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Nian Y, Hu L, Cao Y, Wang Z, Wang H, Feng G, Zhao J, Zheng J, Song W. Measuring the Impact of Postsimultaneous Pancreas-Kidney Transplantation Complications: Comparing the Comprehensive Complication Index and Clavien-Dindo Classification. Clin Transplant 2024; 38:e15440. [PMID: 39212255 DOI: 10.1111/ctr.15440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The Clavien-Dindo classification (CDC) is commonly used for assessing postoperative complications; however, it may not be comprehensive. A comprehensive complication index (CCI) was introduced to address this limitation. This study aimed to compare the effectiveness of the CCI and CDC in evaluating the complications after simultaneous pancreas-kidney (SPK) transplantation. METHODS Data were collected from patients who underwent SPK transplantation at our center between February 2018 and February 2021. Complications encountered during hospitalization were assessed using both the CDC and CCI. Linear regression analyses were performed to identify the factors related to postoperative length of stay (PLOS). RESULTS Overall, 125 patients were included, with an average age of 46.87 years. Type 2 diabetes was present in 79% of the recipients. Among them, 117 patients experienced postoperative complications of CDC grades I (2.4%), II (57.6%), IIIa (8.0%), IIIb (9.6%), IVa (14.4%), IVb (0.8%), and V (0.8%) postoperative complications. The median CCI for the entire cohort was 37.2. Spearman's correlation analysis revealed significant associations between the CDC and PLOS and the CCI and PLOS. Notably, CCI exhibited a stronger correlation with PLOS (CCI: ρ = 0.698 vs. CDC: ρ = 0.524; p = 0.024). CONCLUSION The CCI demonstrated a stronger correlation with PLOS than CDC. Our finding suggests that the CCI may be a useful tool for comprehensively assessing complications following SPK transplantation.
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Affiliation(s)
- Yeqi Nian
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Lu Hu
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Yu Cao
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Zhen Wang
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Hui Wang
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Gang Feng
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Jie Zhao
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Jianming Zheng
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Wenli Song
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Tianjin, China
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Avramidou E, Terlemes K, Lymperopoulou A, Katsanos G, Antoniadis N, Kofinas A, Vasileiadou S, Karakasi KE, Tsoulfas G. Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation. LIVERS 2024; 4:119-137. [DOI: 10.3390/livers4010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2024] Open
Abstract
Since the end of the 20th century and the establishment of minimally invasive techniques, they have become the preferred operative method by many surgeons. These techniques were applied to liver surgery for the first time in 1991, while as far as transplantation is concerned their application was limited to the living donor procedure. We performed a review of the literature by searching in Pubmed and Scopus using the following keywords: Liver transplantation, Minimally invasive surgery(MIS) living liver donor surgery. Applications of MIS are recorded in surgeries involving the donor and the recipient. Regarding the recipient surgeries, the reports are limited to 25 patients, including combinations of laparoscopic, robotic and open techniques, while in the living donor surgery, the reports are much more numerous and with larger series of patients. Shorter hospitalization times and less blood loss are recorded, especially in centers with experience in a large number of cases. Regarding the living donor surgery, MIS follows the same principles as a conventional hepatectomy and is already the method of choice in many specialized centers. Regarding the recipient surgery, significant questions arise mainly concerning the safe handling of the liver graft.
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Affiliation(s)
- Eleni Avramidou
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Konstantinos Terlemes
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Afroditi Lymperopoulou
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Georgios Katsanos
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Nikolaos Antoniadis
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Athanasios Kofinas
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Stella Vasileiadou
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Konstantina-Eleni Karakasi
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
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Ronen O, Robbins KT, Shaha AR, Kowalski LP, Mäkitie AA, Florek E, Ferlito A. Emerging Concepts Impacting Head and Neck Cancer Surgery Morbidity. Oncol Ther 2023; 11:1-13. [PMID: 36565427 PMCID: PMC9935772 DOI: 10.1007/s40487-022-00217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022] Open
Abstract
All treatment modalities for head and neck cancer carry with them a risk of adverse events. Head and neck surgeons are faced with significant challenges to minimize associated morbidity and manage its sequelae. Recognizing situations in which a surgical complication is an adverse event inherent to the procedure can alleviate the psychologic impact a complication might have on the treatment team and minimize external and internal pressures. Focusing on the complications that can be effectively modified, future complications can be avoided. Also, some surgical morbidities may not be preventable, necessitating the option to reconsider whether the incidents should be labeled toxic reactions rather than a complication. This discussion highlights some of the areas in which additional research is needed to achieve the goal of minimizing the impact of surgical morbidity.
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Affiliation(s)
- Ohad Ronen
- Head and Neck Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Affiliated With Azrieli Faculty of Medicine, Galilee Medical Center, Bar-Ilan University, POB 21, Nahariya, Safed, 2210001, Israel.
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, Poznan, Poland
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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Biolato M, Vitale F, Galasso T, Gasbarrini A, Grieco A. Minimum platelet count threshold before invasive procedures in cirrhosis: Evolution of the guidelines. World J Gastrointest Surg 2023; 15:127-141. [PMID: 36896308 PMCID: PMC9988645 DOI: 10.4240/wjgs.v15.i2.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/09/2022] [Accepted: 02/07/2023] [Indexed: 02/27/2023] Open
Abstract
Cirrhotic patients with severe thrombocytopenia are at increased risk of bleeding during invasive procedures. The need for preprocedural prophylaxis aimed at reducing the risk of bleeding in cirrhotic patients with thrombocytopenia who undergo scheduled procedures is assessed via the platelet count; however, establishing a minimum threshold considered safe is challenging. A platelet count ≥ 50000/μL is a frequent target, but levels vary by provider, procedure, and specific patient. Over the years, this value has changed several times according to the different guidelines proposed in the literature. According to the latest guidelines, many procedures can be performed at any level of platelet count, which should not necessarily be checked before the procedure. In this review, we aim to investigate and describe how the guidelines have evolved in recent years in the evaluation of the minimum platelet count threshold required to perform different invasive procedures, according to their bleeding risk.
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Affiliation(s)
- Marco Biolato
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Federica Vitale
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Tiziano Galasso
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Antonio Grieco
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
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Zhong Z, Jiang H, Chen H, Wu C, Wang Y, Zhang Z, Li J, Liu J. Ex vivo tumor dissection followed by kidney autotransplantation in bilateral wilms tumor. Front Pediatr 2023; 11:1120797. [PMID: 36816368 PMCID: PMC9936068 DOI: 10.3389/fped.2023.1120797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Successful management of bilateral Wilm's tumor (BWT) involves a radical resection while preserving enough normal kidney tissue. Nephron-sparing surgery often results in an R1/R2 resection with a high recurrence rate in children with huge or multiple tumors, or tumors proximity to the renal hilum. In contrast, kidney autotransplantation can completely resect the tumor while maintaining homeostasis and preserving the patient's healthy kidney tissues. METHODS We summarized the clinical data of 8 synchronous BWT patients who underwent kidney autotransplantation at the First Affiliated Hospital of Sun Yat-sen University from 2018 to 2020. Ex vivo tumor resection and kidney autotransplantions were performed on 11 kidneys. The baseline characteristics, perioperative management, and survival status were reported. RESULTS Nephron-sparing surgeries were performed on 5 kidneys in vivo. Among all the 8 patients, six of them (75%) received staged operation and the other 2 patients (25%) received single-stage operation. No residual tumors were found on the postoperative imaging in all the 8 patients. In total, 6 (75%) patients occurred complications after the autotransplantation, among which, 2 (33.3%) patients had complication of Clavien-Dindo grade IIIa, and 4 (66.7%) patients had complication of grade < 3. During the 38 months of follow-up, 87.5% (7/8) of patients were tumor-free survival with normal renal function. One patient died from renal failure without tumor recurrence. DISCUSSION Therefore, our study indicated that autologous kidney transplantation can be an option for patients with complex BWT if the hospital's surgical technique and perioperative management conditions are feasible.
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Affiliation(s)
- Zhihai Zhong
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong Jiang
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huadong Chen
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Department of Organ Transplantation, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuanqi Wang
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhichong Zhang
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Department of Organ Transplantation, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Juncheng Liu
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lee YS, Koh CK, Yi NJ, Suh KS, Lee KW. Does living liver donors' underestimation about surgical outcomes impact on their health-related quality of life after donation?: a descriptive cross-sectional study. Health Qual Life Outcomes 2022; 20:146. [PMID: 36280848 PMCID: PMC9594971 DOI: 10.1186/s12955-022-02055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background In South Korea, the number of living-donor liver transplantations in 2019 was 1,188. Living liver donors (LLDs) undergo surgery and the postoperative recovery process for altruistic purposes. This study explored LLDs’ unmet expectations about surgical outcomes and examined their impact on the donors’ health-related quality of life (HRQOL). Methods This descriptive cross-sectional study utilized a self-reported survey. Data were collected at a university hospital in Seoul, South Korea. Among the 535 LLDs who underwent surgery for donation between January 2011 and March 2021, 124 participated in this study. The Korean version of the 12-item Short Form Health Survey version 2 (SF-12v2) was used to measure the HRQOL of LLDs. Unmet expectations regarding surgical outcomes were measured using four items: pain, length of hospital stay, speed of recovery, and complications. Logistic regression model was applied to determine whether the unmet expectations influence HRQOL in LLDs. Odds ratios with 95% confidence interval were used. Results The percentage of the participants who reported that their actual experiences for pain, speed of recovery, hospital stay, and complications were worse than expected were 34.7%, 22.6%, 9.7%, and 7.3%, respectively. Unmet expectations about surgical outcomes were significantly associated with physical and mental HRQOL after controlling for age, sex, education level, income, postoperative complications, recipients’ death, time since donation, and satisfaction with the decision to donate. Conclusion LLDs should be supported in obtaining more accurate and realistic information about surgical outcomes to decrease unmet expectations, which may help improve their quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02055-0.
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Affiliation(s)
- Ye Sol Lee
- grid.31501.360000 0004 0470 5905College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Chin Kang Koh
- grid.31501.360000 0004 0470 5905College of Nursing, The Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Nam-Joon Yi
- grid.31501.360000 0004 0470 5905Department of Surgery, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Kyung-Suk Suh
- grid.31501.360000 0004 0470 5905Department of Surgery, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Kwang-Woong Lee
- grid.31501.360000 0004 0470 5905Department of Surgery, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea
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Scalera I, De Carlis R, Patrono D, Gringeri E, Olivieri T, Pagano D, Lai Q, Rossi M, Gruttadauria S, Di Benedetto F, Cillo U, Romagnoli R, Lupo LG, De Carlis L. How useful is the machine perfusion in liver transplantation? An answer from a national survey. Front Surg 2022; 9:975150. [PMID: 36211259 PMCID: PMC9535084 DOI: 10.3389/fsurg.2022.975150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger post-transplant early allograft dysfunction (EAD). Data from donors of all MP-perfused grafts at six liver transplant centers have been analyzed, whether implanted or discarded after perfusion. The first endpoint was the negative events after perfusion (NegE), which is the number of grafts discarded plus those that were implanted but lost after the transplant. A risk factor analysis for NegE was performed and marginal grafts for MP were identified. Finally, the risk of EAD was analyzed, considering only implanted grafts. From 2015 to September 2019, 158 grafts were perfused with MP: 151 grafts were implanted and 7 were discarded after the MP phase because they did not reach viability criteria. Of 151, 15 grafts were lost after transplant, so the NegE group consisted of 22 donors. In univariate analysis, the donor risk index >1.7, the presence of hypertension in the medical history, static cold ischemia time, and the moderate or severe macrovesicular steatosis were the significant factors for NegE. Multivariate analysis confirmed that macrosteatosis >30% was an independent risk factor for NegE (odd ratio 5.643, p = 0.023, 95% confidence interval, 1.27–24.98). Of 151 transplanted patients, 34% experienced EAD and had worse 1- and 3-year-survival, compared with those who did not face EAD (NoEAD), 96% and 96% for EAD vs. 89% and 71% for NoEAD, respectively (p = 0.03). None of the donor/graft characteristics was associated with EAD even if the graft was moderately steatotic or fibrotic or from an aged donor. For the first time, this study shows that macrovesicular steatosis >30% might be a warning factor involved in the risk of graft loss or a cause of graft discard after the MP treatment. On the other hand, the MP seems to be useful in reducing the donor and graft weight in the development of EAD.
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Affiliation(s)
- Irene Scalera
- Hepatobiliary and Liver Transplant Unit, Department of Emergency and Organ Transplantation, University Hospital Policlinic of Bari, Bari, Italy
- Correspondence: Irene Scalera
| | - R. De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - D. Patrono
- General Surgery 2U-Liver Transplant Centre, A.O.U. “Città della Salute e della Scienza”, Turin, Italy
| | - E. Gringeri
- Hepatobiliary Surgery and Liver Transplantation Unit, University Hospital of Padua, Padua, Italy
| | - T. Olivieri
- Hepato-Pancreato-Biliary Surgery and Liver Transplant Center, University of Modena and Reggio Emilia, Modena, Italy
| | - D. Pagano
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, UPMC, Palermo, Italy
- Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
| | - Q. Lai
- Liver Transplant Unit, Sapienza University of Rome, Rome, Italy
| | - M. Rossi
- Liver Transplant Unit, Sapienza University of Rome, Rome, Italy
| | - S. Gruttadauria
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, UPMC, Palermo, Italy
- Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
| | - F. Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplant Center, University of Modena and Reggio Emilia, Modena, Italy
| | - U. Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, University Hospital of Padua, Padua, Italy
| | - R. Romagnoli
- General Surgery 2U-Liver Transplant Centre, A.O.U. “Città della Salute e della Scienza”, Turin, Italy
| | - L. G. Lupo
- Hepatobiliary and Liver Transplant Unit, Department of Emergency and Organ Transplantation, University Hospital Policlinic of Bari, Bari, Italy
| | - L. De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Ishikawa T. Efficacy of interventional radiology in the management of portal hypertension: A narrative review. Medicine (Baltimore) 2022; 101:e30018. [PMID: 35984127 PMCID: PMC9387995 DOI: 10.1097/md.0000000000030018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 01/05/2023] Open
Abstract
Portal hypertension is associated with numerous adverse effects, including the formation of gastroesophageal varices and a portal vein general circulation shunt. Portal hypertension can lead to portal blood flow into the liver and a subsequent reduction in liver function. Clinical interventions can be hampered by a concurrent reduction in circulating platelets associated with increased splenic activity. Pharmaceutical interventions for the treatment of complications associated with portal hypertension have achieved various degrees of success. However, an effective therapeutic strategy for portal hypertension has not yet been established. A literature search was performed using "PubMed." Database between 1966 and January 2021 using the following keywords: portal hypertension, interventional radiology, balloon-occluded retrograde transvenous obliteration, transjugular retrograde obliteration of gastric varices, percutaneous transhepatic obliteration, partial splenic embolization, and transjugular intrahepatic portosystemic shunting. In this narrative review, we summarize the application of interventional radiology in patients with portal hypertension, including techniques for embolization of collateral veins and portal pressure reduction. These up-to-date interventional radiology techniques can be used to treat portal hypertension. The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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Affiliation(s)
- Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
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Zhou W, Dai X, Le Y, Xing H, Tan B, Zhang M. Learning Curve Analysis of Microvascular Hepatic Artery Anastomosis for Pediatric Living Donor Liver Transplantation: Initial Experience at A Single Institution. Front Surg 2022; 9:913472. [PMID: 35784920 PMCID: PMC9247290 DOI: 10.3389/fsurg.2022.913472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe incidence of hepatic artery thrombosis in pediatric living donor liver transplantation (LDLT) is significantly higher than that in adults, and is closely related to the surgeon’s experience with hepatic artery anastomosis. However, there are few studies on the learning curve of hepatic artery anastomosis among surgeons.MethodsWe collected data related to 75 patients who underwent pediatric LDLT and hepatic artery anastomosis independently by the same surgeon. Cumulative sum method (CUSUM) was used to analyse the duration of hepatic artery anastomosis and determine the cut-off value. Patients were divided into two phases according to CUSUM. We analysed the intraoperative and postoperative data and survival outcomes of the included patients.ResultsTotal anastomosis duration decreased with an increased number of completed procedures, and the average duration was 42.4 ± 2.20 min. A cut-off value and two phases were identified: 1–43 cases and 44–75 cases. Intraoperative blood loss was significantly lower in phase 2 than in phase 1. The immediate functional changes of total bilirubin (TBIL) and direct bilirubin (DBIL) were significantly also lower in phase 2 than in phase 1. Other functional outcomes, postoperative complications, and the long-term survival rate were not significantly different between the two phases.ConclusionsTechnical competence in pediatric LDLT hepatic artery anastomosis may be achieved after completing 43 cases. It is a safe procedure with a surgical loupe that can be systematized and adopted by pediatric surgeons with sufficient experience via a relatively long learning curve.
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Affiliation(s)
- Wanyi Zhou
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xiaoke Dai
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Ying Le
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Huiwu Xing
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Bingqian Tan
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Mingman Zhang
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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Obed D, Jarrad A, Othman MI, Siyam M, Bashir A, Obed A. Hepatic and portal vein transection by vascular stapler in open living donor hepatectomy – A retrospective cohort study. Ann Med Surg (Lond) 2022; 78:103823. [PMID: 35734708 PMCID: PMC9206906 DOI: 10.1016/j.amsu.2022.103823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022] Open
Abstract
Background In an effort to increase donor safety in living donor liver transplantation, the utilization of vascular staplers for the division of the right portal and hepatic veins in patients undergoing right lobe liver donation for living donor liver transplantation (LDLT) was implemented. In here we report our experience with vascular staplers in patients undergoing LDLT and evaluate the subsequent feasibility and safety for donors. Material and methods 17 cases of living donor liver transplant were retrospectively analyzed. The right portal vein was transected directly at the bifurcation of the main portal vein, the right hepatic vein was resected directly at the wall of the inferior vena cava using a vascular stapler device. Results We registered a complication rate of 41.2% (7 donors). According to the Clavien-Dindo classification, grade II and grade III complications were each observed in 5.9% and grade IIIb complications in 29.4%, whereas catastrophic bleeding, complications with residual disability or the necessity of re-laparatomy did not occur. Upon 6 weeks, all donors were able to return to their previous occupation in fully recovered condition. Conclusions The utilization of vascular staplers in donors during open LDLT presents an encouraging alternative to manual over-sewing of vascular stumps. Apart from its timesaving aspect, the technique reduces the potential risk of life-threatening clamp slippage with subsequent uncontrolled blood loss. Portal or hepatic vein injuries are severe complications in liver transplant. Vascular staplers were used in an effort to increase donor safety. Hepatic or portal vein injuries or bleeding did not occur when using staplers. Vascular staplers may be a safe alternative to manual vascular sewing. Their use may be timesaving and reduce the risk of clamp slippage.
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Cuk N, Melamed KH, Vangala S, Salah R, Miller WD, Swanson S, Dai D, Antongiorgi Z, Wang T, Agopian VG, Dinorcia J, Farmer DG, Yanagawa J, Kaldas FM, Barjaktarevic I. Postoperative Trapped Lung After Orthotopic Liver Transplantation is a Predictor of Increased Mortality. Transpl Int 2022; 35:10387. [PMID: 35592450 PMCID: PMC9110663 DOI: 10.3389/ti.2022.10387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/10/2022] [Indexed: 12/10/2022]
Abstract
Pleural effusions are a common complication of orthotopic liver transplantation (OLT), and chronic post-OLT pleural effusions have been associated with worse outcomes. Furthermore, “trapped lung” (TL), defined as a restrictive fibrous visceral pleural peel preventing lung re-expansion, may have prognostic significance. We performed a retrospective analysis of adult OLT recipients over a 9-year period at UCLA Medical Center. Post-OLT patients with persistent pleural effusions, defined by the presence of pleural fluid requiring drainage one to 12 months after OLT, were included for analysis. Outcomes for patients with and without TL were compared using univariate and multivariate analysis. Of the 1722 patients who underwent OLT, 117 (7%) patients met our criteria for persistent postoperative pleural effusion, and the incidence of TL was 21.4% (25/117). Compared to patients without TL, those with TL required more surgical pleural procedures (OR 59.8, 95%CI 19.7–181.4, p < 0.001), spent more days in the hospital (IRR 1.56, 95%CI 1.09–2.23, p = 0.015), and had a higher risk of mortality (HR 2.47, 95%CI 1.59–3.82, p < 0.001) following transplant. In sum, we found that post-OLT TL was associated with higher morbidity, mortality, and healthcare utilization. Future prospective investigation is warranted to further clarify the risk factors for developing postoperative pleural effusions and TL.
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Affiliation(s)
- Natasha Cuk
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kathryn H. Melamed
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- *Correspondence: Kathryn H. Melamed,
| | - Sitaram Vangala
- Clinical and Translational Science Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ramy Salah
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - W. Dwight Miller
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sarah Swanson
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - David Dai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Zarah Antongiorgi
- Division of Critical Care Medicine, Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tisha Wang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Vatche G. Agopian
- Division of Transplant Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Joseph Dinorcia
- Division of Transplant Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Douglas G. Farmer
- Division of Transplant Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jane Yanagawa
- Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Fady M. Kaldas
- Division of Transplant Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Hattori K, Mizuno Y, Ogura Y, Inoue T, Nagaya M, Jobara K, Kurata N, Nishida Y. Effects of Neuromuscular Electrical Stimulation on Lower Limb Muscle Strength After Living Donor Liver Transplant: A Case-Control Study. Transplant Proc 2022; 54:749-754. [DOI: 10.1016/j.transproceed.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
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13
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Amara D, Parekh J, Sudan D, Elias N, Foley DP, Conzen K, Grieco A, Braun HJ, Greenstein S, Byrd C, Ko C, Hirose R. Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience. Clin Transplant 2022; 36:e14610. [PMID: 35143698 DOI: 10.1111/ctr.14610] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 12/01/2022]
Abstract
This study used the prospective National Surgical Quality Improvement Program (NSQIP) Transplant pilot database to analyze surgical complications after liver transplantation (LT) in LT recipients from 2017-2019. The primary outcome was surgical complication requiring intervention (Clavien-Dindo grade II or greater) within 90 days of transplant. Of the 1684 deceased donor and 109 living donor LT cases included from 29 centers, 38% of deceased donor liver recipients and 47% of living donor liver recipients experienced a complication. The most common complications included biliary complications (19% DDLT; 31% LDLT), hemorrhage requiring reoperation (14% DDLT; 9% LDLT) and vascular complications (6% DDLT; 9% LDLT). Management of biliary leaks (35.3% ERCP, 38.0% percutaneous drainage, 26.3% reoperation) and vascular complications (36.2% angioplasty/stenting, 31.2% medication, 29.8% reoperation) was variable. Biliary (aHR 5.14, 95% CI 2.69-9.8, p<0.001), hemorrhage (aHR 2.54, 95% CI 1.13-5.7, p = 0.024) and vascular (aHR 2.88, 95% CI 0.85-9.7, p = 0.089) complication status at 30-days post-transplant were associated with lower 1-year patient survival. We conclude that biliary, hemorrhagic and vascular complications continue to be significant sources of morbidity and mortality for LT recipients. Understanding the different risk factors for complications between deceased and living donor liver recipients and standardizing complication management represent avenues for continued improvement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dominic Amara
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Justin Parekh
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Debra Sudan
- Department of Surgery, Duke University, Durham, NC, USA
| | - Nahel Elias
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David P Foley
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Kendra Conzen
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | | | - Hillary J Braun
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Clifford Ko
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.,The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Ryutaro Hirose
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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14
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Adib R, Das D, Ahamed SI, Lerret SM. An mHealth App-Based Self-management Intervention for Family Members of Pediatric Transplant Recipients (myFAMI): Framework Design and Development Study. JMIR Nurs 2022; 5:e32785. [PMID: 34780344 PMCID: PMC8767472 DOI: 10.2196/32785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/01/2021] [Accepted: 11/14/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Solid-organ transplantation is the treatment of choice for children with end-stage organ failure. Ongoing recovery and medical management at home after transplant are important for recovery and transition to daily life. Smartphones are widely used and hold the potential for aiding in the establishment of mobile health (mHealth) protocols. Health care providers, nurses, and computer scientists collaboratively designed and developed mHealth family self-management intervention (myFAMI), a smartphone-based intervention app to promote a family self-management intervention for pediatric transplant patients' families. OBJECTIVE This paper presents outcomes of the design stages and development actions of the myFAMI app framework, along with key challenges, limitations, and strengths. METHODS The myFAMI app framework is built upon a theory-based intervention for pediatric transplant patients, with aid from the action research (AR) methodology. Based on initially defined design motivation, the team of researchers collaboratively explored 4 research stages (research discussions, feedback and motivations, alpha testing, and deployment and release improvements) and developed features required for successful inauguration of the app in the real-world setting. RESULTS Deriving from app users and their functionalities, the myFAMI app framework is built with 2 primary components: the web app (for nurses' and superadmin usage) and the smartphone app (for participant/family member usage). The web app stores survey responses and triggers alerts to nurses, when required, based on the family members' response. The smartphone app presents the notifications sent from the server to the participants and captures survey responses. Both the web app and the smartphone app were built upon industry-standard software development frameworks and demonstrate great performance when deployed and used by study participants. CONCLUSIONS The paper summarizes a successful and efficient mHealth app-building process using a theory-based intervention in nursing and the AR methodology in computer science. Focusing on factors to improve efficiency enabled easy navigation of the app and collection of data. This work lays the foundation for researchers to carefully integrate necessary information (from the literature or experienced clinicians) to provide a robust and efficient solution and evaluate the acceptability, utility, and usability for similar studies in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1002/nur.22010.
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Affiliation(s)
- Riddhiman Adib
- Department of Computer Science, Marquette University, Milwaukee, WI, United States
| | - Dipranjan Das
- Department of Computer Science, Marquette University, Milwaukee, WI, United States
| | - Sheikh Iqbal Ahamed
- Department of Computer Science, Marquette University, Milwaukee, WI, United States
| | - Stacee Marie Lerret
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
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15
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Peltec A, Hotineanu A, Popescu I, Braşoveanu V. The impact of liver steatosis on the postoperative evolution after right lobe living-donor hepatectomy. Med Pharm Rep 2021; 94:S43-S50. [PMID: 38912410 PMCID: PMC11188031 DOI: 10.15386/mpr-2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Living donor liver transplantation has become a feasible treatment modality for end-stage liver disease. The obesity epidemic worldwide has made it increasingly common to encounter liver steatosis in living donor candidates. The aim of study was to analyze the impact of moderate hepatic steatosis on the postoperative evolutions after right lobe living-donor hepatectomy. Methods Living donors who underwent donor hepatectomy during the period 2000 to 2020 in two medical centers were included in this study. We distinguished 3 groups based on the degree of steatosis: Group O - 0%, Group I - 1-10% and Group II >10%. Results A total number of 157 living donors underwent surgery, of whom 112 (71.34%) were right lobe liver donors. There were 62 without steatosis, 31 - with steatosis 1-10% and 19 with steatosis >10%. No difference has been found in proportion of men, median of age, body mass index and left lobe/total liver volume ration in compared groups. Total liver volume was significantly higher in the Group I than in the Group O (p=0.028). The moderate hepatic steatosis (HS) group presented significant higher volume of intraoperative hemorrhage than no-HS group (p=0.041). No differences were observed in the postoperative liver function between the groups. The minimal HS group comprised a significantly higher proportion of postoperative complications than no-HS group (67.7% vs 40.3%, p=0.043). The longer postoperative length of hospital stay in ICU was observed in Group I than in Group O (p=0.024). Conclusion Moderate HS does not importantly impair living liver donors' safety.
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Affiliation(s)
- Angela Peltec
- Discipline of Gastroenterology, Department of Internal Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Adrian Hotineanu
- Department of Surgery No. 2, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Irinel Popescu
- Department of Hepatobiliary Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Vladislav Braşoveanu
- Department of Hepatobiliary Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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16
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Karatoprak S, Kutlu R, Yılmaz S. Role of percutaneous radiological treatment in biliary complications associated with adult left lobe living donor liver transplantation: a single-center experience. ACTA ACUST UNITED AC 2021; 27:546-552. [PMID: 33599206 DOI: 10.5152/dir.2021.20523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Biliary complications develop at a higher rate in living donor liver transplantation (LDLT) compared with cadaveric liver transplantation. Almost all studies about biliary complications after LDLT were made with the right lobe. The aim of this study was to determine the frequency of biliary complications developing after adult left lobe LDLT and to evaluate the efficacy of the algorithm followed in diagnosis and treatment, particularly percutaneous radiological treatment. METHODS A total of 2185 LDLT operations performed in our center between May 2009 and December 2019 were retrospectively reviewed and patients receiving left lobe LDLT were analyzed regarding biliary complications and treatments. Biliary complications were treated via percutaneous drainage under ultrasound (US) guidance, endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography (PTC)/ percutaneous transhepatic biliary drainage (PTBD). Patient demographics, ERCP procedures before percutaneous treatment, and percutaneous treatment indications were analyzed. RESULTS A total of 69 adult patients received left lobe LDLT. Biliary complications requiring endoscopic and/or percutaneous treatment developed in 28 patients (40%). Of these patients, 4 had bile leakage (14%), 20 had anastomosis stricture (72%), and 4 had both leakage and anastomosis stricture (14%). External drainage treatment under ultrasound guidance was sufficient for 2 of 4 patients with bile leakage, and these cases were accepted as minor bile leakage (7%). Overall, 26 patients underwent ERCP; of these, 8 were referred for PTC/PTBD because the guidewire and/or balloon-stent could not pass the anastomosis stricture (n=7) and common bile duct cannulation could not be obtained because of duodenal diverticulum (n=1). Diagnostic PTC was performed in 10 patients, 8 were referred after inadequate/failed ERCP procedure and two were referred directly without ERCP. Anastomosis stricture was found in 7 patients and anastomosis stricture and bile leakage in 3. In 7 patients determined to have stricture, balloon dilatation was applied and then biliary drainage was performed. In 3 patients who had leakage and anastomosis stricture, balloon dilatation was applied for stricture; after dilatation, an IEBD catheter was placed through the leakage region in 2 patients, while a covered metallic stent passing through the leakage region was placed in one patient. CONCLUSION Generally, ERCP is the first preferred method in biliary complications of LDLT; however, in cases where a response cannot be obtained by endoscopic treatment or require complex and/or aggressive treatment, percutaneous radiological treatment should be the treatment of choice before surgery in left lobe LDLT.
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Affiliation(s)
- Sinan Karatoprak
- Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yılmaz
- Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
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17
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Gordon K, Figueira ERR, Rocha-Filho JA, Mondadori LA, Joaquim EHG, Seda-Neto J, da Fonseca EA, Pugliese RPS, Vintimilla AM, Auler Jr JOC, Carmona MJC, D'Alburquerque LAC. Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation. World J Gastroenterol 2021; 27:1161-1181. [PMID: 33828392 PMCID: PMC8006094 DOI: 10.3748/wjg.v27.i12.1161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation.
AIM To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT.
METHODS We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications (n = 109) and major complications (n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC ≤ 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed.
RESULTS High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion.
CONCLUSION Transfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.
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Affiliation(s)
- Karina Gordon
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
- Department of Anesthesiology, AC Camargo Cancer Center, São Paulo 01509-010, Brazil
| | - Estela Regina Ramos Figueira
- Department of Gastroenterology, Discipline of Liver and Gastrointestinal Transplantation, Laboratory of Medical Investigations LIM37 Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
| | - Joel Avancini Rocha-Filho
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | | | | | - Joao Seda-Neto
- Department of Liver Transplantation, AC Camargo Cancer Center, São Paulo 01525-901, Brazil
| | | | | | - Agustin Moscoso Vintimilla
- Department of Gastroenterology, Division of Liver and Gastrointestinal Transplant, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
| | - Jose Otavio Costa Auler Jr
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Maria Jose Carvalho Carmona
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Luiz Augusto Carneiro D'Alburquerque
- Department of Gastroenterology, Division of Liver and Gastrointestinal Transplant, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
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18
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Venous outflow reconstruction using a polytetrafluoroethylene (PTFE) graft in right lobe living donor liver transplantation: A single center study. Surgery 2021; 169:1500-1509. [PMID: 33642052 DOI: 10.1016/j.surg.2021.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venous outflow reconstruction is very important especially in right lobe living donor liver transplantation without middle hepatic vein. Various interposition (venous or synthetic) grafts have been recommended for reconstruction of anterior sector tributaries. METHODS We aimed to describe our surgical technique and analyze anterior sector venous reconstruction using expanded polytetrafluroethylene graft. Retrospective analysis of prospectively collected data for 760 primary right lobe living donor liver transplantations performed at our institute between December 2011 and June 2018. Reconstruction of anterior sector: expanded polytetrafluroethylene (group A, n = 705) and autologous vein (group B, n = 55). RESULTS Pretransplant characteristics were comparable among both groups. Group A has significantly lower cold ischemia time (68.7 ± .3.5 minutes vs 127.8 ± 7.2 minutes; P < .001) and anhepatic time (116.3 ± 5.5 minutes vs 190.81 ± 9.35 minutes; P < .001) compared with group B. There was no difference in recovery pattern of liver functions, morbidity, and mortality between the 2 groups. One- and 6-month patency rates of interposition grafts were 97.6% and 84.4% (group A) and 96.4% and 78.1% (group B), respectively. CONCLUSION In centers with limited access to homologous or autologous vascular grafts, use of expanded polytetrafluroethylene graft for anterior sector venous outflow reconstruction in right lobe living donor liver transplantation is a viable option with excellent patency and patient outcomes.
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Kilic M, Karaca CA, Yilmaz C, Farajov R, Iakobadze Z, Kilic K, Aydogdu S. Bilioenteric Reconstruction Techniques in Pediatric Living Donor Liver Transplantation. Liver Transpl 2021; 27:257-263. [PMID: 37160015 DOI: 10.1002/lt.25845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 01/13/2023]
Abstract
Biliary complications (BCs) are still a major cause of morbidity following liver transplantation despite the advancements in the surgical technique. Although Roux-en-Y (RY) hepaticojejunostomy has been the standard technique for years in pediatric patients, there is a limited number of reports on the feasibility of duct-to-duct (DD) anastomosis, and those reports have controversial outcomes. With the largest number of patients ever reported on the topic, this study aims to discuss the feasibility of the DD biliary reconstruction technique in pediatric living donor liver transplantation (LDLT). After the exclusion of the patients with biliary atresia, patients who received either deceased donor or right lobe grafts, and retransplantation patients, data from 154 pediatric LDLTs were retrospectively analyzed. Patients were grouped according to the applied biliary reconstruction technique, and the groups were compared using BCs as the outcome. The overall BC rate was 13% (n = 20), and the groups showed no significant difference (P = 0.6). Stricture was more frequent in the DD reconstruction group; however, this was not statistically significant (P = 0.6). The rate of bile leak was also similar in both groups (P = 0.6). The results show that the DD reconstruction technique can achieve similar outcomes when compared with RY anastomosis. Because DD reconstruction is a more physiological way of establishing bilioenteric integrity, it can safely be applied.
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Affiliation(s)
- Murat Kilic
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Can A Karaca
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkey
| | - Cahit Yilmaz
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Rasim Farajov
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Zaza Iakobadze
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Kamil Kilic
- Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Sema Aydogdu
- Department of Pediatric Gastroenterology, Ege University Faculty of Medicine, Izmir, Turkey
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Bhangui P, Saigal S, Gautam D, Piplani T, Choudhary N, Chaudhary R, Yadav S, Thiagarajan S, Rastogi A, Saraf N, Nundy S, Soin AS. Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria. Liver Transpl 2021; 27:209-221. [PMID: 37160010 DOI: 10.1002/lt.25956] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/09/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
Conventional selection criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) are based on tumour size/number only, and do not consider vital surrogates of tumor biology such as alpha-fetoprotein (AFP) and tumor [18 F]fluorodeoxyglucose positron emission tomography ([18 F]FDG PET) avidity. We analyzed survival outcomes, and predictors of HCC recurrence in 405 patients with cirrhosis and HCC (HCC-cirr) who underwent living donor LT (LDLT) using our expanded selection criteria: no extrahepatic disease or major vascular invasion, irrespective of tumor size/number. Fifty-one percent patients had tumours beyond Milan, and 43% beyond the University of California San Francisco [UCSF] criteria. The 5-year overall survival (OS) and recurrence-free survival (RFS) were 64% and 70%, respectively. Three preoperatively available factors predicted recurrence: pre-LT AFP ≥100 ng/mL (P = 0.005; hazard ratio [HR], 2.190), tumor burden beyond the UCSF criteria (P = 0.001; HR, 2.640), and [18 F]FDG PET avidity (P = 0.004; HR, 2.442). A prognostic model based on the number and combination of the aforementioned preoperative risk factors was developed using a competing-risk RFS model. Three risk groups were identified: low (none or a single risk factor present, 9.3% recurrence), moderate (AFP ≥100 ng/mL and [18 F]FDG PET avidity, or beyond UCSF tumor and [18 F]FDG PET avidity, 25% recurrence), and high (AFP ≥100 ng/mL and beyond UCSF, or presence of all 3 risk factors, 46% recurrence). Acceptable long-term outcomes were achieved using our expanded selection criteria. Our prognostic model to predict recurrence based on preoperative biological and morphological factors could guide pretransplant management (downstaging versus upfront LDLT) with the aim of reducing post-LDLT recurrence.
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Affiliation(s)
- Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Sanjiv Saigal
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Dheeraj Gautam
- Department of Pathology, Medanta-The Medicity, Delhi NCR, India
| | - Tarun Piplani
- Department of Radiodiagnosis and Interventional Radiology, Medanta-The Medicity, Delhi NCR, India
| | - Narendra Choudhary
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Rohan Chaudhary
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Sanjay Yadav
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - S Thiagarajan
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Amit Rastogi
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Neeraj Saraf
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Gangaram Hospital, New Delhi, India
| | - A S Soin
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
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Rammohan A, Reddy MS, Narasimhan G, Rajalingam R, Kaliamoorthy I, Krishnan M, Kanagavelu R, Kota V, Rela M. Live Liver Donors: Is Right Still Right? World J Surg 2021; 44:2385-2393. [PMID: 32140761 DOI: 10.1007/s00268-020-05446-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conventional wisdom dictates that a larger hepatectomy is more prone to complications. Consequently, with the donor safety as paramount, the transplant community has intuitively been proponents of left lobe donation in live donor liver transplantation (LDLT), thereby satisfying the tenet of double equipoise. More recently some data suggest that this may not always be the case, especially in established centres. Our aim was to compare right and left lobe donor outcomes in LDLT from a centre with cumulative experience. METHODS Review of a prospectively collected database of right and left lobe liver donors operated between August 2009 and July 2017 was performed. Their preoperative demographics, operative and post-operative outcomes were compared. RESULTS Of 904 liver transplantations, 458 were right lobe donors [379 without middle hepatic vein (MHV), 79 with MHV] and 58 left lobe donors. There was a significant difference in GRWR and functional liver remnant between the right and left lobe donors (1.27 ± 0.45 vs. 1.03 ± 0.28 p = 0.004, and 63.2 ± 7.9 vs. 37.7 ± 16.3, respectively, p value). The end portal pressure (7 vs. 8 mmHg p = <0.001), peak bilirubin (1.6 ± 0.8 vs. 2.9 ± 1.5 p = <0.001) and day 5 bilirubin (0.8 ± 0.3 vs. 1.4 ± 0.9 p = <0.001) were significantly higher in right lobe donors. There was no difference in blood loss, duration of surgery or peak lactate between the groups. Complications (20.7% vs. 25.9% p = 0.48), including serious complications (Clavien-Dindo > III) (6.9% vs. 8.1% p = 0.95), duration of ICU and hospital stay, were comparable between the groups. Subgroup analysis between left lobe and right lobe with and without MHV donor was also comparable. CONCLUSION Though biochemical differences exist between the groups, no difference in outcomes was noted. Despite larger liver mass loss in right lobe donors, a strict protocol-based approach to donor selection leads to comparable outcomes between left lobe and right lobe donations.
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Affiliation(s)
- Ashwin Rammohan
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India.
- The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India.
| | - Mettu S Reddy
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India
- The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Gomathy Narasimhan
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India
- The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Rajesh Rajalingam
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India
- The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Ilankumaran Kaliamoorthy
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India
- The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Mathangi Krishnan
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India
| | - Rathnavel Kanagavelu
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India
- The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Venugopal Kota
- The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Mohamed Rela
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India
- The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
- Institute of Liver Studies, King's College Hospital, London, UK
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Learning Curve Under Proctorship of Pure Laparoscopic Living Donor Left Lateral Sectionectomy for Pediatric Transplantation. Ann Surg 2020; 271:542-548. [PMID: 29995683 DOI: 10.1097/sla.0000000000002948] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the learning curve of an expert liver transplantation surgeon approaching fully laparoscopic living donor left lateral sectionectomy (L-LLS) under proctorship. BACKGROUND Laparoscopic liver resections necessitate a long learning curve trough a stepwise fulfillment of difficulties. L-LLS requires expertise in both living donor liver transplantation and advanced laparoscopic liver surgery. There is currently no data about the learning curve of L-LLS. METHODS A total of 72 pure L-LLS were included in this study. A Broken line model was used to identify the periods of the learning curve. A CUSUM analysis of the operative time was performed to evaluate improvements of outcomes with time. To evaluate the relationship between operative time and progressive number of procedures, a linear regression model was applied. A receiver operating characteristic (ROC) curve was carried out to identify the cutoff for completion of the learning curve. RESULTS Operative time decreased with the progressive increase of procedures. Two cutoffs and 3 different periods were identified: cases 1 to 22, cases 23 to 55, and cases 56 to 72. A significant decrease in blood loss and operative time was noted. The CUSUM analysis showed an increase in operative time in the first period, a stable duration in the second period, and a decrease in the last. Blood loss was significantly associated with an increase in operative time (P = 0.003). According to the ROC curve, the learning curve was completed after 25 procedures. CONCLUSIONS L-LLS is a safe procedure that can be standardized and successfully taught to surgeons with large experience in donor hepatectomy through a proctored learning curve.
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Guzmán GE, Victoria AM, Ramos I, Maldonado A, Manzi E, Contreras-Valero JF, Mesa L, Schweineberg J, Posada JG, Villegas JI, Caicedo LA, Durán CE. Risk Factors Related to New-Onset Diabetes after Renal Transplantation in Patients of a High Complexity University Hospital in Colombia, 20 Years of Experience. Int J Endocrinol 2020; 2020:8297192. [PMID: 32908503 PMCID: PMC7477588 DOI: 10.1155/2020/8297192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION New-onset diabetes after transplantation (NODAT) is associated with immunosuppression. Its complications can negatively influence patients' quality of life, which is why it is important to study the associated risk factors and expand the possible therapies in this particular group of patients. Materials and methods. Case-control study nested in a retrospective cohort. It included patients who received kidney transplantation at the high complexity University Hospital Fundación Valle del Lili in Cali, Colombia, between 1995 and 2014. Two controls were assigned for each case, depending on the type of donor and the date of the surgery. Information was collected from clinical records and the institutional TRENAL registry. We carried out a descriptive analysis of the selected variables and identified the risk factors with conditional logistic regression. RESULTS 122 cases were identified to which 224 controls were assigned. The median age was 44 years (IQR: 34-55), and 54% were men. Having >50 years of age at the time of transplantation (OR: 3.18, 95% CI: 1.6-6.3, p = 0.001), body mass index >30 kg/m2 (OR: 3.6, 95% CI: 1.3-9.7, p = 0.010) and being afro-descendant (OR: 2.74, 95% CI: 1.1-6.5, p = 0.023) were identified as risk factors for the development of NODAT. Pretransplant fasting plasma glucose >100 mg/dl (OR: 2.9, 95% CI: 1.4-6.4, p = 0.005) and serum triglycerides >200 mg/dl (OR: 2.5, 95% CI: 1.4-4.4, p = 0.002) were also reported as independent risk factors. CONCLUSION We ratify some risk factors for the development of this important disease, which include certain modifiable characteristics. Interventions aimed at changes in lifestyle could be established in a timely manner before transplant surgery.
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Affiliation(s)
- Guillermo E. Guzmán
- Fundación Valle del Lili, Departamento de Endocrinología, Cra 98, No. 18-49, Cali 760032, Colombia
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
| | - Angela M. Victoria
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
| | - Isabella Ramos
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
| | - Alejandro Maldonado
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
| | - Eliana Manzi
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Juan F. Contreras-Valero
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
- Fundación Valle del Lili, Departamento de Medicina Interna, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Liliana Mesa
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Johanna Schweineberg
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Juan G. Posada
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Jorge I. Villegas
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Luis A. Caicedo
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Carlos E. Durán
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
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Reshetnyak VI, Maev IV, Reshetnyak TM, Zhuravel SV, Pisarev VM. Liver Diseases and the Hemostasis (Rewiew) Part 1. Non-Cholestatic Diseases of the Liver and Hemostasis. GENERAL REANIMATOLOGY 2019. [DOI: 10.15360/1813-9779-2019-5-74-87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In liver diseases, most commonly in the terminal stage of liver failure, a variety of hemostatic defects affecting almost all parts of the blood coagulation system are developing. This leads to diminishing the capabilities of patients with liver diseases to correctly maintain the hemostatic balance.The severity of hemostatic disorders depends on the nosological form and degree of a liver damage. Depending on the imbalance of the hemostasis system and accumulated clinical/laboratory data, patients with liver diseases can be subdivided into three groups as exhibiting: 1. non-cholestatic liver damage; 2. cholestatic liver damage and 3. liver damage of vascular origin.The first part of the review discusses multiple alterations in the hemostasis system in patients with noncholestatic liver diseases, which are commonly accompanied by hypocoagulation.
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Affiliation(s)
- V. I. Reshetnyak
- A. I. Evdokimov Moscow State University of medicine and dentistry, Ministry of Health of Russia
| | - I. V. Maev
- A. I. Evdokimov Moscow State University of medicine and dentistry, Ministry of Health of Russia
| | | | - S. V. Zhuravel
- N. V. Sklifosovsky Research Institute of Emergency Care, Moscow Healthcare Department
| | - V. M. Pisarev
- V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
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25
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Idriss AM, Tfeil Y, Baba JS, Boukhary SM, Deddah MA. [Applicability of the Clavien-Dindo classification in the evaluation of postoperative complications at the Surgery Department of the National Hospital Center of Nouakchott: observational study of 834 cases]. Pan Afr Med J 2019; 33:254. [PMID: 31692805 PMCID: PMC6814940 DOI: 10.11604/pamj.2019.33.254.18024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/07/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Postoperative complications are common; some are transient, others may be serious, but they are all important to patients. One of the most important gaps in surgical research is the lack of consensus over the preferred result, the type of measurement or of evaluation. Methods We conducted a retrospective study of postoperative complications at the Surgery Department of the National Hospital Center of Nouakchott. Eight hundred thirty-four patients underwent surgery over a seven-month period (1 January 2017-31 July 2017). The demographic and clinical parameters were studied and analyzed statistically using SPSS software 20. Results The study involved 834 patients, of whom 426 (51.1%) were men. The average age of patients was 34.81 years (1-90 years). Four hundred thirty-two (51.2%) patients underwent emergency surgery. The sex ratio (M/F) was 1.04. Arab-Berbers race accounted for 77.8%. Appendicular disease accounted for 41.12%, hepatobiliary disease accounted for 17.76%, and abdominal wall disease accounted for 16.1%). Thyroid disease accounted for 5.6%. One hundred eighty-three (21.94%) patients developed postoperative complications, including 4 (2.1%) deaths. Clavien-Dindo grade II was the most represented with 82.5% of complications and accounted for 17.91% of all operated patients. Surgical site infection accounted for 62.8% of all complications. Conclusion This study shows that the Clavien-Dindo classification can be applied to patients who have undergone elective surgery and emergency surgery. We think that the lack of follow-up and the lack of means to fight the infection and the non-rigorous respect of asepsis and antisepsis procedures would play an important role.
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Affiliation(s)
- Ahmedou Moulaye Idriss
- Département des Spécialités Chirurgicales, Faculté de Médecine, Université de Nouakchott Al Aasriya, Nouakchott, Mauritanie
| | - Yahya Tfeil
- Département des Spécialités Chirurgicales, Faculté de Médecine, Université de Nouakchott Al Aasriya, Nouakchott, Mauritanie
| | - Jiddou Sidi Baba
- Département des Spécialités Chirurgicales, Faculté de Médecine, Université de Nouakchott Al Aasriya, Nouakchott, Mauritanie
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Groose MK, Aldred BN, Mezrich JD, Hammel LL. Risk Factors for Intracardiac Thrombus During Liver Transplantation. Liver Transpl 2019; 25:1682-1689. [PMID: 31119833 DOI: 10.1002/lt.25498] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
Abstract
Intracardiac thrombus (ICT) is an intraoperative complication with high mortality that occurs during orthotopic liver transplantation (OLT). Patients with end-stage liver disease have compromised coagulation pathways, and when combined with stressors of surgery, thrombi can form. However, it is unknown which patients are most likely to develop ICT. We performed a retrospective cohort study of all OLT patients at our hospital from 2010 to 2017 to identify risk factors for ICT. An analysis was performed with conventional bivariate tests and logistic regression. The incidence of ICT during OLT was 4.2% (22/528) with a 45.5% (10/22) mortality. Patients who developed ICT had higher physiologic Model for End-Stage Liver Disease scores at the time of transplant (25.1 versus 32.4; P = 0.004), received grafts from donors with a higher body mass index (28.1 versus 32.2 kg/m2 ; P = 0.007), and had longer intraoperative warm ischemia times (53.1 versus 67.5 minutes; P = 0.001). The odds of developing ICT were significantly lower after administration of intravenous (IV) heparin prior to inferior vena cava (IVC) clamping compared with no administration of heparin (odds ratio, 0.25; 95% confidence interval, 0.08-0.75; P = 0.01). In conclusion, the incidence of ICT at our institution is higher than previously reported, which may be explained by our routine use of transesophageal echocardiography. Although many factors associated with ICT in this study are nonmodifiable, administration of IV heparin prior to IVC cross-clamping is modifiable and was found to be protective. Further studies will be needed to confirm findings and ultimately aid in preventing these lethal events.
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Affiliation(s)
- Molly K Groose
- Departments of Anesthesiology, Transplantation Division, University of Wisconsin Hospital, Madison, WI
| | - Breanna N Aldred
- Departments of Anesthesiology, Transplantation Division, University of Wisconsin Hospital, Madison, WI
| | - Joshua D Mezrich
- Departments of Surgery, Transplantation Division, University of Wisconsin Hospital, Madison, WI
| | - Laura L Hammel
- Departments of Anesthesiology, Transplantation Division, University of Wisconsin Hospital, Madison, WI
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27
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Martins PN, Rawson A, Movahedi B, Brüggenwirth IMA, Dolgin NH, Martins AB, Mahboub P, Bozorgzadeh A. Single-Center Experience With Liver Transplant Using Donors With Very High Transaminase Levels. EXP CLIN TRANSPLANT 2019; 17:498-506. [DOI: 10.6002/ect.2017.0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vieira V, Pacheco L, Demetrio L, Balbi E, Bellinha T, Toledo R, Auler L, Pestana D, Schul M. Left Hepatic Lobectomy in the Living Donor-Comparison Between Open vs Laparoscopic Surgery. Transplant Proc 2019; 51:1601-1604. [PMID: 31155200 DOI: 10.1016/j.transproceed.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Laparoscopic hepatic surgery dramatically changed surgical practice in the last decades, improving outcomes in correctly selected patients. The reduction of postoperative pain, lower rate of complication, early return to work activities, and better esthetic result have been well described in several studies. The success of these procedures would inevitably clash in the more complex and delicate field of hepatectomy in the living donor. The 2nd International Consensus of the Conference on Laparoscopic Liver Surgery considers laparoscopic hepatectomy in the donor as an ideal procedure. The aim of this study is to compare the results between conventional and laparoscopic surgery; prospective data and retrospective analysis of 55 cases of live liver donor lobectomy were collected between January 2013 and June 2018. The mean age was 30.4 years in the video laparoscopic technique and 32.1 years in conventional surgery; the majority of donors were male in both groups. The mean time of ischemia was 70.2 minutes (range, 50-120 minutes) in laparoscopic surgery and 80.2 minutes (range, 50-165 minutes) in conventional surgery. The surgical time ranged from 270 to 800 minutes (mean, 452 minutes) in laparoscopic surgery and ranged from 300 to 600 minutes (mean, 424 minutes) in conventional surgery. The mean length of hospital stay was 2.2 days in laparoscopy and 3.97 days in conventional surgery. Laparoscopic left liver lobectomy in the living donor is safe and feasible. There was no significant difference in surgical time; however, the time of hospitalization was lower in patients submitted to laparoscopic technique.
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Affiliation(s)
- V Vieira
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil.
| | - L Pacheco
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil
| | - L Demetrio
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil
| | - E Balbi
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil
| | - T Bellinha
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil
| | - R Toledo
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil
| | - L Auler
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil
| | - D Pestana
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil
| | - M Schul
- Liver Transplant Service of Children's State Hospital, Rio de Janeiro, Brazil
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Bauschke A, Altendorf-Hofmann A, Malessa C, Rohland O, Settmacher U. [Influence of bile duct anatomy on biliary complications in hepatic right lobe living donors]. Chirurg 2019; 89:222-228. [PMID: 28940029 DOI: 10.1007/s00104-017-0514-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Perioperative morbidity in the living donation of partial livers is mainly due to infections and biliary complications. Bile duct anatomy variants, in particular of the right system, are suspected to be causative. We investigated the influence of bile duct variants on the incidence of biliary donor complications in donations of the right liver lobe. We analyzed 103 donors. Twelve patients had a bile leak that required treatment. All of these were treated endoscopically without any residual defect. We did not see a central extrahepatic bile duct lesion Nagano type C. The anatomic variant Huang A3 is a challenge with respect to the surgical technique. Three of 17 patients with biliary anatomy Huang A3 developed leaks. The bile duct anatomy can be carefully evaluated by magnetic resonance cholangiopancreatography (MRCP) and intraoperative cholangiography. The anatomic variant Huang A3 warrants particular attention for the closure of the bile duct orifice.
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Affiliation(s)
- A Bauschke
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland.
| | - A Altendorf-Hofmann
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - C Malessa
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - O Rohland
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - U Settmacher
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
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30
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Zhang QK, Wang ML. Value of Model for End-Stage Liver Disease-Serum Sodium Scores in Predicting Complication Severity Grades After Liver Transplantation for Acute-on-chronic Liver Failure. Transplant Proc 2019; 51:833-841. [DOI: 10.1016/j.transproceed.2019.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023]
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Egeli T, Unek T, Agalar C, Ozbilgin M, Derici S, Cevlik AD, Akarsu M, Altay C, Obuz F, Ellidokuz H, Astarcioglu I. The Analysis of Posthepatectomy Liver Failure Incidence and Risk Factors Among Right Liver Living Donors According to International Study Group of Liver Surgery Definition. Transplant Proc 2019; 51:1121-1126. [PMID: 30981405 DOI: 10.1016/j.transproceed.2019.01.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
AIM There is a well-known risk of the emergence of hepatic failure in living donor transplant cases on whom are performed a right donor hepatectomy (RDH). There are different prevalence ratios in literature on this phenomenon. In our study, we aim to depict the prevalence of hepatic failure and risk factors in our cases regarding the most recent description criteria related to hepatic failure. PATIENTS AND METHODS We included right liver donor hepatectomy cases who fit the donor evaluation algorithm at the Dokuz Eylul University Liver Transplantation Unit between the period of June 2000 and September 2017. The patients were evaluated regarding preoperative data. Liver failure was defined according to the International Study Group of Liver Surgery (ISGLS) criteria. We also included statistical analysis of risk factors that are potentially related to liver failure. RESULTS We included a total of 276 patients. In 27 (9.7%) patients, we observed posthepatectomy liver failure (PHLF). In 26 (9.4%) patients, we observed Grade A liver failure; in 1 (0.3%) patient, we observed Grade B liver failure. We did not observe any Grade C hepatic failure. In patients with hepatic failure, we observed a significantly longer period of hospitalization (P = .007). Old age (odds ratio = 1.065, 95% confidence interval, 1.135-29.108, P = .035) and preoperatory red blood cell (RBC) transfusion (odds ratio = 5.749, 95% confidence interval, 1.019-1.113, P = .005) were shown as independent risk factors for PHLF. CONCLUSION Posthepatectomy liver failure is a vital complication of RDH. The risk can be decreased by careful selection of donor candidates. Elderly donor candidates and intraoperative RBC are independent risk factors for PHLF.
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Affiliation(s)
- T Egeli
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey.
| | - T Unek
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - C Agalar
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - M Ozbilgin
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S Derici
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - A D Cevlik
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - M Akarsu
- Department of Internal Medicine, Division of Gastroenterology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - C Altay
- Department of Radiodiagnostic, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - F Obuz
- Department of Radiodiagnostic, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - H Ellidokuz
- Department of Preventive Oncology, Institute of Oncology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - I Astarcioglu
- Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Weng LC, Huang HL, Lee WC, Tsai YH, Wang WS, Chen KH. Health-related quality of life of living liver donors 1 year after donation. Hepatobiliary Surg Nutr 2019; 8:1-9. [PMID: 30881960 DOI: 10.21037/hbsn.2018.11.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Improving the health-related quality of life (HRQOL) of living liver donors post-donation is an important aspect of care quality. Analyzing the HRQOL of living liver donors prospectively could help improve our understanding of the recovery of HRQOL and help improve the quality of donor care. In this study, we examined the HRQOL of living liver donors at pre-donation and at 1-year post-donation and analyzed the effect of pre- and post-donation factors on the donors' physical and mental HRQOL. Methods This was a prospective study. During the enrollment period (August 2013 to December 2015), 68 living liver donors completed the study questionnaires 5 times: at pre-donation and at 1, 3, 6, and 12 months post-donation. The Medical Outcomes Study Questionnaire Short Form-36, which yields both physical (PCS) and mental (MCS) component summary scores, was used to measure the HRQOL. The pre- and post-donation factors included donation ambivalence, recipients' physical condition, post-donation complications, and recipients' survival status. Results Participants' mean PCS scores were 43.59 and 56.50 at 1 and 12 months after donation, respectively, whereas their mean MCS scores were 46.89 and 46.28, respectively. The mean PCS score was worse at 1 month after donation but improved significantly over time (P<0.05); conversely, the MCS was quite stable over time (P>0.05). A good PCS score was associated with no surgical complications of donation (coefficient =2.87, P=0.02), whereas a poor MCS score was associated with an education of less than a bachelor's degree (coefficient =-3.60, P=0.004), a higher Model for End-Stage Liver Disease (MELD) score in the recipient (coefficient =-0.13, P=0.03), and recipient death (coefficient =-3.48, P=0.03). Pre-donation ambivalence and sense of coherence were not significant predictors of the PCS or MCS scores. Conclusions The impact of living liver donation on HRQOL was strongest in the early stages of the post-surgery period for the physical domain. Health-care professionals should carefully manage and monitor the progress of surgical outcomes, particularly in high-risk groups such as donors with a low education level or donors whose recipients have severe illness or end up dying after the surgery. Doing so may allow for suitable intervention opportunities to improve the HRQOL of living liver donors.
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of General Surgery, Transplantation Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Transplantation Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Yu-Hsia Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Cardiovascular Medicine, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
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Kang R, Han S, Lee KW, Kim GS, Choi SJ, Ko JS, Lee SH, Gwak MS. Portland Intensive Insulin Therapy During Living Donor Liver Transplantation: Association with Postreperfusion Hyperglycemia and Clinical Outcomes. Sci Rep 2018; 8:16306. [PMID: 30390037 PMCID: PMC6214899 DOI: 10.1038/s41598-018-34655-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 10/23/2018] [Indexed: 12/20/2022] Open
Abstract
Many liver transplant recipients experience intraoperative hyperglycemia after graft reperfusion. Accordingly, we introduced the Portland intensive insulin therapy (PoIIT) in our practice to better control blood glucose concentration (BGC). We evaluated the effects of PoIIT by comparing with our conventional insulin therapy (CoIT). Of 128 patients who underwent living donor liver transplantation (LDLT) during the phaseout period of CoIT, 89 were treated with the PoIIT and 39 were treated with CoIT. The primary outcome was hyperglycemia (BGC > 180 mg/dL) during the intraoperative postreperfusion phase. The secondary outcomes were postoperative complications such as infection. The incidence of hyperglycemia (22.5% vs. 53.8%, p = 0.001) and prolonged hyperglycemia for >2 hours (7.9% vs. 30.8%, p = 0.002) was significantly lower in PoIIT group than in CoIT group. A mixed linear model further demonstrated that repeatedly measured BGCs were lower in PoIIT group (p < 0.001). The use of PoIIT was significantly associated with decreases in major infections (OR = 0.23 [0.06-0.85], p = 0.028), prolonged mechanical ventilation (OR = 0.29 [0.09-0.89], p = 0.031), and biliary stricture (OR = 0.23 [0.07-0.78], p = 0.018) after adjustments for age, sex, and diabetes mellitus. In conclusion, the PoIIT is effective for maintaining BGC and preventing hyperglycemia during the intraoperative postreperfusion phase of living donor liver transplantation with potential clinical benefits.
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Affiliation(s)
- RyungA Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Joo Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Justin S Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Donor Outcomes After Liver Donation in Adult to Adult Living Donor Liver Transplantation. Transplant Proc 2018; 50:2588-2592. [DOI: 10.1016/j.transproceed.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/06/2018] [Accepted: 04/06/2018] [Indexed: 01/13/2023]
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Ahmed EA, El-Badry AM, Mocchegiani F, Montalti R, Hassan AEA, Redwan AA, Vivarelli M. Impact of Graft Steatosis on Postoperative Complications after Liver Transplantation. Surg J (N Y) 2018; 4:e188-e196. [PMID: 30474065 PMCID: PMC6193803 DOI: 10.1055/s-0038-1675236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background Steatotic grafts are more susceptible to ischemia-reperfusion injury than are normal grafts. Therefore, using steatotic grafts for liver transplantation (LT) is associated with high primary dysfunction and decreased survival rates. The aim of this study is to evaluate the impact of graft steatosis on post LT outcomes. Methods A retrospective cohort analysis of 271 LT recipients from 2005 to 2016 was performed and patients were classified based on two types of steatosis, macrosteatosis (MaS), and microsteatosis (MiS). Each category was subdivided into three groups according to the degree of steatosis: no (< 5%), mild (≥5 to < 30%), and moderate (≥30 to ≤60%). The primary hospital stays and 6-month postoperative complications were analyzed by the Clavien-Dindo classification system. Additionally, patient and graft survivals were studied. Results Significant differences were observed in grade III MaS ( p -value = 0.019) and grade V MiS ( p -value = 0.020). A high trend of early graft dysfunction was found in the moderate MaS and MiS groups; however, they were not statistically significant ( p -value = 0.199 and 0.282, respectively). Interestingly, the acute cellular rejection (ACR) rate was found to be inversely proportional to the degree of steatosis in both categories but it did not reach a significant level ( p -value = 0.161 and 0.111, respectively). Conclusion Excellent post LT long-term outcomes using grafts with mild and moderate steatosis were determined. Further studies are needed to evaluate the newly proposed relationship between ACR and steatosis.
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Affiliation(s)
- Emad Ali Ahmed
- Division of Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.,Division of Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, University of Sohag, Sohag, Egypt
| | - Ashraf Mohammad El-Badry
- Division of Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, University of Sohag, Sohag, Egypt
| | - Federico Mocchegiani
- Division of Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Roberto Montalti
- Division of Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Asem Elsani Ali Hassan
- Division of Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, University of Sohag, Sohag, Egypt
| | - Alaa Ahmed Redwan
- Division of Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, University of Sohag, Sohag, Egypt
| | - Marco Vivarelli
- Division of Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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Lim TZ, Chan DKH, Tan KK. Endoscopic stenting should be advocated in patients with stage IV colorectal cancer presenting with acute obstruction. J Gastrointest Oncol 2018; 9:785-790. [PMID: 30505576 DOI: 10.21037/jgo.2018.06.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background It remains contentious whether endoscopic stenting or upfront surgery is more optimal in patients with metastatic colorectal cancers presenting with large bowel obstruction. Methods A retrospective review of all patients with metastatic colorectal cancer who underwent either endoscopic stenting or emergency surgery for acute large bowel obstruction was performed. Results Between January 2007 and June 2014, 66 patients, median age, 64 (range, 25-96) years, presented with acute large bowel obstruction from metastatic colorectal cancer. Forty (60.6%) patients underwent endoscopic stenting whilst the rest received immediate upfront surgical intervention. Of the 40 patients, 29 (72.5%) were successfully stented. The remaining 11 (27.5%) patients who failed endoscopic stenting required immediate emergency surgery to relieve the obstruction. Patients who failed endoscopic stenting had worse complications than those patients who had their stents successfully inserted [odds ratio (OR), 23.3; 95% confidence interval (CI), 2.29-250.00, P=0.004]. Patients who underwent emergency surgery had a longer median length of stay than patients who had successful endoscopic stenting (P=0.003). The patients that underwent successful stenting had earlier commencement of chemotherapy compared to those who had upfront surgery (P=0.02). There was no difference in stoma creation rates between patients who had emergency surgery versus those who were successfully stented. Conclusions Stenting is a safe option in patients with stage IV colorectal cancer presenting with acute large bowel obstruction. Earlier commencement of chemotherapy occurs in patients who were successfully stented. Patients who failed stenting have equivalent outcomes to those who undergone upfront emergency surgery.
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Affiliation(s)
- Tian-Zhi Lim
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Dedrick Kok Hong Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Prevalence and Predictors of Patient-Reported Long-term Mental and Physical Health After Donation in the Adult-to-Adult Living-Donor Liver Transplantation Cohort Study. Transplantation 2018; 102:105-118. [PMID: 28885494 DOI: 10.1097/tp.0000000000001942] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prospective and longitudinal studies have examined liver donors' medical outcomes beyond the first 1 to 2 years postdonation. There is no analogous longitudinal evidence on long-term psychosocial outcomes, including patient-reported clinically significant mental health problems and perceptions of physical well-being. We examined prevalence, descriptive characteristics, and predictors of diagnosable mental health conditions and self-reported physical health problems, including fatigue and pain, in the long-term years after liver donation. METHODS Donors from 9 centers who initially completed telephone interviews at 3 to 10 years postdonation (mean, 5.8 years; SD, 1.9) were reinterviewed annually for 2 years using validated measures. Outcomes were examined descriptively. Repeated-measures regression analyses evaluated potential predictors and correlates of outcomes. RESULTS Of 517 donors initially interviewed (66% of those eligible), 424 (82%) were reassessed at least once. Prevalence rates of major depression and clinically significant pain were similar to general population norms; average fatigue levels were better than norms. All prevalence rates showed little temporal change. Anxiety and alcohol use disorder rates exceeded normative rates at 1 or more assessments. Longer postdonation hospitalization, female sex, higher body mass index, concerns about donation-related health effects, and burdensome donation-related financial costs were associated with increased risk for most outcomes (P's < 0.05). Men were at higher risk for alcohol use disorder (P < 0.001). CONCLUSIONS Anxiety and alcohol use disorders were more common than would be expected; they may warrant increased research attention and clinical surveillance. Surveillance for long-term problems in the areas assessed may be optimized by targeting donors at higher risk based on identified predictors and correlates.
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Daugaard TR, Pommergaard HC, Rostved AA, Rasmussen A. Postoperative complications as a predictor for survival after liver transplantation - proposition of a prognostic score. HPB (Oxford) 2018; 20:815-822. [PMID: 29705344 DOI: 10.1016/j.hpb.2018.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/14/2018] [Accepted: 03/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Liver transplantation is major surgery with a high risk of complications. Existing scoring systems for evaluating complications after surgery are not specific for liver transplantation. Nor are they designed to evaluate the relation to recipient survival or graft loss. We wished to uncover the relation between postoperative complications and one-year risk of death or retransplantation, and to develop a prognostic score for complications based on our findings. METHOD The study was a retrospective cohort study including 253 adult liver recipients. Thirty-days postoperative complications were registered using the Clavien-Dindo classification. A prognostic score was developed based on types, severity, and quantity of complications. RESULTS A total of 1113 complications occurred in 233 (92.1%) of the patients. One-year mortality or graft loss was associated with graft, biliary, surgical, systemic, pulmonary, cardiovascular, renal, and infectious complication but not with neurologic or gastrointestinal complications. The developed score was more accurate in predicting the outcome than both the modified Clavien-Dindo score and the Comprehensive Complication Index. CONCLUSION Types, severity, and quantity of different postoperative complications after liver transplantation are not equally important. The proposed score may focus attention on treating or preventing complications with strong relation to recipient mortality or graft loss.
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Affiliation(s)
- Thomas R Daugaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Andreas A Rostved
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Predictive Factors of Liver Dysfunction After Right Hemihepatectomy for Adult Living Donor Liver Transplantation. Transplant Proc 2018; 50:1114-1122. [PMID: 29731077 DOI: 10.1016/j.transproceed.2017.11.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Living liver donors represent a special group of patients. They are healthy individuals who are exposed to a major surgery, in which the dominant liver proportion is extracted as a graft. Of all potential donor-related morbidities, posthepatectomy liver dysfunction (PHLD) is the most significant as it may be directly related to donor mortality. We aimed to review our data of adult living donor liver transplantation (LDLT) utilizing the right hemiliver grafts to determine the incidence and potential predictors for the development of PHLD, defined according to the International Study Group of Liver Surgery. METHODS We reviewed the data of all adult living donors who underwent right hemihepatectomy during the period between May 2004 and 2016. RESULTS During the study period, 434 cases underwent right hemihepatectomy for adult LDLT. We divided our cases into 2 groups according to the occurrence of PHLD. A significant lower residual liver volume and percentage were noted in PHLD group. Longer intensive care unit stay and hospital stay, and more postoperative morbidities, were observed in PHLD group. PHLD occurred in 50 cases (11.5%), and most of them were grade A (47 cases [10.8%]). Two cases (0.5%) had grade B requiring diuretic therapy, and 1 case (0.2%) had grade C requiring ultrasound guided tube drainage and surgical exploration finally. CONCLUSIONS We should not underestimate the risks of liver donation surgery, especially when utilizing the right hemiliver graft. Donor safety should be ensured by accurate preoperative volumetric assessment of the remnant liver and remnant liver volume limitations must be strictly followed.
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Perioperative Fresh Red Blood Cell Transfusion May Negatively Affect Recipient Survival After Liver Transplantation. Ann Surg 2018; 267:346-351. [DOI: 10.1097/sla.0000000000002062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Lee HW, Lee JM, Yoon JH, Kim YJ, Park JW, Park SJ, Kim SH, Yi NJ, Suh KS. A prospective randomized study comparing radiofrequency ablation and hepatic resection for hepatocellular carcinoma. Ann Surg Treat Res 2018; 94:74-82. [PMID: 29441336 PMCID: PMC5801331 DOI: 10.4174/astr.2018.94.2.74] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/03/2017] [Accepted: 07/18/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose Although there are several prospective clinical studies comparing radiofrequency ablation (RFA) and hepatic resection (HR) for the treatment of hepatocellular carcinoma, there are few trials that have been performed in strictly homogeneous patients. Methods Patients who were newly diagnosed with a solitary hepatocellular carcinoma were randomized to the HR or RFA group. Inclusion criteria were as follows: age ≥ 20 years but ≤ 70 years, Child-Pugh class A, maximal diameter of the tumor ≥ 2 cm but ≤ 4 cm, no previous treatment history, and platelet count > 80,000/mm3. Results Although the study was early terminated, 29 and 34 patients were enrolled in the HR and RFA groups, respectively, and prospectively followed on an intention-to-treat basis. The 5-year overall survival rates were 83.4% and 86.2% in the HR and RFA groups, respectively, which were not significantly different (P = 0.812 by log-rank, P = 0.990 by Breslow). The 3- and 5-year disease-free survival rates in the HR group were significantly superior to those in the RFA group (66.7%, 44.4% vs. 44.1%, 31.2%, P = 0.071 by log-rank, P = 0.023 by Breslow). Intrahepatic local recurrence tended to develop more frequently in the RFA group (P = 0.042), while the frequency of intrahepatic distant and extrahepatic recurrence was similar bet ween the 2 groups. There were no significant differences in the frequency and severity of complications between the 2 groups. Conclusion HR was significantly superior to RFA in terms of disease-free survival; however, the overall survival was excellent in both groups.
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Affiliation(s)
- Hae Won Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joong-Won Park
- Liver Cancer Center, National Cancer Center, Goyang, Korea
| | - Sang-Jae Park
- Liver Cancer Center, National Cancer Center, Goyang, Korea
| | - Seong Hoon Kim
- Liver Cancer Center, National Cancer Center, Goyang, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Goja S, Yadav SK, Saigal S, Soin AS. Right lobe donor hepatectomy: is it safe? A retrospective study. Transpl Int 2017; 31:600-609. [DOI: 10.1111/tri.13092] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/18/2017] [Accepted: 10/31/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Sanjay Goja
- Institute of Liver Transplantation and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Sanjay Kumar Yadav
- Institute of Liver Transplantation and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Sanjiv Saigal
- Institute of Liver Transplantation and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
| | - Arvinder Singh Soin
- Institute of Liver Transplantation and Regenerative Medicine; Medanta-The Medicity; Gurgaon Delhi (NCR) India
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Levine MA, Schuler T, Gourishankar S. Complications in the 90-day postoperative period following kidney transplant and the relationship of the Charlson Comorbidity Index. Can Urol Assoc J 2017; 11:388-393. [PMID: 29106360 DOI: 10.5489/cuaj.4378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Renal transplant experiences widespread success, but little is published regarding the postoperative complications. The Charlson Comorbidity Index (CCI) is a system of mortality risk assessment. Our purpose is to assess the 90-day postoperative complications after renal transplantation. The secondary objective is to clarify whether CCI predicts complications. We hypothesized increased CCI corresponds to worse complication on the Clavien scale. METHODS This is a retrospective analysis of renal recipients at our institution (2011-2013) who were ≥18 years old and received complete follow up. CCI, age, gender, body mass index (BMI), and graft type were extracted from the electronic medical records. Complications were scored using the Clavien scale. Descriptive statistics and logistic regression were used to analyze 198 patients. RESULTS The mean age was 53 (standard deviation [SD] 14), mean BMI 27.4 (SD 14), median CCI 1. Grade 2 or higher (significant) complications occurred in 60% of patients and Grade 3b or higher (severe) in 15% of patients in the 90-day postoperative period. Sixty-eight different complications were identified, the most common being blood transfusion (19%). Logistic regression suggests a predictive value of CCI (odds ratio [OR] 1.70; 95% confidence interval [CI] 1.3-2.3) for severe complications, with diabetes mellitus and peripheral vascular disease conferring increased risk. CONCLUSIONS Renal transplant carries significant risk. This data can be used to improve patient counselling on the likely postoperative course. Study limitations include the retrospective design, predisposing to potential bias in data capture.
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Affiliation(s)
- Max A Levine
- Division of Urology; University of Alberta, Edmonton, AB, Canada
| | - Trevor Schuler
- Division of Urology; University of Alberta, Edmonton, AB, Canada
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Lauterio A, De Carlis R, Di Sandro S, Ferla F, Buscemi V, De Carlis L. Liver transplantation in the treatment of severe iatrogenic liver injuries. World J Hepatol 2017; 9:1022-1029. [PMID: 28932348 PMCID: PMC5583534 DOI: 10.4254/wjh.v9.i24.1022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/19/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
The place of liver transplantation in the treatment of severe iatrogenic liver injuries has not yet been widely discussed in the literature. Bile duct injuries during cholecystectomy represent the leading cause of liver transplantation in this setting, while other indications after abdominal surgery are less common. Urgent liver transplantation for the treatment of severe iatrogenic liver injury may-represent a surgical challenge requiring technically difficult and time consuming procedures. A debate is ongoing on the need for centralization of complex surgery in tertiary referral centers. The early referral of patients with severe iatrogenic liver injuries to a tertiary center with experienced hepato-pancreato-biliary and transplant surgery has emerged as the best treatment of care. Despite widespread interest in the use of liver transplantation as a treatment option for severe iatrogenic injuries, reported experiences indicate few liver transplants are performed. This review analyzes the literature on liver transplantation after hepatic injury and discusses our own experience along with surgical advances and future prospects in this uncommon transplant setting.
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Affiliation(s)
- Andrea Lauterio
- Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Riccardo De Carlis
- Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- Department of Surgical Sciences, University of Pavia, 27100 Pavia, Italy
| | - Stefano Di Sandro
- Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- Department of Experimental Medicine, University of Pavia, 27100 Pavia, Italy
| | - Fabio Ferla
- Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Vincenzo Buscemi
- Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- Department of Surgical Sciences, University of Pavia, 27100 Pavia, Italy
| | - Luciano De Carlis
- Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- School of Medicine, University of Milan-Bicocca, 20162 Milan, Italy
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Association Between Intraoperative Platelet Transfusion and Early Graft Regeneration in Living Donor Liver Transplantation. Ann Surg 2017; 264:1065-1072. [PMID: 26720430 DOI: 10.1097/sla.0000000000001526] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the association between anesthetic management before and after graft reperfusion and early graft regeneration in living donor liver transplantation (LDLT). BACKGROUND Sufficient graft regeneration is essential for the success of LDLT. Diverse signals start to trigger liver regeneration immediately after graft reperfusion. METHODS Graft volume at 14 ± 2 days after LDLT was measured in 379 consecutive recipients using computed tomography images with 3-dimensional reconstruction. The association between anesthetic variables and the degree of graft regeneration for 2 weeks was analyzed using simple and multiple linear regressions. The anesthetic variables included hemodynamics, laboratory measurements, vasoactive drugs, and blood products transfusion. RESULTS The degree of graft regeneration for 2 weeks was 52% in median and ranged from 5% to 123%. Platelet transfusion was identified as the sole independent anesthetic factor contributing to graft regeneration. Platelet concentrate transfusion of 1 to 6 units vs none was correlated with a 6.5% increase in graft regeneration (P = 0.012). Platelet concentrate transfusion of more than 6 units vs none was further correlated with an 18.4% increase in regeneration (P < 0.001). In the subgroup of recipients without intraoperative platelet transfusion, mean platelet count measured during the intraoperative reperfusion phase was positively associated with graft regeneration (P = 0.033). CONCLUSIONS Graft regeneration after LDLT increased in relation to a graded increase in the amount of transfused platelets and higher postreperfusion platelet counts during surgery. These results offer additional evidence regarding the important role of platelets in initiating liver regeneration and, furthermore, the indications for and the benefits vs risks of platelet transfusion during LDLT.
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47
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Living donor liver transplantation: eliminating the wait for death in end-stage liver disease? Nat Rev Gastroenterol Hepatol 2017; 14:373-382. [PMID: 28196987 DOI: 10.1038/nrgastro.2017.2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adult-to-adult living donor liver transplantation (A2ALDLT), outside of Asia, remains an important yet underutilized gift of life. For patients with end-stage liver disease, A2ALDLT is a proven transplantation option, with lower waiting list mortality and suffering, and equivalent or better allograft and patient survival than deceased-donor liver transplantation (DDLT). The risks to living donors and the benefit to their recipients have been carefully defined with long-term level 1 and 2 evidence-based study. An overview of the development and practice of living donor liver transplant (LDLT), including donor and recipient surgical allograft innovation, is provided. The issues of recipient selection, outcomes and morbidity, including disease-variable study and challenges past and present are presented in comparison with DDLT cohorts, and future insights are described. Central to practice is the careful and concise review of donor evaluation and selection and donor outcome, morbidity, quality of life and present and future strategies for donor advocacy and growth of the technique.
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Peck-Radosavljevic M. Thrombocytopenia in chronic liver disease. Liver Int 2017; 37:778-793. [PMID: 27860293 DOI: 10.1111/liv.13317] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022]
Abstract
Thrombocytopenia is a common haematological disorder in patients with chronic liver disease. It is multifactorial and severity of liver disease is the most influential factor. As a result of the increased risk of bleeding, thrombocytopenia may impact upon medical procedures, such as surgery or liver biopsy. The pathophysiology of thrombocytopenia in chronic liver disease has long been associated with the hypothesis of hypersplenism, where portal hypertension causes pooling and sequestration of all corpuscular elements of the blood, predominantly thrombocytes, in the enlarged and congested spleen. Other mechanisms of importance include bone marrow suppression by toxic substances, such as alcohol or viral infection, and immunological removal of platelets from the circulation. However, insufficient platelet recovery after relief of portal hypertension by shunt procedures or minor and transient recovery after splenic artery embolization have caused many to question the importance and relative contribution of this mechanism to thrombocytopenia. The discovery of the cytokine thrombopoietin has led to the elucidation of a central mechanism. Thrombopoietin is predominantly produced by the liver and is reduced when liver cell mass is severely damaged. This leads to reduced thrombopoiesis in the bone marrow and consequently to thrombocytopenia in the peripheral blood of patients with advanced-stage liver disease. Restoration of adequate thrombopoietin production post-liver transplantation leads to prompt restoration of platelet production. A number of new treatments that substitute thrombopoietin activity are available or in development.
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Affiliation(s)
- Markus Peck-Radosavljevic
- Department of Gastroenterology, Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
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Psychosocial Outcomes 3 to 10 Years After Donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study. Transplantation 2017; 100:1257-69. [PMID: 27152918 DOI: 10.1097/tp.0000000000001144] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies of liver donors' psychosocial outcomes focus on the short term and rely largely on quality-of-life measures not specific to donation. We sought to examine long-term donation effects on 3 psychosocial domains: perceived physical, emotional, and socioeconomic outcomes. METHODS Individuals donating 3 to 10 years previously at 9 centers were eligible for telephone surveys. Survey responses were examined descriptively. Cluster analysis was used to identify distinct donor groups based on response profiles across psychosocial domains. Potential predictors of response profiles were evaluated with regression analysis. RESULTS Five hundred seventeen donors (66%) participated (M = 5.8 years postdonation, SD = 1.9). Fifteen percent to 48% of donors endorsed current donation-related physical health problems and concerns, and 7%-60% reported socioeconomic concerns (eg, insurance difficulties, financial expenditures). However, on average, donors experienced high psychological growth, and 90% felt positively about donation. Cluster analysis revealed 5 donor groups. One group showed high psychological benefit, with little endorsement of physical or socioeconomic concerns (15% of donors). Four groups showed less favorable profiles, with varying combinations of difficulties. The largest such group showed high endorsement of physical concerns and financial expenditures, and only modest psychological benefit (31% of donors). Men and nonHispanic whites were most likely to have unfavorable response profiles (Ps < 0.01). Compared with donors aged 19 to 30 years, older donors were less likely to have unfavorable profiles; these differences were significant for donors in the >40 to 50 year age group (Ps < 0.008). CONCLUSIONS Even many years postdonation, donors report adverse physical and socioeconomic effects, but positive emotional effects as well. Identification of response profiles and predictors may improve targeting of postdonation surveillance and care.
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Lim TZ, Chan DKH, Tan KK. Endoscopic Stenting Does Not Worsen Long Term Outcomes Amongst Patients Presenting with Obstruction from Colorectal Cancers. Ann Surg Oncol 2017; 24:1618-1625. [DOI: 10.1245/s10434-016-5724-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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