Living donor liver transplantation using a left hepatic graft from a donor with a history of gastric cancer operation

Prevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference

As with any other intervention in health, liver transplantation (LT) entails a variety of risks, including donor-transmitted cancers (DTCs). At present, 2%-4% of used deceased organ donors are known to have a current or past history of malignancy. The frequency of DTCs is consistently reported at 3-6 cases per 10 000 solid organ transplants, with a similar frequency in the LT setting. A majority of DTCs are occult cancers unknown in the donor at the time of transplantation. Most DTCs are diagnosed within 2 y after LT and are associated with a 51% probability of survival at 2 y following diagnosis. The probability of death is greatest for DTCs that have already metastasized at the time of diagnosis. The International Liver Transplantation Society-Sociedad Española de Trasplante Hepático working group on DTC has provided guidance on how to minimize the occurrence of DTCs while avoiding the unnecessary loss of livers for transplantation both in deceased and living donor LT. The group endorses the Council of Europe classification of risk of transmission of cancer from donor to recipient (minimal, low to intermediate, high, and unacceptable), classifies a range of malignancies in the liver donor into these 4 categories, and recommends when to consider LT, mindful of the risk of DTCs, and the clinical condition of patients on the waiting list. We further provide recommendations to professionals who identify DTC events, stressing the need to immediately alert all stakeholders concerned, so a coordinated investigation and management can be initiated; decisions on retransplantation should be made on a case-by-case basis with a multidisciplinary approach.

How to explant a diseased liver for living donor liver transplantation after previous gastrectomy with severe adhesion (with video)

We performed living donor liver transplantation (LDLT) in a patient who had undergone distal gastrectomy for gastric ulcer disease with Billroth I reconstruction 30 years before the LDLT. The adhesion was very severe between remnant stomach and hepatic hilum as well as left liver lobe with shortening of hepatoduodenal structures. After dissection of the infrahepatic inferior vena cava, the Spiegel lobe was identified from the dorsal side. The Spiegel lobe was then penetrated with a right angle dissector so that a plastic tape could be placed around the whole adhesion, including important structures in the hepatoduodenal ligament. Next, the right hepatic vein was transected with a vascular stapler using Pringle's maneuver using the plastic tape to fasten the entire adhesional structure. Subsequently, the trunk of the middle and left hepatic vein was transected after clamping. The remaining short hepatic veins in the left side were divided completely from the cranial to the caudal direction to dissect Spiegel's lobe. Finally, the hepatoduodenal ligament was identified from the attached remnant stomach and the duodenum and a vascular clamp was placed on the entire hepatoduaodenal ligament. Finally, the diseased liver was explanted for graft implantation. Thus, retrograde explantation of the liver was effective in decreasing the risk of damaging vital elements in the hepatoduodenal ligament, the remnant stomach, and the duodenum.

Effects of a whey peptide-based enteral formula diet on liver dysfunction following living donor liver transplantation

BACKGROUND AND AIMS

Whey protein, a protein complex derived from milk is well known as a functional food with a number of health benefits. MEIN(®) (Meiji Dairies Co., Tokyo Japan) is a functional liquid-type nutritional diet containing whey-hydrolyzed peptide. In this study, we examined the effects of MEIN(®) on postoperative liver dysfunction in patients who underwent living donor-related liver transplantation (LDLT).

METHODS

Sixteen adult patients transplanted between 2005 and 2011 at our institute were evaluated retrospectively. In MEIN group (n = 8), administration of MEIN(®) was started around 14 days after liver transplantation when serum liver enzymes were re-elevated, while MEIN(®) was not administered in the control group (n = 8) who did not have postoperative liver dysfunction.

RESULTS

In the preoperative clinical characteristics, the model for end-stage liver disease score in the MEIN group was significantly lower than that in the control group. The graft-to-recipient body weight ratio in the MEIN group was lower than that in the control group. Elevation of enzymes in the liver function tests such as alanine aminotransferase and total bilirubin, and C-reactive protein in the MEIN group had significantly improved, and became almost normal values which were the same as those in the control group.

CONCLUSION

These findings suggest that administration of whey-hydrolyzed peptide attenuates the post-transplant liver dysfunction and may avoid an unnecessary liver biopsy.