang CC, Wang SH, Liu YW, Yang CH, Yong CC, Jawan B, Cheng YF. Routine microsurgical biliary reconstruction decreases early anastomotic complications in living donor liver transplantation. Liver Transpl 2009; 15:1766-75. [PMID: 19938121 DOI: 10.1002/lt.21947] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Biliary reconstruction using a microsurgical technique in living donor liver transplantation was routinely performed on 88 grafts primarily transplanted into 85 patients. All procedures were performed under a microscope by a single microsurgeon. Except for biliary atresia and Alagille syndrome, duct-to-duct reconstruction was performed. Stents were not used. The outcomes with microsurgical biliary reconstruction (MB) were compared with the outcomes of a cohort of 86 grafts in 85 patients that underwent conventional biliary reconstruction (CB). The identification of complications included only up to 12 months of follow-up for each recipient in both groups. The average graft duct sizes were 2.8 mm for MB and 3.4 mm for CB. Most complications occurred in the first 15 cases with MB, and these cases were considered to constitute the learning curve phase. The MB complication rate was 46.7% in the first 15 cases, 20.0% in the next 15 cases, and 5.4% in the last 55 cases. When the learning curve phase was excluded, the overall complication rate over time with MB (8.9%) was significantly lower than that with CB (21.9%). CB increased the risk of biliary complications by 2.5 times (relative risk: 2.5; attributable risk: 128; odds ratio: 2.9). In conclusion, routine MB is a technical innovation that leads to decreased early anastomotic complications in living donor liver transplantation.
Collapse
Affiliation(s)
- Tsan-Shiun Lin
- Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Baker TB, Jay CL, Ladner DP, Preczewski LB, Clark L, Holl J, Abecassis MM. Laparoscopy-assisted and open living donor right hepatectomy: a comparative study of outcomes. Surgery 2009; 146:817-23; discussion 823-5. [PMID: 19789043 DOI: 10.1016/j.surg.2009.05.022] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 05/21/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Minimally invasive liver surgery is a rapidly advancing field with demonstrated applicability to living donation. In this paper, we compare the safety and efficacy of laparoscopy-assisted donor right hepatectomy (LADRH) to open donor right hepatectomy (ODRH). METHODS We performed a retrospective, comparative analysis of 33 LADRH to the most recent 33 ODRH performed at our institution, evaluating donor complications, costs, and recipient outcomes. RESULTS Donor demographics including age, gender, body mass index (BMI), and vascular and biliary anomalies were comparable. Donor complication rates were equivalent for LADRH and ODRH. Donor operative times were shorter for LADRH (LADRH 265 minutes, ODRH 316; P < .001) even after adjusting for BMI. Blood loss and length of stay were comparable. Additionally, total hospitalization costs were equivalent (LADRH $1.11, ODRH $1.00; P = .19). Higher operative supply costs for LADRH were balanced by higher time-based operative costs for ODRH resulting in no significant differences in total operative costs. Finally, there were no differences in graft size, recipient patient or graft survival, or recipient vascular or biliary complications. CONCLUSION Our experience suggests that LADRH compares favorably with ODRH with equivalent safety, resource utilization, and effectiveness. We believe that LADRH provides potential physical and psychological benefits without an adverse effect on outcomes.
Collapse
Affiliation(s)
- Talia B Baker
- Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
García-Valdecasas JC, Fuster J, Fondevila C, Calatayud D. [Adult living-donor liver transplantation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:577-83. [PMID: 19647346 DOI: 10.1016/j.gastrohep.2009.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 02/13/2009] [Indexed: 11/30/2022]
Abstract
Living donor liver transplantation in adults continues to be controversial. Viewed as an alternative to prevent deaths on the waiting list, this type of transplant is the only possibility in Asian countries (Japan, Korea, China, etc) but is not widely applied in the west. This intervention is associated with significant donor morbidity (depending on the scale of the intervention) and mortality which, although sporadic, reduces its acceptance, especially in a context with high cadaveric donation. Outcomes in recipients are similar to those in cadaveric transplant recipients, although the high incidence of biliary complications could compromise long-term results. We describe the experience of Hospital Clínic in a total of 67 transplant recipients. Graft and patient survival at 1 and 5 years was 90.7%, 70.3%, 90.7% and 77.6%, respectively. Although the frequency of biliary complications was high (37.3%), death from sepsis and retransplantation only occurred in two patients.
Collapse
Affiliation(s)
- Juan Carlos García-Valdecasas
- Departamento de Cirugía, Universidad de Barcelona, IDIBAPS, CIBEREHD, Unidad de Trasplante Hepático, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
| | | | | | | |
Collapse
|
36
|
Dirsch O, Li J, He Q, Ji Y, Gu YL, Dahmen U. Induction of rejection after small-for-size liver transplantation: size matters. J INVEST SURG 2009; 21:288-98. [PMID: 19160137 DOI: 10.1080/08941930802216823] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reduced-size liver transplantation is associated with liver regeneration. This study was designed to analyze the influence of graft size on liver rejection and liver regeneration. METHODS Reduced-size liver transplantations were performed in the rejecting ACI to Lewis and the graft acceptance BN to Lewis strain combination. The BN to Lewis control group was treated with the immunosuppressive drug FK506. RESULTS An accelerated liver rejection in the ACI to Lewis strain combination was found in small-for-size partial liver grafts. Graft weight to recipient liver weight ratio (GW/RLW) showed a positive correlation with survival time. In the BN to Lewis strain combination, lethal rejection was seen in small-for-size partial liver grafts. A critical immunologic GW/RLW of 33% was calculated. In rats dying from lethal rejection, GW/RLW and survival time showed a positive correlation. However, GW/RLW showed a negative correlation with hepatocellular proliferation. In regenerating livers, MHC II upregulation was also observed in the control group. All control animals survived small-for-size liver transplantation. CONCLUSIONS The relative graft size seems to be a decisive factor influencing the kinetic of liver rejection and the induction of liver rejection. Relative critical immunologic liver mass was determined to be 33%.
Collapse
Affiliation(s)
- Olaf Dirsch
- Institute of Pathology, University Hospital Cologne, Cologne
| | | | | | | | | | | |
Collapse
|
37
|
De Carlis L, Lauterio A, Giacomoni A, Slim AO, Pirotta V, Mangoni J, Mihaylov P. Adult living donor liver transplantation with right lobe graft: the venous outflow management in the Milan-Niguarda experience. Transplant Proc 2008; 40:1944-6. [PMID: 18675096 DOI: 10.1016/j.transproceed.2008.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In right lobe living donor liver transplantation (ALDLT), reconstruction of middle hepatic vein (MHV) tributaries is often necessary to avoid severe graft congestion. From March 2001, we performed 36 right lobe ALDLT (segments 5, 6, 7, and 8) without MHV and one pediatric transplant (segments 2 and 3). In the presence of MHV tributaries larger than 5 mm, we intraoperatively evaluated the need for reconstruction. At a mean follow-up of 848 days (range=8-2412), 33/37 transplanted patients are alive with overall patient and graft survivals of 89.2% and 83.8%, respectively. Large MHV tributaries (>5 mm) were present in 10 cases, and inferior right hepatic veins (IRHV) draining segment 6 in 11 cases. In 10 cases, we performed an end-to-side anastomosis between the IRHV and the side of the recipient vena cava. In three cases, the MHV tributaries were end-to-end anastomosed to the stump of the recipient MHV. In all other cases, the vein tributaries were not reconstructed. A computed tomography scan performed from 1 to 3 months after surgery did not show any congested area in the liver parenchyma. In our experience, reconstruction of the MHV tributaries was not always necessary when graft-to-recipient weight ratio is >0.8. Pre- and intraoperative evaluation of the segmental branches of the hepatic vein is crucial to decide about reconstructing these collaterals. Anastomosis of V5 or V8 to the stump of the recipient MHV reduces the number of vascular anastomosis and maintains a physiological angle between these collaterals and the caval vein.
Collapse
Affiliation(s)
- L De Carlis
- Hepato-biliary Surgery and Liver Transplantation Unit, Azienda Ospedaliera Niguarda Cà Granda, Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
38
|
Kayashima H, Taketomi A, Yonemura Y, Ijichi H, Harada N, Yoshizumi T, Soejima Y, Yoshimitsu K, Maehara Y. Accuracy of an age-adjusted formula in assessing the graft volume in living donor liver transplantation. Liver Transpl 2008; 14:1366-71. [PMID: 18756495 DOI: 10.1002/lt.21547] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In living donor liver transplantation, the estimated graft volume (GV) from young donors tends to be overestimated. One reason for this error may be a decrease in GV due to dehydration by University of Wisconsin (UW) solution. The aim of this study was to clarify (1) the usefulness of an age-adjusted formula and (2) the correlation between the decrease in GV and donor age. First, we created the age-adjusted formula using regression analysis retrospectively in 167 donors, and we evaluated the difference in the error ratio of GV from the age-adjusted formula and 3-dimensional computed tomography (3D-CT) prospectively in 49 donors. Second, we measured intraoperative GV both before and after flushing with UW solution and calculated the decrease ratio, and we then evaluated the difference in the decrease ratio between young donors and older donors prospectively in 41 donors. The age-adjusted formula was created as follows: age-adjusted GV = 70.767 + (0.703 x GV estimated with 3D-CT volumetry) + (1.298 x donor age). The mean error ratio for the age-adjusted formula (9.6%) was significantly lower than that from 3D-CT (14.0%). The mean decrease ratio in all 41 donors was 5.4%, and that in young donors (6.9%) was significantly higher than that in older donors (4.4%). In conclusion, although younger donor age is a major factor for estimation errors in hepatic volumetry, our age-adjusted formula is very useful in reducing the error in estimating GV.
Collapse
Affiliation(s)
- Hiroto Kayashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
MR Cholangiography for Evaluation of Hilar Branching Anatomy in Transplantation of the Right Hepatic Lobe from a Living Donor. AJR Am J Roentgenol 2008; 191:537-45. [DOI: 10.2214/ajr.07.3162] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
40
|
The Role of Basiliximab Induction Therapy in Adult-to-Adult Living-Related Transplantation and Deceased Donor Liver Transplantation: A Comparative Retrospective Analysis of a Single-Center Series. Transplant Proc 2008; 40:1953-5. [DOI: 10.1016/j.transproceed.2008.05.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
41
|
Giacomoni A, Lauterio A, Donadon M, De Gasperi A, Belli L, Slim A, Dorobantu B, Mangoni I, De Carlis L. Should we still offer split-liver transplantation for two adult recipients? A retrospective study of our experience. Liver Transpl 2008; 14:999-1006. [PMID: 18581461 DOI: 10.1002/lt.21466] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The role of split-liver transplantation (SLT) for two adult recipients is still a matter of debate, and no agreement exists on indications, surgical techniques, and results. The aim of this study was to retrospectively analyze the outcome of our series of SLT. From May 1999 to December 2006, 16 patients underwent SLT at our unit. We used 9 full right grafts (segments 5-8) and 7 full left grafts (segments 1-4). The splitting procedure was always carried out in situ with a fully perfused liver. Postoperative complications were recorded in 8 (50%) patients: 5 (55%) in full right grafts and 3 (43%) in full left grafts. No one was retransplanted. After a median follow-up of 55.82 months (range, 0.4-91.2), 5 (31%) patients died, and the 1-, 3-, and 5-year overall survival rate for patients and grafts was 69%. We considered as a control group for the global outcome 232 whole liver transplantations performed at our unit in the same period of time. Postoperative complications were recorded in 53 (23%) patients, and after a median follow-up of 57.37 months (mean, 55.11; range, 1-102.83), the 1-, 3-, and 5-year overall patient survival was 87%, 82%, and 80%, respectively. In conclusion, SLT for two adult recipients is a technically demanding procedure that requires complex logistics and surgical teams experienced in both liver resection and transplantation. Although the reported rate of survival might be adequate for such a procedure, more efforts have to be made to improve the short-term outcome, which is inadequate in our opinion. The true feasibility of SLT for two adults has to be considered as still under investigation.
Collapse
Affiliation(s)
- Alessandro Giacomoni
- Hepatobiliary Surgery and Liver Transplantation Unit, Niguarda Hospital, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Brown RS. Live donors in liver transplantation. Gastroenterology 2008; 134:1802-13. [PMID: 18471556 PMCID: PMC2654217 DOI: 10.1053/j.gastro.2008.02.092] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 01/31/2008] [Accepted: 02/06/2008] [Indexed: 12/13/2022]
Abstract
Living donor liver transplantation (LDLT) has been controversial since its inception. Begun in response to deceased donor organ shortage and waiting list mortality, LDLT was initiated in 1989 in children, grew rapidly after its first general application in adults in the United States in 1998, and has declined since 2001. There are significant risks to the living donor, including the risk of death and substantial morbidity, and 2 highly publicized donor deaths are thought to have contributed to decreased enthusiasm for LDLT. Significant improvements in outcomes have been seen over recent years, and data, including from the National Institutes of Health-funded Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL), have established a survival benefit from pursuing LDLT. Despite this, LDLT still composes less than 5% of adult liver transplants, significantly less than in kidney transplantation where living donors compose approximately 40% of all transplantations performed. The ethics, optimal utility, and application of LDLT remain to be defined. In addition, most studies to date have focused on posttransplantation outcomes and have not included the effect of the learning curve on outcome or the potential impact of LDLT on waiting list mortality. Further growth of LDLT will depend on defining the optimal recipient and donor characteristics for this procedure as well as broader acceptance and experience in the public and in transplant centers.
Collapse
Affiliation(s)
- Robert S. Brown
- Center for Liver Diseases and Transplantation, Columbia College of Physicians and Surgeons, New York, NY
| |
Collapse
|
43
|
Russo MW. Current concepts in the evaluation of patients for liver transplantation. Expert Rev Gastroenterol Hepatol 2007; 1:307-20. [PMID: 19072423 DOI: 10.1586/17474124.1.2.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Candidates for liver transplantation undergo a thorough medical, surgical, psychosocial and financial evaluation prior to listing for transplantation. Prioritization for allocating livers is based upon the model for end-stage liver disease score and waiting-time mortality with the fundamental concept of giving organs to the sickest first. In the upcoming years the allocation system may be modified to include other factors associated with mortality, such as serum sodium, and may incorporate both pre- and post-transplant mortality. Strategies to expand the donor pool include utilizing livers from donors after cardiac death, split liver transplantation and living donor liver transplantation. Future challenges for liver transplantation will include the obesity epidemic and the prevention and treatment of recurrent disease, particularly hepatitis C.
Collapse
Affiliation(s)
- Mark W Russo
- Carolinas Medical Center, Transplant Center, 3rd Floor Annex Building, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
| |
Collapse
|
44
|
Dimitroulopoulos D, Xinopoulos D, Tsamakidis K, Zisimopoulos A, Andriotis E, Panagiotakos D, Fotopoulou A, Chrysohoou C, Bazinis A, Daskalopoulou D, Paraskevas E. Long acting octreotide in the treatment of advanced hepatocellular cancer and overexpression of somatostatin receptors: Randomized placebo-controlled trial. World J Gastroenterol 2007; 13:3164-70. [PMID: 17589893 PMCID: PMC4436600 DOI: 10.3748/wjg.v13.i23.3164] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC).
METHODS: A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with 111Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner.
RESULTS: Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49 ± 6 wk) as compared to the control group (28 ± 1 wk) and to the SSTR negative group (28 ± 2 wk), LR = 20.39, df = 2, P < 0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the first year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group respectively.
CONCLUSION: The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.
Collapse
Affiliation(s)
- D Dimitroulopoulos
- Liver Cancer Unit, Agios Savvas Cancer Hospital, 35 Parnassou str., GR-152 34 Halandri-Athens, and Laboratory of Biostatistics, Department of Nursing, University of Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200706010-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|
46
|
Yan L, Li B, Zeng Y, Wen T, Zhao J, Wang W, Yang J, Xu M, Ma Y, Chen Z, Liu J, Wu H. Preliminary experience in adult-to-adult living donor liver transplantation in a single center in China. FRONTIERS OF MEDICINE IN CHINA 2007; 1:136-41. [PMID: 24557665 DOI: 10.1007/s11684-007-0026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 12/10/2006] [Indexed: 02/05/2023]
Abstract
The aim of this paper is to report the authors' experience in performing adult-to-adult living donor liver transplantation (LDLT) by using a modified technique in using grafts of the right lobe of the liver. From January 2002 to September 2006, 56 adult patients underwent LDLT using right lobe grafts at the West China Hospital, Sichuan University Medical School, China. All patients underwent a modified operation designed to improve the reconstruction of the right hepatic vein (RHV) and the tributariers of the middle hepatic vein (MHV) by interposing a vessel graft, and by anastomosing the hepatic arteries and bile ducts. There were no severe complications or deaths in all donors. Fifty-two (92.8%) recipients survived the operations. Among the 56 recipients, complications were seen in 15 recipients (26.8%), including hepatic vein stricture (one case), small-for-size syndrome (one case), hepatic artery thrombosis (two cases), intestinal bleeding (one case), bile leakage (two cases), left subphrenic abscess (one case), renal failure (two cases) and pulmonary infection (five cases). Within three months after transplantation, four recipients (7.14%) died due to small-for-size syndrome (one case), renal failure (one case) and multiple organ failure (two cases). All patients underwent direct anastomoses of the RHV and the inferior vena cava (IVC), and in 23 cases, reconstruction of the right inferior hepatic vein was also done. In 24 patients, the reconstruction of the tributaries of the MHV was also done by interposing a vessel graft to provide sufficient venous outflow. Trifurcation of the portal vein was seen in nine cases. Thus, veno-plasty or separate anastomoses were performed. The graft and recipient body weight ratios (GRWR) were between 0.72% and 1.43%, and in three cases it was <0.8%. The graft weight to recipient standard liver volume ratios (GV/SLV) were between 31.86% and 71.68%, among which four cases had <40%. No "small-for-size syndrome" occurred. With modification of the surgical technique, especially in the reconstruction of the hepatic vein to provide sufficient venous outflow, living donor liver grafts in adults using the right lobe of the liver can become a relatively safe procedure and prevent the "small-for-size syndrome".
Collapse
Affiliation(s)
- Lunan Yan
- Liver Transplantation Division, Department of Surgery, West China Hospital, Sichun University Medical School, Chengdu, 610041, China,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kodama Y, Ng CS, Wu TT, Ayers GD, Curley SA, Abdalla EK, Vauthey JN, Charnsangavej C. Comparison of CT methods for determining the fat content of the liver. AJR Am J Roentgenol 2007; 188:1307-12. [PMID: 17449775 DOI: 10.2214/ajr.06.0992] [Citation(s) in RCA: 362] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to assess which of a number of methods of measuring attenuation on CT scans is best for prediction of hepatic fat content. MATERIALS AND METHODS This retrospective study was approved by our institutional review board. Consecutively registered patients who underwent liver resection for metastatic disease formed the study group. Attenuation measurements were obtained from 12 regions of interest in the liver and three in the spleen on both unenhanced and portal phase contrast-enhanced preoperative hepatic CT images. Hepatic attenuation measurements were analyzed both with and without normalization with the spleen. Normalization included both differences and ratios between hepatic and splenic attenuation values. Pathologic fat content was graded semiquantitatively as a percentage of the nonneoplastic liver parenchyma of the resected specimen. Average attenuation values of the liver were compared with pathologic fat content, as were the differences and ratios between hepatic and splenic attenuation values. Linear regression analysis was conducted on a log-log scale. RESULTS Data on 88 patients were analyzed. On unenhanced and contrast-enhanced CT images, all associations between pathologic fat content and attenuation measurements were significant (p < 0.0001). All series of R2 values for unenhanced CT scans were much higher than those for contrast-enhanced CT scans. The R2 values of liver-only measurement were higher than those of hepatic values normalized with splenic values on both unenhanced (0.646-0.649 > 0.523, 0.565) and contrast-enhanced (0.516 > 0.242, 0.344) CT. CONCLUSION Measurement of attenuation of liver only on unenhanced CT scans is best for prediction of pathologic fat content.
Collapse
Affiliation(s)
- Yoshihisa Kodama
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 368, Houston TX 77030, USA
| | | | | | | | | | | | | | | |
Collapse
|
48
|
When duties collide: beneficence and veracity in the evaluation of living organ donors. Curr Opin Organ Transplant 2007. [DOI: 10.1097/mot.0b013e3280951965] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
49
|
Gruttadauria S, Marsh JW, Cintorino D, Biondo D, Luca A, Arcadipane A, Vizzini G, Volpes R, Marcos A, Gridelli B. Adult to adult living-related liver transplant: report on an initial experience in Italy. Dig Liver Dis 2007; 39:342-50. [PMID: 17337259 DOI: 10.1016/j.dld.2007.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/21/2006] [Accepted: 01/09/2007] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Living-related liver transplantation has become the treatment of choice for many liver diseases. We present our initial analysis of 53 cases of adult to adult living-related liver transplantation performed in a single institute in Italy. MATERIALS AND METHODS From January 2002 to September 2006, we performed 53 adult to adult living-related liver transplantations. The donors (age 18-53) all had genetic or emotional relationships; they were all ABO identical or compatible. Recipients (ages 18-68) suffered from cirrhosis secondary to viral etiology (18), hepatocellular carcinoma with viral cirrhosis (24), cystic fibrosis (2), primary biliary cirrhosis (2), hepatocellular carcinoma with non-viral cirrhosis (2), alcoholic cirrhosis (1), ornithine transcarbamylase deficiency (OTC), (1) criptogenic cryptogenic cirrhosis, (1) primary sclerosing cholangitis, (1) biliary atresia and metastatic carcinoid (1). Donor liver resection resulted in 51 right hepatectomies and two left hepatectomies. Graft body weight ratio was always above 0.8%; graft implantation was performed with the piggy back technique and, in 43 cases, with the use of veno-venous bypass. RESULTS There was neither donor mortality nor need of blood transfusion. Actuarial recipient survival rate at 3 years was 82.66% and graft survival rate was 75.34%. Six patients underwent retransplantation: in four cases due to hepatic artery thrombosis, and in two, due to graft dysfunction. Three patients had one episode each of acute cellular rejection. CONCLUSION Adult to adult living-related liver transplantation represents a resource to be used in confronting organ shortage, and is a valuable option for decreasing mortality and drop out from the waiting list.
Collapse
Affiliation(s)
- S Gruttadauria
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies, University of Pittsburgh Medical Center in Italy, Palermo, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Radtke A, Nadalin S, Sotiropoulos GC, Molmenti EP, Schroeder T, Valentin-Gamazo C, Lang H, Bockhorn M, Peitgen HO, Broelsch CE, Malagó M. Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein. World J Surg 2007; 31:175-85. [PMID: 17180479 DOI: 10.1007/s00268-005-0718-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An adequate venous outflow is essential for securing viability of both graft and remnant in adult living donor liver transplantation (ALDLT). Seventy-five potential live liver donors were evaluated for LDLT by means of an "all-in-one" CT, which defined the biliary tree, portal vein, hepatic artery, and hepatic vein anatomy. The acquired data sets were further analysed by means of the software HepaVision (MeVis, Germany). Only a minority (29%) of potential donors were found to have a vascular and biliary anatomy consistent with the classically described "normal" patterns. The vast majority (71%) had "anatomical variations". Thirty-nine (52%) donors underwent ALDLT hepatectomy. The right hepatic vein was dominant in 64 cases, representing 48 +/- 6% of the total liver volume (TLV). The middle hepatic vein was dominant in 11 cases, making up 40 +/- 8% of the TLV. The left hepatic vein was never dominant. The volume contribution of the middle hepatic vein (MHV) was 114-782 ml for the right and 87-419 ml for the left hemiliver. Computer-assisted planning allows for the 3D reconstruction of the vascular and biliary anatomy, automatic calculation of the total and territorial liver volumes, and risk analysis of hepatic vein dominance relationships. This comprehensive data acquisition supports preoperative evaluation and provides a high degree of safety for donors and improved outcomes for recipients.
Collapse
Affiliation(s)
- A Radtke
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|