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Kirchner VA, Shankar S, Victor DW, Tanaka T, Goldaracena N, Troisi RI, Olthoff KM, Kim JM, Pomfret EA, Heaton N, Polak WG, Shukla A, Mohanka R, Balci D, Ghobrial M, Gupta S, Maluf D, Fung JJ, Eguchi S, Roberts J, Eghtesad B, Selzner M, Prasad R, Kasahara M, Egawa H, Lerut J, Broering D, Berenguer M, Cattral MS, Clavien PA, Chen CL, Shah SR, Zhu ZJ, Ascher N, Ikegami T, Bhangui P, Rammohan A, Emond JC, Rela M. Management of Established Small-for-size Syndrome in Post Living Donor Liver Transplantation: Medical, Radiological, and Surgical Interventions: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference. Transplantation 2023; 107:2238-2246. [PMID: 37749813 DOI: 10.1097/tp.0000000000004771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Small-for-size syndrome (SFSS) following living donor liver transplantation is a complication that can lead to devastating outcomes such as prolonged poor graft function and possibly graft loss. Because of the concern about the syndrome, some transplants of mismatched grafts may not be performed. Portal hyperperfusion of a small graft and hyperdynamic splanchnic circulation are recognized as main pathogenic factors for the syndrome. Management of established SFSS is guided by the severity of the presentation with the initial focus on pharmacological therapy to modulate portal flow and provide supportive care to the patient with the goal of facilitating graft regeneration and recovery. When medical management fails or condition progresses with impending dysfunction or even liver failure, interventional radiology (IR) and/or surgical interventions to reduce portal overperfusion should be considered. Although most patients have good outcomes with medical, IR, and/or surgical management that allow graft regeneration, the risk of graft loss increases dramatically in the setting of bilirubin >10 mg/dL and INR>1.6 on postoperative day 7 or isolated bilirubin >20 mg/dL on postoperative day 14. Retransplantation should be considered based on the overall clinical situation and the above postoperative laboratory parameters. The following recommendations focus on medical and IR/surgical management of SFSS as well as considerations and timing of retransplantation when other therapies fail.
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Affiliation(s)
- Varvara A Kirchner
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Sadhana Shankar
- The Liver Unit, King's College Hospital, London, United Kingdom
| | - David W Victor
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX
| | - Tomohiro Tanaka
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Iowa, Iowa City, IA
| | - Nicolas Goldaracena
- Abdominal Organ Transplant and Hepatobiliary Surgery, University of Virginia Health System, Charlottesville, VA
| | - Roberto I Troisi
- Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Department of Public Health, Federico II University Hospital, Naples, Italy
| | - Kim M Olthoff
- Department of Surgery, Division of Transplant Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Elizabeth A Pomfret
- Division of Transplant Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nigel Heaton
- The Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Wojtek G Polak
- The Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Akash Shukla
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Ravi Mohanka
- Institute of Liver Disease, HPB Surgery and Transplant, Global Hospital, Mumbai, Maharashtra, India
| | - Deniz Balci
- Department of General Surgery and Organ Transplantation Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Mark Ghobrial
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX
| | - Subash Gupta
- Max Centre for Liver and Biliary Sciences, Max Saket Hospital, New Delhi, India
| | - Daniel Maluf
- Program in Transplantation, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD
| | - John J Fung
- Department of Surgery, University of Chicago Medicine Transplant Institute, Chicago, IL
| | - Susumu Eguchi
- Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - John Roberts
- Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA
| | - Bijan Eghtesad
- Digestive Disease and Surgery Institute, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Markus Selzner
- HPB and Multi-Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Raj Prasad
- Division of Transplantation, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Mureo Kasahara
- National Center for Child Health and Development, Tokyo, Japan
| | - Hiroto Egawa
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Jan Lerut
- Institute for Experimental and Clinical Research-Université catholique de Louvain, Brussels, Belgium
| | - Dieter Broering
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Marina Berenguer
- Liver Unit, CIBERehd, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe-Universidad de Valencia, Valencia, Spain
| | - Mark S Cattral
- HPB and Multi-Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Chao-Long Chen
- Liver Transplant Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Samir R Shah
- Institute of Liver Disease, HPB Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Zhi-Jun Zhu
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University; and Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China
| | - Nancy Ascher
- Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA
| | - Toru Ikegami
- Divsion of Hepatobiliary Surgery and Pancreas Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, New Delhi, India
| | - Ashwin Rammohan
- The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Jean C Emond
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Mohamed Rela
- The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
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Chadha R, Sakai T, Rajakumar A, Shingina A, Yoon U, Patel D, Spiro M, Bhangui P, Sun LY, Humar A, Bezinover D, Findlay J, Saigal S, Singh S, Yi NJ, Rodriguez-Davalos M, Kumar L, Kumaran V, Agarwal S, Berlakovich G, Egawa H, Lerut J, Clemens Broering D, Berenguer M, Cattral M, Clavien PA, Chen CL, Shah S, Zhu ZJ, Ascher N, Bhangui P, Rammohan A, Emond J, Rela M. Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference. Transplantation 2023; 107:2216-2225. [PMID: 37749811 DOI: 10.1097/tp.0000000000004803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND During the perioperative period of living donor liver transplantation, anesthesiologists and intensivists may encounter patients in receipt of small grafts that puts them at risk of developing small for size syndrome (SFSS). METHODS A scientific committee (106 members from 21 countries) performed an extensive literature review on aspects of SFSS with proposed recommendations. Recommendations underwent a blinded review by an independent expert panel and discussion/voting on the recommendations occurred at a consensus conference organized by the International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplantation Society of India. RESULTS It was determined that centers with experience in living donor liver transplantation should utilize potential small for size grafts. Higher risk recipients with sarcopenia, cardiopulmonary, and renal dysfunction should receive small for size grafts with caution. In the intraoperative phase, a restrictive fluid strategy should be considered along with routine use of cardiac output monitoring, as well as use of pharmacologic portal flow modulation when appropriate. Postoperatively, these patients can be considered for enhanced recovery and should receive proactive monitoring for SFSS, nutrition optimization, infection prevention, and consideration for early renal replacement therapy for avoidance of graft congestion. CONCLUSIONS Our recommendations provide a framework for the optimal anesthetic and critical care management in the perioperative period for patients with grafts that put them at risk of developing SFSS. There is a significant limitation in the level of evidence for most recommendations. This statement aims to provide guidance for future research in the perioperative management of SFSS.
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Affiliation(s)
- Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Akila Rajakumar
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Alexandra Shingina
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Uzung Yoon
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Dhupal Patel
- Department of Anesthesia and Intensive Care Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Michael Spiro
- Department of Anaesthesia, Royal Devon and Exeter and Department of Anaesthesia and Intensive Care Medicine, The Royal Free Hospital, London, United Kingdom
| | - Pooja Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi, NCR, India
| | - Li-Ying Sun
- Department of Critical Liver Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Abhinav Humar
- Division of Transplantation, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Dmitri Bezinover
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - James Findlay
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Sanjiv Saigal
- Centre of Liver and Biliary Sciences, Centre of Gastroenterology, Hepatology and Endoscopy, Max Super Specialty Hospital, New Delhi, India
| | - Shweta Singh
- Department of Anesthesiology and Critical Care, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Nam-Joon Yi
- Division of HBP Surgery, Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Manuel Rodriguez-Davalos
- Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Lakshmi Kumar
- Department of Anesthesiology, Amrita Hospital, Kochi, India
| | - Vinay Kumaran
- Division of Transplant Surgery, Department of Surgery, VCU Medical Center, Richmond, VA
| | - Shaleen Agarwal
- Centre of Liver and Biliary Sciences, Centre of Gastroenterology, Hepatology and Endoscopy, Max Super Specialty Hospital, New Delhi, India
| | | | - Hiroto Egawa
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Jan Lerut
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dieter Clemens Broering
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Marina Berenguer
- Liver Transplantation and Hepatology Unit, La Fe University Hospital and IISLaFe and Ciberehd, Valencia, Spain
| | - Mark Cattral
- Ajmera Transplant Center, University of Toronto, Toronto, ON, Canada
| | | | - Chao-Long Chen
- Liver Transplantation Centre, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Samir Shah
- Department of Hepatology, Institute of Liver Disease, HPB Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Zhi-Jun Zhu
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China
| | - Nancy Ascher
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi, NCR, India
| | - Ashwin Rammohan
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Jean Emond
- Liver and Abdominal Transplant Surgery, Columbia University Irving Medical Center, New York, NY
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
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3
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Sharaf H, El Sattar Abd El Hamed MA, Elghandour AM, Elsaid K. Strategies in management of small-for-size graft in recipients of right lobe graft in living donor liver transplantation: a retrospective study. THE EGYPTIAN JOURNAL OF SURGERY 2023; 42:49-58. [DOI: 10.4103/ejs.ejs_13_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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4
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Hyslip J, Martins PN. Liver Repair and Regeneration in Transplant: State of the Art. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Lin NC, Wu HH, Ho JHC, Liu CS, Lee OKS. Mesenchymal stem cells prolong survival and prevent lethal complications in a porcine model of fulminant liver failure. Xenotransplantation 2019; 26:e12542. [PMID: 31219208 DOI: 10.1111/xen.12542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fulminant liver failure (FLF) is a life-threatening disease. METHODS Lethal FLF was induced by ischemia-reperfusion (I-R) injury in mini-pigs, and MSCs were infused via splenic vein after reperfusion. RESULTS Accumulated survival within 28 days was significantly improved by MSCs (P = 0.0348). Notably, MSCs maintained blood-gas homeostasis in the first 24 hours and prevented FLF-induced elevation of prothrombin time, international normalized ratio, and creatinine and ammonia levels in the first 3 days. With MSCs, serum levels of liver enzymes gradually decreased after 3 days, and platelet count was back to normal at 1 week of FLF. MSCs promoted liver regeneration within 2 weeks and differentiated into functional hepatocytes at 2-4 weeks after transplantation, evidenced by increase in Ki67-positive cells, detectable human hepatocyte growth factor, human vascular endothelial growth factor, human hepatocyte-specific antigen, and human albumin-expressing cells in the liver at different time points. Reactive oxidative species (ROS) were accumulated after FLF and eliminated at 4 weeks after MSC transplantation. CONCLUSIONS Together, MSCs prolong the survival and prevent lethal sequelae of I-R injury-induced FLF by maintenance of liver-function homeostasis and rescue of ROS in the acute stage and by homing and differentiation into hepatocytes in the subacute stage.
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Affiliation(s)
- Niang-Cheng Lin
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Division of Transplantation Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang Ming University, Taipei, Taiwan
| | - Hao-Hsiang Wu
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Stem Cell Research Center, National Yang Ming University, Taipei, Taiwan
| | - Jennifer Hui-Chun Ho
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Stem Cell Research Center, National Yang Ming University, Taipei, Taiwan
| | - Chin-Su Liu
- Department of Surgery, National Yang Ming University, Taipei, Taiwan.,Divisions of Pediatric Surgery and Transplantation Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Oscar Kuang-Sheng Lee
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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6
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Xie P, Quan L, Xie S, Chen B, Wei K, Ren J, Meng X. Quantitative study of liver hemodynamic changes in rats with small-for-size syndrome by the 4D-CT perfusion technique. Br J Radiol 2019; 92:20180847. [PMID: 31017448 DOI: 10.1259/bjr.20180847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The microcirculatory hemodynamic changes of small-for-size syndrome (SFSS) are still unclear. In this study, they were investigated by four-dimensional CT perfusion (4D-CTP) technique. METHODS The sham group, 50, 60, 70 and 80 % partial hepatectomy (PH) rat groups were established. At 1 hour (1 h), 1 day (1 d), 3 days (3 d) and 7 days (7 d) post-operation, serological examination, 4D-CTP scan and histopathological examination were performed. One-way analysis of variance and the Kruskal-Wallis test were used for the comparison. RESULTS Based on the diagnostic criteria of SFSS, the 80 % group was considered to be a successful model. In all the PH groups, portal vein perfusion and total liver perfusion peaked at 1 h and declined at 1d and 3d. Both portal vein perfusion and total liver perfusion were significantly higher in the 80 % group than the sham group, 50 and 60% groups at 1 h (p < 0.05), and 80 % group at 3d and 7d (p < 0.05). In the 50 and 60 % groups, hepatic artery perfusion decreased at 1 h and maintained at a lower level until at 7 d; whereas, in the 70 and 80% groups, it increased at 1 h, then decreased and reached the lowest level at 7 d. No significant difference appeared in hepatic artery perfusion between any two groups at any time points. At all time points, hepatic perfusion index was lower in all the PH groups than the sham group. Significant differences in hepatic perfusion index appeared between the 80% group and the sham group at 1 h and 1 d (p < 0.05). CONCLUSIONS The CTP parameters quantitatively revealed the microcirculatory hemodynamic changes in SFSS, which were further confirmed to be associated with histopathological injury. It is suggested that the hemodynamic changes in SFSS remnant liver can provide useful information for further revealing the mechanism of SFSS and may help for guiding the treatments. ADVANCES IN KNOWLEDGE By using the 4D-CTP technique, the hepatic microcirculatory hemodynamic changes could be quantitatively measured in vivo for small animal research.
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Affiliation(s)
- Peiyi Xie
- 1 Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Li Quan
- 2 Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Sidong Xie
- 2 Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Binghui Chen
- 3 Department of Radiology, The fifth Affiliated Hospital of Sun Yat-sen University , Zhuhai , China
| | - Kaikai Wei
- 1 Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Jie Ren
- 4 Department of Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen Univerysity , Guangzhou , China
| | - Xiaochun Meng
- 1 Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
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Hsieh CE, Venkatesulu BP, Lee CH, Hung SP, Wong PF, Aithala SP, Kim BK, Rao A, Tung-Chieh Chang J, Tsang NM, Wang CC, Lee CC, Lin CC, Tseng JH, Chou WC, Wang YC, Krishnan S, Hong JH. Predictors of Radiation-Induced Liver Disease in Eastern and Western Patients With Hepatocellular Carcinoma Undergoing Proton Beam Therapy. Int J Radiat Oncol Biol Phys 2019; 105:73-86. [PMID: 30797890 DOI: 10.1016/j.ijrobp.2019.02.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/03/2019] [Accepted: 02/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify predictors of radiation-induced liver disease (RILD) in patients with hepatocellular carcinoma (HCC) treated with proton beam therapy (PBT). METHODS This multicenter study included 136 patients with HCC (eastern, n = 102; western, n = 34) without evidence of intrahepatic tumor progression after PBT. The RILD was defined as ascites with alkaline-phosphatase abnormality, grade ≥3 hepatic toxicity, or Child-Pugh score worsening by ≥2 within 4 months after PBT completion. The proton doses were converted to equivalent doses in 2-GyE fractions. The unirradiated liver volume (ULV) was defined as the absolute liver volume (LV) receiving <1 GyE; the standard liver volume (SLV) was calculated using body surface area. Possible correlations of clinicodosimetric parameters with RILD were examined. RESULTS The mean pretreatment LV was 85% of SLV, and patients with a history of hepatectomy (P < .001) or hepatitis B virus infection (P = .035) had significantly smaller LV/SLV. Nineteen (14%) patients developed RILD. Multivariate logistic regression analysis identified ULV/SLV (P = .001), gross tumor volume (P = .001), and Child-Pugh classification (P = .002) as independent RILD predictors, and mean liver dose and target-delivered dose were not associated with RILD occurrence. A "volume-response" relationship between ULV/SLV and RILD was consistently observed in both eastern and western cohorts. In Child-Pugh class-A patients whose ULV/SLV were ≥50%, 49.9%-40%, 39.9%-30% and <30%, the RILD incidences were 0%, 6%, 16%, and 39% (P < .001), respectively. For the Child-Pugh class-B group, the RILD incidences in patients with ≥60%, 59.9%-40%, and <40% of ULV/SLV were 0%, 14%, and 83% (P = .006), respectively. CONCLUSIONS The ULV/SLV, not mean liver dose, independently predicts RILD in patients with HCC undergoing PBT. The relative and absolute contraindications for Child-Pugh class-A patient's ULV/SLV are <50% and <30%, and <60% and <40% for Child-Pugh class-B patients, respectively. Our results indicate that the likelihood of hepatic complications for PBT is dictated by similar metrics as that for surgery.
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Affiliation(s)
- Cheng-En Hsieh
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China; Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center-UT Health Graduate School of Biomedical Sciences, Houston, Texas
| | - Bhanu Prasad Venkatesulu
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Sheng-Ping Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Pei-Fong Wong
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sathvik Panambur Aithala
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Byung Kyu Kim
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center-UT Health Graduate School of Biomedical Sciences, Houston, Texas
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China; School of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China; Department of Medical Imaging and Radiological Science, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Chung-Chi Lee
- Department of Medical Imaging and Radiological Science, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Jeng-Hwei Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Wen-Chi Chou
- Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Yu-Chao Wang
- Department of Surgery, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Sunil Krishnan
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center-UT Health Graduate School of Biomedical Sciences, Houston, Texas; Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ji-Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China; Department of Institute for Radiological Research, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China.
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8
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Abstract
Living donor liver transplantation (LDLT) has found a place to serve the end-stage liver disease community as the donor safety and recipient suitability has been elucidated. Donor safety is of paramount importance and transplant programs must continue endeavors to maintain the highest possible standards. At the same time, adequacy of grafts based on recipient clinical status via their model for end-stage liver disease (MELD) score and volumetric studies to achieve a GRBWR >0.8, along with special attention to anatomic tailoring and portal venous flow optimization are necessary for successful transplantation. Technical innovations have improved sequentially the utility and availability of LDLT.
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9
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Issues in Pediatric Liver Transplantation. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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10
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Kertai MD, Twite MM, Weitzel N. Facing the Ever-Changing Challenges of Caring for Cardiothoracic and Transplant Surgery Patients. Semin Cardiothorac Vasc Anesth 2017; 21:197-199. [PMID: 28758560 DOI: 10.1177/1089253217718620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Mark M Twite
- 2 Children's Hospital Colorado, Aurora, CO, USA.,3 University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nathaen Weitzel
- 3 University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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