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Aoki H, Ito T, Hirata M, Okumura S, Masano Y, Ogawa E, Haga H, Hatano E. Adverse effects of graft congestion and ameliorative effects of hepatocyte growth factor after liver transplantation in rats. Liver Transpl 2024:01445473-990000000-00453. [PMID: 39225679 DOI: 10.1097/lvt.0000000000000449] [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] [Received: 05/08/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
Living donor liver transplantation (LT) and deceased donor split-LT often result in congestion within liver grafts. The regenerative process and function of congested areas, especially graft congestion associated with LT, are not well understood. Therefore, we created new rat models with congested areas in partially resected livers and orthotopically transplanted these livers into syngeneic rats to observe liver regeneration and function in congested areas. This study aimed to compare liver regeneration and the function of congested areas after liver resection and LT, and to explore a new approach to ameliorate the adverse effects of graft congestion. Although the congested areas after liver resection regenerated normally on postoperative day 7, the congested areas after LT had poor regeneration with abscess development on postoperative day 7. Necrotic areas in congested areas were larger after LT than after liver resection on postoperative days 1, 3, and 7 ( p < 0.05, p < 0.05, and p < 0.01, respectively). Although congested areas after liver resection did not affect survival, in the LT model, the survival of rats with congested areas was significantly poorer even with larger grafts than that of rats with smaller noncongested grafts ( p = 0.04). Hepatocyte growth factor administration improved the survival rate of rats with congested grafts from 41.7% to 100%, improved the regeneration of congested areas, and significantly reduced the size of necrotic areas ( p < 0.05). Thus, congested areas in liver grafts may negatively impact recipients. Short-term administration of hepatocyte growth factor may improve postoperative outcomes of recipients with graft congestion and contribute to more effective use of liver grafts (approval number: MedKyo-23137, Institutional Ethics Committee/Kyoto University).
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Affiliation(s)
- Hikaru Aoki
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaaki Hirata
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Okumura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Masano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eri Ogawa
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Han S, Rhu J, Lim S, Choi GS, Kim JM, Joh JW. Multivariable linear model for predicting graft weight based on 3-dimensional volumetry in regards to body weight change of living liver donor: an observational cohort study. Ann Surg Treat Res 2024; 107:91-99. [PMID: 39139829 PMCID: PMC11317358 DOI: 10.4174/astr.2024.107.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose The purpose of this study is to build a prediction model for estimating graft weight about different graft volumetry methods combined with other variables. Methods Donors who underwent living-donor right hepatectomy from March 2021 to March 2023 were included. Estimated graft volume measured by conventional method and 3-dimensional (3D) software were collected as well as the actual graft weight. Linear regression was used to build a prediction model. Donor groups were divided according to the 3D volumetry of <700 cm3, 700-899 cm3, and ≥900 cm3 to compare the performance of different models. Results A total of 119 donors were included. Conventional volumetry showed R2 of 0.656 (P < 0.001) while 3D software showed R2 of 0.776 (P < 0.001). The R2 of the multivariable model was 0.842 (P < 0.001) including for 3D volume (β = 0.623, P < 0.001), body mass index (β = 7.648, P < 0.001), and amount of weight loss (β = -7.252, P < 0.001). The median errors between different models and actual graft weight did not differ in donor groups (<700 and 700-899 cm3), while the median error of univariable linear model using 3D software (122.5; interquartile range [IQR], 61.5-179.8) was significantly higher than multivariable-adjusted linear model (41.5; IQR, 24.8-69.8; P = 0.003) in donors with estimated graft weight ≥900 cm3. Conclusion The univariable 3D volumetry model showed an acceptable outcome for donors with an estimated graft volume <900 cm3. For donors with an estimated graft volume ≥900 cm3, the multivariable-adjusted linear model showed higher accuracy.
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Affiliation(s)
- Seungwook Han
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soyoung Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Di Sandro S, Centonze L, Catellani B, Odorizzi R, Caracciolo D, Guidetti C, Magistri P, Esposito G, Guerrini GP, Di Benedetto F. Current role and perspectives of living donor liver transplantation for hepatocellular carcinoma: systematic review of the past 20 years. Updates Surg 2024:10.1007/s13304-024-01862-y. [PMID: 38704462 DOI: 10.1007/s13304-024-01862-y] [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: 01/11/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
Hepatocellular carcinoma (HCC) poses a significant global health challenge, and liver transplantation (LT) remains the best curative option. Living donor liver transplantation (LDLT) emerged as a potential solution to organ scarcity, reducing waitlist times. This comprehensive review explores LDLT practices, focusing on patient selection criteria and oncologic outcomes. A systematic review following PRISMA guidelines included 50 studies (2004-2023) with 8062 patients. Data encompassed baseline characteristics, HCC features, and oncologic outcomes. Further analysis categorized results by geography and publication year. Heterogeneity in patient demographics, tumor burden, and transplant characteristics was observed. Recent LDLT series demonstrated a shift towards refined selection criteria, increased neoadjuvant treatment, and improved oncologic outcomes. Geographic disparities revealed unique challenges in Eastern and Western practices. LDLT proves effective for HCC, addressing donor shortages. Evolving practices highlight the importance of refining inclusion criteria and optimizing tumor management. While geographic differences exist, LDLT, when judiciously applied, offers promising outcomes.
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Affiliation(s)
- Stefano Di Sandro
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Leonardo Centonze
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Catellani
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberta Odorizzi
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Daniela Caracciolo
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Cristiano Guidetti
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Paolo Magistri
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Giuseppe Esposito
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Piero Guerrini
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabrizio Di Benedetto
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Yang J, Rhu J, Kwon J, Choi GS, Kim JM, Jeong WK, Joh JW. Hepatic venous territory mapping in living donor liver transplantation using right liver graft: an objective parameter for venous reconstruction. Ann Surg Treat Res 2023; 104:348-357. [PMID: 37337606 PMCID: PMC10277178 DOI: 10.4174/astr.2023.104.6.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 06/21/2023] Open
Abstract
Purpose This study evaluated the clinical implication of hepatic venous territory mapping in living donor liver transplantation. Methods Living donor liver transplantations performed using right graft since 2017 were included. Hepatic venous volume mapping was started in 2019. Risk factors for graft failure and overall survival were analyzed. Analysis for factors related to occlusion of reconstructed vein was performed. Results Among 445 patients included, 213 underwent hepatic venous mapping. Hepatic venous mapping itself was not a significant factor for graft (hazard ratio [HR], 0.958; 95% confidence interval [CI], 0.441-2.082; P = 0.913) and overall survival (HR, 0.627; 95% CI, 0.315-1.247; P = 0.183). Inferior hepatic vein occlusion was a significant risk factor for both graft survival (HR, 8.795; 95% CI, 1.628-47.523; P = 0.012) and overall survival (HR, 11.13; 95% CI, 2.460-50.300; P = 0.002). In a subgroup with middle hepatic vein reconstruction, occlusion was a significant risk factor for overall survival (HR, 3.289; 95% CI, 1.304-8.296; P = 0.012). In patients with middle hepatic vein reconstruction whose venous territory volumes were measured, right anterior volume of ≥300 cm3 was protective for vein occlusion (OR, 0.317; 95% CI, 0.152-0.662; P = 0.002). In patients with V5 reconstruction, V5 volume of ≥150 cm3 was protective for vein occlusion (OR, 0.253; 95% CI, 0.087-0.734; P = 0.011). Conclusion Inferior and middle hepatic vein reconstruction has significant impact on clinical outcome. Hepatic venous territory mapping can provide an objective measure for successful reconstruction of venous branches.
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Affiliation(s)
- Jaehun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jieun Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rhu J, Choi GS, Kim JM, Kwon CHD, Joh JW. Complete transition from open surgery to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomies. Liver Transpl 2022; 28:1158-1172. [PMID: 35138684 DOI: 10.1002/lt.26429] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 01/13/2023]
Abstract
This study was designed to review laparoscopic living donor liver transplantations (LDLTs) at a single center that achieved complete transition from open surgery to laparoscopy. LDLTs performed from January 2013 to July 2021 were reviewed. Comparisons between open and laparoscopic surgeries were performed according to periods divided into initial, transition, and complete transition periods. A total of 775 LDLTs, 506 laparoscopic and 269 open cases, were performed. Complete transition was achieved in 2020. Bile duct variations were significantly abundant in the open group both in the initial period (30.2% vs. 8.1%; p < 0.001) and transition period (48.1% vs. 24.3%; p < 0.001). Portal vein variation was more abundant in the open group only in the initial period (13.0% vs. 4.1%; p = 0.03). Although the donor reoperation rate (0.0% vs. 4.1%; p = 0.02) and Grade III or higher complication rate (5.6% vs. 13.5%; p = 0.03) were significantly higher in the laparoscopy group in the initial period, there were no differences during the transition period as well as in overall cases. Median number of opioids required by the donor (three times [interquartile range, IQR, 1-6] vs. 1 time [IQR, 0-3]; p < 0.001) was lower, and the median hospital stay (10 days [IQR, 8-12] vs. 8 days [IQR, 7-9]; p < 0.001) was shorter in the laparoscopy group. Overall recipient bile leakage rate (23.8% vs. 12.8%; p < 0.001) and overall Grade III or higher complication rate (44.6% vs. 37.2%; p = 0.009) were significantly lower in the laparoscopy group. Complete transition to laparoscopic living donor hepatectomy was possible after accumulating a significant amount of experience. Because donor morbidity can be higher in the initial period, donor selection for favorable anatomy is required for both the donor and recipient.
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Affiliation(s)
- Jinsoo Rhu
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Gyu-Seong Choi
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jong Man Kim
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Choon Hyuck David Kwon
- Department of General SurgeryDigestive Disease & Surgery InstituteLerner College of MedicineCleveland ClinicClevelandOhioUSA
| | - Jae-Won Joh
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
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Li L, Xu L, Zhou S, Wang P, Zhang M, Li B. Tumour site is a risk factor for hepatocellular carcinoma after hepatectomy: a 1:2 propensity score matching analysis. BMC Surg 2022; 22:104. [PMID: 35313888 PMCID: PMC8935716 DOI: 10.1186/s12893-022-01564-5] [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: 11/18/2021] [Accepted: 03/15/2022] [Indexed: 02/08/2023] Open
Abstract
Background The effect of the anatomic location of HCC on the prognosis of patients after hepatectomy is currently unclear. Methods Patients who underwent hepatectomy were retrospectively enrolled and divided into the right tumour resection group (R group) and the left tumour resection group (L group) according to the tumour anatomic location. To avoid bias, 1:2 propensity score matching (PSM) analysis was used. Based on the survival data, disease-free survival (DFS) and overall survival (OS) were evaluated by the Kaplan–Meier method, and long-term survival analysis was performed. Cox proportional hazards regression was used to analyse the risk factors associated with postoperative prognosis. Results A total of 700 patients were enrolled in our study. After 1:2 PSM, 354 and 177 patients were enrolled in the R group and the L group, respectively, with comparable baseline characteristics. Survival analysis showed that patients in the L group had a significantly higher recurrence rate than patients in the R group (P = 0.036), but there was no significant difference in the survival rate (P = 0.99). Long-term survival analysis showed that the survival rate of the L group was lower than that of the R group (P < 0.01). Multivariate analysis showed that tumour location in the left liver was an independent risk factor for tumour recurrence (hazard ratio, 1.263; 95% CI, 1.005–1.587) and long-term survival (hazard ratio, 3.232; 95% CI, 1.284–8.134). Conclusion For HCC patients, the recurrence rate and long-term survival rate of left liver tumours were significantly higher than those of right liver tumours, indicating that the anatomical location of the tumour has a significant effect on the survival of HCC patients. Trial registration Chinese Clinical Trial Registry, ChiCTR2100052407. Registered 25 October 2021, http://www.chictr.org.cn/showproj.aspx?proj=135500.
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Affiliation(s)
- Lian Li
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Liangliang Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Siqi Zhou
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Peng Wang
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Ming Zhang
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Bo Li
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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