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Usta S, Akbulut S, Sarici KB, Garzali IU, Ozdemir F, Gonultas F, Baskiran A, Isik B, Yilmaz S. An Elbow Patch Reconstruction Technique for Narrowed Remnant Portal Veins during Right Lobe Living Donor Hepatectomy: A Rescue Surgery. J Clin Med 2024; 13:2924. [PMID: 38792466 PMCID: PMC11122611 DOI: 10.3390/jcm13102924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 04/28/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Treatment of established portal vein narrowing after living donor hepatectomy is challenging. We aimed to present a new approach termed the "elbow patch reconstruction technique" to correct the narrowed remnant portal vein just or late after right lobe living donor hepatectomy. Methods: Demographic and clinical data of 12 living liver donors with narrowed remnant portal veins and treated with the "elbow patch reconstruction technique" were prospectively collected and retrospectively evaluated. Anatomic variation of the portal vein was defined in accordance with the Nakamura classification; six of the living liver donors had type A, three had type B, and the remaining three had type C. In eight of the living liver donors with a narrowed remnant portal vein, diagnosis was detected by intraoperative Doppler ultrasonography and visual inspection by experienced transplant surgeons in the living donor hepatectomy procedure. In the remaining four living liver donors, diagnosis was performed postoperatively when elevation of liver enzymes was noticed during the routine liver function test and Doppler US. The diagnosis was confirmed by multidetector computed tomography. Results: Data from nine males and three females aged 18 to 54 years were analyzed. All of the living liver donors were followed up for a median of 1710 days (min-max: 1178-4447 days; IQR: 1516 days), and none of the living liver donors had any structural or functional complications in the portal vein. Conclusions: Narrowing remnant portal veins are rare, but they are a life-threatening complication in living liver donors, and this condition requires urgent management. Image guided interventions and narrowed segment resection with end-to-end anastomosis using a vascular graft carried a potential risk for thrombosis and restenosis. To avoid these complications, we shared a technique named "elbow patch reconstruction technique". This technique can be very effective in relieving the narrowing of the remnant portal vein after right lobe living donor hepatectomy.
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Affiliation(s)
- Sertac Usta
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey; (S.U.); (F.O.); (F.G.); (A.B.); (B.I.); (S.Y.)
| | - Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey; (S.U.); (F.O.); (F.G.); (A.B.); (B.I.); (S.Y.)
| | - Kemal Baris Sarici
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey; (S.U.); (F.O.); (F.G.); (A.B.); (B.I.); (S.Y.)
| | | | - Fatih Ozdemir
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey; (S.U.); (F.O.); (F.G.); (A.B.); (B.I.); (S.Y.)
| | - Fatih Gonultas
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey; (S.U.); (F.O.); (F.G.); (A.B.); (B.I.); (S.Y.)
| | - Adil Baskiran
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey; (S.U.); (F.O.); (F.G.); (A.B.); (B.I.); (S.Y.)
| | - Burak Isik
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey; (S.U.); (F.O.); (F.G.); (A.B.); (B.I.); (S.Y.)
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey; (S.U.); (F.O.); (F.G.); (A.B.); (B.I.); (S.Y.)
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Reddy MS, Kasahara M, Ikegami T, Lee KW. An international survey of venous thromboembolic events and current practices of peri-operative VTE prophylaxis after living donor hepatectomy. Clin Transplant 2024; 38:e15209. [PMID: 38064308 DOI: 10.1111/ctr.15209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Venous thromboembolic complications are an uncommon but significant cause of morbidity & mortality after live donor hepatectomy . The precise incidence of these events and the current practices of centers performing living donor liver transplantation worldwide are unknown. METHODS An online survey was shared amongst living donor liver transplantation centers containing questions regarding center activity, center protocols for donor screening, peri-operative thromboembolic prophylaxis and an audit of -perioperative venous thromboembolic events after live donor hepatectomy in the previous five years (2016-2020). RESULTS Fifty-one centers from twenty countries completed the survey. These centers had cumulatively performed 11500 living donor liver transplants between 2016-2020. All centers included pre-operative l assessment for thromboembolic risk amongst potential liver donors in their protocols. Testing for inherited prothrombotic conditions was performed by 58% of centers. Dual-mode prophylaxis was the most common practice (65%), while eight and four centers used single mode or no routine prophylaxis respectively. Twenty (39%) and 15 (29%) centers reported atleast one perioperative deep venous thrmobosis or pulmonary embolism event respectively. There was one donor mortality directly related to post-operative pulmonary embolism. Overall incidence of deep venous thrombosis and pulmonary embolism events was 3.65 and 1.74 per 1000 live donor hepatectomies respectively. Significant variations in center practices and incidence of thromboembolic events was identified in the survey primarily divided along world regions. 75% of participating centers agreed on the need for clear international guidelines. CONCLUSION Venous thromboembolic events after live donor hepatectomy are an uncommon but important cause of donor morbidity. There is significant variation in practice among centers. Evidence-based guidelines regarding risk assessment, and peri-operative prophylaxis are needed.
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Affiliation(s)
- Mettu Srinivas Reddy
- Department of Liver Transplantation & Hepatobiliary Surgery, Gleneagles Global Hospital, Chennai, India
| | - Mureo Kasahara
- Center for Organ Transplantation, National Center for Child Health & Development, Tokyo, Japan
| | - Toru Ikegami
- Department of Surgery & Science, Kyushu University, Fukuoka, Japan
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
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3
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The relationship between anxiety and stress levels with quality of sleep in patients after living donor liver transplantation. Transpl Immunol 2022; 71:101561. [DOI: 10.1016/j.trim.2022.101561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
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Akbulut S, Sahin TT. Comment on "Minimally Invasive Donor Hepatectomy for Adult Living Donor Liver Transplantation: An International, Multi-institutional Evaluation of Safety, Efficacy, and Early Outcomes". Ann Surg 2021; 274:e771-e772. [PMID: 33201100 DOI: 10.1097/sla.0000000000004281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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5
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The Delicate Balance Between Donors and Recipients. Transplantation 2021; 105:2342-2343. [PMID: 33239539 DOI: 10.1097/tp.0000000000003560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yilmaz S, Akbulut S, Usta S, Ozsay O, Sahin TT, Sarici KB, Karabulut E, Baskiran A, Gonultas F, Ozdemir F, Ersan V, Isik B, Kutlu R, Dirican A, Harputluoglu M. Diagnostic and therapeutic management algorithm for biliary complications in living liver donors. Transpl Int 2021; 34:2226-2237. [PMID: 34510566 DOI: 10.1111/tri.14104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 02/05/2023]
Abstract
This study aimed to demonstrate the efficacy of our diagnostic and therapeutic management algorithm and catheter-assisted (percutaneous transhepatic biliary tract drainage [PTBD] or transanastomotic feeding tube) hepaticojejunostomy (HJ) procedures in living liver donors (LLDs) with biliary complications. Living donor hepatectomy (LDH) was performed between September 2005 and April 2021 in 2 489 LLDs. Biliary complications developed in 220 LLDs (8.8%), 136 of which were male, and the median age was 29 (interquartile range [IQR]: 12) years. Endoscopic sphincterotomy ± stenting was performed in 132 LLDs, which was unsuccessful in 9 LLDs and required HJ. Overall, 142 LLDs underwent interventional radiologic procedures. Fifteen LLDs with biliary complications underwent HJ (PTBD catheter = 6 and transanastomotic feeding tube = 9) at a median of 44 days (IQR: 82). Following HJ, 14 LLDs did not have any complications throughout the median follow-up period of 1619 days (IQR: 1454). However, percutaneous dilation for HJ anastomotic stricture was performed in one patient. Biliary complications are very common following LDH; therefore, surgeons in the field should have a low threshold to perform HJ for biliary complications that persist after other treatments. Our catheter-assisted HJ techniques demonstrated a high success rate and aided HJ in a hostile abdomen during revisional surgery.
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Affiliation(s)
- Sezai Yilmaz
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Oguzhan Ozsay
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Kemal Baris Sarici
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ertugrul Karabulut
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Adil Baskiran
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Fatih Gonultas
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Fatih Ozdemir
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Veysel Ersan
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Burak Isik
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Abuzer Dirican
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Inonu University, Malatya, Turkey
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7
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DÖNMEZ R, ANDAÇOĞLU O. Retrospective Donor Hepatectomy Results in Living Donor Liver Transplant– A Single-Center Experience. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2021. [DOI: 10.25000/acem.929684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Akbulut S, Yilmaz S. Comment on biliary complications among live donors following live donor liver transplantation. Surgeon 2021; 19:61-62. [PMID: 32376204 DOI: 10.1016/j.surge.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey
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9
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Yankol Y, Mecit N, Kanmaz T, Kalayoğlu M, Acarlı K. Complications and outcomes of 890 living liver donor hepatectomies at a single center: risks of saving loved one's life. Turk J Surg 2020; 36:192-201. [PMID: 33015564 DOI: 10.5578/turkjsurg.4548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022]
Abstract
Objectives Living liver donor surgery is a major surgical procedure applied to healthy people with mortality and morbidity risks and does not provide any direct therapeutic advantage to the donor. We retrospectively analyzed the postoperative complication of our living liver donors to figure out the risks of donation. Material and Methods Between November, 2006 and December, 2018, a total of 939 living liver donor hepatectomies were performed with no mortality to the living-related donors. Eight hundred and ninety donors with a minimum 1-year follow-up were analyzed retrospectively. Results Of the 890 donors, 519 (58.3%) were males and 371 (41.7%) were females. Mean age was 35 years (18-64) and mean body mass index was 25.7 kg/m2 (17.7-40). Right donor hepatectomy was performed to 601 (67.5%), left donor hepatectomy to 28 (3.2%) and left lateral sector hepatectomy to 261 (29.3%) of the donors. Of the 890 donors, 174 (19.5%) donors experienced a total of 204 early and late complications including life- threatening and nearly life- threatening complications in 26 (2.9%) of them. Intraoperative complication occurred in 4 (0.5%) donors. Right donors hepatectomy complication rate (23.3%) was higher than left donor (14.3%) and left lateral sector donor hepatectomy (11.5%). Conclusion All donor candidates should be well-informed not only on the details of early and late complications of living liver donation, also possible outcomes of the recipient. In addition to detailed physical evaluation, preoperative psychosocial evaluation is also mandatory. Comprehensive donor evaluation, surgical experience, surgical technique, close postoperative follow-up and establishing a good dialog with the donor allows better outcomes.
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Affiliation(s)
- Yücel Yankol
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.,Department of Surgery Division of Transplantation, University of Wisconsin, Madison, WI, United States of America
| | - Nesimi Mecit
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.,Organ Transplantation Center, Koc University School of Medicine Hospital, Istanbul, Turkey
| | - Turan Kanmaz
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.,Organ Transplantation Center, Koc University School of Medicine Hospital, Istanbul, Turkey
| | - Münci Kalayoğlu
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.,Organ Transplantation Center, Koc University School of Medicine Hospital, Istanbul, Turkey
| | - Koray Acarlı
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey
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10
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Shorbagy MS, Saleh M, Elbeialy MAK, Elsaid K. Respiratory Complications Among Living Liver Donors: A Single-Center Retrospective Observational Study. EXP CLIN TRANSPLANT 2020; 18:474-480. [PMID: 32370694 DOI: 10.6002/ect.2019.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The safety of living liver donors is considered a high priority. In this study, we aimed to highlight the incidence and risk factors of respiratory complications among living liver transplant donors at our institute. MATERIALS AND METHODS We evaluated data of 178 related living liver donors who were seen from January 2014 to December 2018. We recorded significant respiratory complications, such as pulmonary embolism, pleural effusion, pneumothorax, pneumonia, acute lung injury, acute respiratory distress syndrome, and transfusion-related acute lung injury. Complications were noted as clinically evident and/or needing intervention. We also recorded the frequency of nonrespiratory complications and duration of intensive care unit and hospital stays. RESULTS Ten donors (5.6%) developed significant respiratory complications: 2 (1.1%) had pulmonary embolisms, 3 (1.7%) developed symptomatic pleural effusion that required thoracentesis, and 4 (2.25%) had chest infections. The remaining donor (0.6%) had unexplained respiratory insufficiency. Logistic regression analyses identified age ≥ 35 years and previous surgery as the main risk factors of significant respiratory complications. There were no recorded cases of pneumothorax, acute lung injury, acute respiratory distress syndrome, and transfusion-related acute lung injury. Raw surface collection (14.6%) and biliary leakage (7.9%) were the most frequent nonrespiratory complications. There was no significant difference between patients with and without significant respiratory complications with regard to intensive care unit and hospital stays. CONCLUSIONS Despite the low incidence of significant respiratory complications among our living liver donor cohort, close monitoring and early management are essential to achieve better prognosis, especially in donors older than 35 years or those with previous surgery.
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Affiliation(s)
- Mohammed S Shorbagy
- From the Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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11
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Wu ZF, Lin WL, Lee MS, Hung NK, Huang YS, Chen TW, Lu CH. Propofol vs desflurane on the cytokine, matrix metalloproteinase-9, and heme oxygenase-1 response during living donor liver transplantation: A pilot study. Medicine (Baltimore) 2019; 98:e18244. [PMID: 31770287 PMCID: PMC6890360 DOI: 10.1097/md.0000000000018244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We investigated the effects of propofol vs desflurane on ischemia and reperfusion injury (IRI)-induced inflammatory responses, especially in matrix metalloproteinase-9 (MMP-9) downregulation and heme oxygenase-1 (HO-1) upregulation, which may result in different clinical outcomes in liver transplant recipients. METHODS Fifty liver transplant recipients were randomized to receive propofol-based total intravenous anesthesia (TIVA group, n = 25) or desflurane anesthesia (DES group, n = 25). We then measured the following: perioperative serum cytokine concentrations (interleukin 1 receptor antagonist [IL-1RA], IL-6, IL-8, and IL-10); MMP-9 and HO-1 mRNA expression levels at predefined intervals. Further, postoperative outcomes were compared between the 2 groups. RESULTS The TIVA group showed a significant HO-1 level increase following the anhepatic phase and a significant MMP-9 reduction after reperfusion, in addition to a significant increase in IL-10 levels after the anhepatic phase and IL-1RA levels after reperfusion. Compared to DES patients, TIVA patients showed a faster return of the international normalized ratio to normal values, lower plasma alanine aminotransferase concentrations 24 hours after transplantation, and fewer patients developing acute lung injury. Moreover, compared with DES patients, TIVA patients showed a significant reduction in serum blood lactate levels. However, there were no differences in postoperative outcomes between the two groups. CONCLUSION Propofol-based TIVA attenuated inflammatory response (elevated IL-1RA and IL-10 levels), downregulated MMP-9 response, and increased HO-1 expression with improved recovery of graft function and better microcirculation compared with desflurane anesthesia in liver transplant recipients.
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Affiliation(s)
- Zhi-Fu Wu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
| | - Wei-Lin Lin
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
| | | | - Nan-Kai Hung
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
| | - Yuan-Shiou Huang
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
| | - Teng-Wei Chen
- Division of General Surgery, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan
| | - Chueng-He Lu
- Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital
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12
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Onda S, Shiba H, Sakamoto T, Furukawa K, Gocho T, Yanaga K. Pulmonary Embolism in a Donor of Living Donor Liver Transplantation. Case Rep Gastroenterol 2019; 13:258-264. [PMID: 31275089 PMCID: PMC6600034 DOI: 10.1159/000501068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/18/2019] [Indexed: 11/19/2022] Open
Abstract
Pulmonary embolism (PE) is a rare but potentially fatal complication that may develop in a living liver donor. Here, we report a case of non-massive PE diagnosed by elevated serum D-dimer levels and successfully treated using anticoagulant therapy. A 57-year-old man underwent extended left hepatectomy as a living liver donor. His past medical history included hypertension and dyslipidemia which required medication and a history of smoking. Mechanical prophylactic measures for venous thromboembolism, including intermittent pneumatic compression and elastic stocking, were used; however, no pharmacological prophylaxis was used. Although the patient ambulated on postoperative day (POD) 1, he developed hypoxia. Serum D-dimer level was elevated to 29.3 ng/mL on POD 2. Enhanced computed tomography revealed small peripheral PEs in the branches of the right upper, right middle, and left lower lobes without deep vein thrombosis. Intravenous heparin was initiated followed by warfarin. The thrombi resolved completely by POD 13, following which warfarin was continued for 3 months. As of 25 months after donation, the patient remains well without recurrence of PE. Early diagnosis and treatment of postoperative PE are critical for preventing mortality of liver donors.
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Affiliation(s)
- Shinji Onda
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroaki Shiba
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Taro Sakamoto
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenei Furukawa
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeshi Gocho
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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13
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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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14
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Weng LC, Huang HL, Lee WC, Tsai YH, Lin CR, Wang WS, Wang YW, Yang TY, Tseng LC. Psychological profiles of excluded living liver donor candidates: An observational study. Medicine (Baltimore) 2018; 97:e13898. [PMID: 30593201 PMCID: PMC6314726 DOI: 10.1097/md.0000000000013898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Living donor liver transplantation has advantages over deceased organ liver transplantation. However, the living liver donor candidates must be carefully assessed before surgery. Candidates may be excluded for various reasons. The purpose of this study was to evaluate the psychological profiles of excluded living liver donor candidates according to the reason for exclusion.A descriptive and cross-sectional study was conducted. Donor candidates were invited to participate if they were at least 20 years of age, related biologically or by marriage to the recipient (within 5 degrees), and had undergone living donor evaluation. Among the 338 participants recruited from August 2013 to December 2015, 116 were excluded for the following reasons: a medical condition (n = 35), failure to be chosen (n = 63), or withdrawal from the selection process (n = 18). The psychological profiles of these 3 exclusion groups were evaluated.There were no significant group differences in age, sex, education level, religion, marital status, and consanguinity (P > .05). The withdrawal group had fewer recipients with an hepatitis B virus infection than did the other groups (χ = 9.28, P = .01). Additionally, compared with the unchosen group, the withdrawal group had lower intimacy with the recipient (F = 5.32, P = .006) and higher ambivalence (F = 5.53, P = .005). In terms of family relationship parameters, the withdrawal group had lower family cohesion than the medical condition and unchosen groups (F = 4.44, P = .01), lower family expressiveness than the medical condition group (F = 3.76, P = .03), and higher family conflict than the medical condition and unchosen groups (F = 7.05, P = .001). The withdrawal group also had lower emotional social support than the medical condition group (F = 3.55, P = .03). There were no significant group difference in motivation, expectations, donation-related concerns, informational social support, value social support, instrumental social support, and health-related quality of life.The living donor candidates who withdrew from the selection process had obvious ambivalence, poorer family relationships, and insufficient emotional social support. The transplantation team should respect the autonomy of the candidate's decision and mitigate the impact of the donation decision on living liver donor candidates.
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan
- Department of General Surgery, Chang Gung Memorial Hospital Linkuo
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing Health Science
| | - Wei-Chen Lee
- Department of General Surgery, Chang Gung Memorial Hospital Linkuo
| | - Yu-Hsia Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan
- Department of Cardiovascular Medicine
| | - Ching-Rong Lin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan
- Department of Radiation Oncology
- Proton and Radiation Therapy Center
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan
| | - Yi-Wen Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan
| | - Tsui-Yun Yang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan
| | - Li-Chuan Tseng
- Department of Nursing, Chang Gung Memorial Hospital (Linkuo), Taoyuan, Taiwan
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