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Pagano D, Badami E, Zito G, Conaldi PG, Vella I, Buscemi B, Amico G, Busà R, Salis P, Li Petri S, di Francesco F, Calamia S, Bonsignore P, Tropea A, Accardo C, Piazza S, Gruttadauria S. Impact of T Lymphocytes Isolated from Liver Perfusate of Deceased Brain Donors on Kidney Transplantation: Preliminary Evidence and Future Directions. J Clin Med 2023; 12:4786. [PMID: 37510901 PMCID: PMC10381596 DOI: 10.3390/jcm12144786] [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: 04/29/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Ischemia/reperfusion injury (IRI), acute rejection (AR), and delayed graft function (DGF) might occur as major complications following kidney transplantation. Thus, the identification of biomarkers for the IRI, AR, and/or DGF development becomes crucial as it may help to guide post-transplant management. Natural killer (NK) cells, hepatic interstitial T-lymphocytes (T-Li), and NK-T cells are crucial in both innate and adaptive immunity after abdominal solid organ transplantation. Hence, the aim of this study was to evaluate the impact of the immune system after graft reperfusion during KT in adults in order to identify predictive biomarkers. METHODS The NK, T-Li, and NK-T phenotypes and concentrations were retrospectively analyzed in a consecutive series of liver perfusates obtained after organ procurement flushing the abdominal cavity recovered from deceased brain donors (DBDs). Their percentage was compared with the renal transplant recipients' characteristics with kidneys taken from the same DCDs. The hepatic perfusate cells were purified by density gradient centrifugation. Flow cytometric investigation was used to determine their phenotype with the following immunological markers in order to determine the relative percentage of T-Li, NK-T, and NK cells: CD3, CD4, CD8, and CD56. RESULTS 42 DBDs' liver perfusates were analyzed. The related clinical outcomes of kidney transplant recipients from 2010 to 2020 performed at our Institute were evaluated. Time in days of delayed functional recovery of transplanted kidneys (DGF) (p = 0.02) and the onset of secondary infection from a cytomegalovirus (p = 0.03) were significantly associated with the T-Li percentage. An increased relative risk (HR) of organ survival was significantly associated with the percent cell concentration of T-Li and time to DGF, on COX analysis, were (HR = 1.038, p = 0.04; and HR = 1.029, p = 0.01, respectively). None relevant clinical outcomes in kidney transplant patients were associated with the specificity of the NK and NK-T cell proportions. CONCLUSIONS A new potential role of T-Li cells was detected in the context of hepatic perfusate from DBDs. It could detect potential impacts in organ allocation, surgical procuring techniques, and in the analysis of IRI pathophysiological events.
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Affiliation(s)
- Duilio Pagano
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Ester Badami
- Department of Laboratory Medicine and Advanced Biotechnologies, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy
- Ri.MED Foundation, 90133 Palermo, Italy
| | - Giovanni Zito
- Department of Laboratory Medicine and Advanced Biotechnologies, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy
| | - Pier Giulio Conaldi
- Department of Laboratory Medicine and Advanced Biotechnologies, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy
| | - Ivan Vella
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Barbara Buscemi
- Nephrology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | | | - Rosalia Busà
- Department of Laboratory Medicine and Advanced Biotechnologies, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy
| | - Paola Salis
- Nephrology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Sergio Li Petri
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Fabrizio di Francesco
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Sergio Calamia
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Pasquale Bonsignore
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Alessandro Tropea
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Caterina Accardo
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Salvatore Piazza
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
| | - Salvatore Gruttadauria
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center Italy (UPMCI), 90127 Palermo, Italy
- Department of Surgery and Surgical and Medical Specialties, University of Catania, 95124 Catania, Italy
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Pagano D, Gruttadauria S. Comment to “Donor Simvastatin Treatment in Liver Transplantation: Post-hoc Analysis of a Randomized Placebo-controlled Trial With Long-term Follow-up”. Transplantation 2023; 107:e124. [PMID: 37001555 DOI: 10.1097/tp.0000000000004502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Pagano D, Bosch J, Tuzzolino F, Oliva E, Ekser B, Zito G, Cintorino D, di Francesco F, Li Petri S, Ricotta C, Bonsignore P, Calamia S, Magro B, Trifirò G, Alduino R, Barbara M, Conaldi PG, Gallo A, Venuti F, Luca A, Gruttadauria S. Donor Simvastatin Treatment Is Safe and Might Improve Outcomes After Liver Transplantation: A Randomized Clinical Trial. Transplantation 2022; 106:2379-2390. [PMID: 35862782 PMCID: PMC9698118 DOI: 10.1097/tp.0000000000004220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The current curative approaches for ischemia/reperfusion injury on liver transplantation are still under debate for their safety and efficacy in patients with end-stage liver disease. We present the SIMVA statin donor treatment before Liver Transplants study. METHODS SIMVA statin donor treatment before Liver Transplants is a monocentric, double-blind, randomized, prospective tial aiming to compare the safety and efficacy of preoperative brain-dead donors' treatment with the intragastric administration of 80 mg of simvastatin on liver transplant recipient outcomes in a real-life setting. Primary aim was incidence of patient and graft survival at 90 and 180 d posttransplant; secondary end-points were severe complications. RESULTS The trial enrolled 58 adult patients (18-65 y old). The minimum follow-up was 6 mo. No patient or graft was lost at 90 or 180 d in the experimental group (n = 28), whereas patient/graft survival were 93.1% ( P = 0.016) and 89.66% ( P = 0.080) at 90 d and 86.21% ( P = 0.041) and 86.2% ( P = 0.041) at 180 d in the control group (n = 29). The percentage of patients with severe complications (Clavien-Dindo ≥IIIb) was higher in the control group, 55.2% versus 25.0% in the experimental group ( P = 0.0307). The only significant difference in liver tests was a significantly higher gamma-glutamyl transferase and alkaline phosphatase at 15 d ( P = 0.017), ( P = 0.015) in the simvastatin group. CONCLUSIONS Donor simvastatin treatment is safe, and may significantly improve early graft and patient survival after liver transplantation, although further research is mandatory.
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Affiliation(s)
- Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Jaime Bosch
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabio Tuzzolino
- Department of Research, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | | | - Burcin Ekser
- Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Giovanni Zito
- Department of Research, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | - Davide Cintorino
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Sergio Li Petri
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Calogero Ricotta
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Pasquale Bonsignore
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Sergio Calamia
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Bianca Magro
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health – University of Verona, Verona, Italy
| | - Rossella Alduino
- Department of Research, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | - Marco Barbara
- Department of Research, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | | | - Alessia Gallo
- Department of Research, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | - Francesca Venuti
- Department of Research, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | - Angelo Luca
- Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
- Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy
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Pagano D, Khouzam S, Magro B, Barbara M, Cintorino D, di Francesco F, Li Petri S, Bonsignore P, Calamia S, Deiro G, Cammà C, Canzonieri M, Gruttadauria S. How important is the role of iterative liver direct surgery in patients with hepatocellular carcinoma for a transplant center located in an area with a low rate of deceased donation? Front Oncol 2022; 12:929607. [PMID: 35965558 PMCID: PMC9372920 DOI: 10.3389/fonc.2022.929607] [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: 04/27/2022] [Accepted: 06/28/2022] [Indexed: 12/24/2022] Open
Abstract
IntroductionHepatocellular carcinoma (HCC) accounts for nearly 90% of primary liver cancers, with estimates of over 1 million people affected by 2025. We aimed to explore the impacting role of an iterative surgical treatment approach in a cohort of HCC patients within the Milan criteria, associated with clinical risk factors for tumor recurrence (RHCC) after liver transplant (LT) and loco-regional therapies (LRT), as well as liver resection (LR) and/or microwave thermal ablation (MWTA).MethodsWe retrospectively analyzed our experience performed during an 8-year period between January 2013 and December 2021 in patients treated for HCC, focusing on describing the impact on preoperative end-stage liver disease severity, oncologic staging, tumor characteristics, and surgical treatments. The Cox model was used to evaluate variables that could predict relapse risks. Relapse risk curves were calculated according to the Kaplan–Meier method, and the log-rank test was used to compare them.ResultsThere were 557 HCC patients treated with a first-line approach of LR and/or LRTs (n = 335) or LT (n = 222). The median age at initial transplantation was 59 versus 68 for those whose first surgical approach was LR and/or LRT. In univariate analysis with the Cox model, nodule size was the single predictor of recurrence of HCC in the posttreatment setting (HR: 1.61, 95% CI: 1.05–2.47, p = 0.030). For the LRT group, we have enlightened the following clinical characteristics as significantly associated with RHCC: hepatitis B virus infection (which has a protective role with HR: 0.34, 95% CI: 0.13–0.94, p = 0.038), number of HCC nodules (HR: 1.54, 95% CI: 1.22–1.94, p < 0.001), size of the largest nodule (HR: 1.06, 95% CI: 1.01–1.12, p = 0.023), serum bilirubin (HR: 1.57, 95% CI: 1.03–2.40, p = 0.038), and international normalized ratio (HR: 16.40, 95% CI: 2.30–118.0, p = 0.006). Among the overall 111 patients with RHCC in the LRT group, 33 were iteratively treated with further curative treatment (12 were treated with LR, two with MWTA, three with a combined LR-MWTA treatment, and 16 underwent LT). Only one of 18 recurrent patients previously treated with LT underwent LR. For these RHCC patients, multivariable analysis showed the protective roles of LT for primary RHCC after IDLS (HR: 0.06, 95% CI: 0.01–0.36, p = 0.002), of the time relapsed between the first and second IDLS treatments (HR: 0.97, 95% CI: 0.94–0.99, p = 0.044), and the impact of previous minimally invasive treatment (HR: 0.28, 95% CI: 0.08–1.00, p = 0.051).ConclusionThe coexistence of RHCC with underlying cirrhosis increases the complexity of assessing the net health benefit of ILDS before LT. Minimally invasive surgical therapies and time to HCC relapse should be considered an outcome in randomized clinical trials because they have a relevant impact on tumor-free survival.
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Affiliation(s)
- Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Simone Khouzam
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Bianca Magro
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Marco Barbara
- Research Department, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Davide Cintorino
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Sergio Li Petri
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Pasquale Bonsignore
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Sergio Calamia
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Giacomo Deiro
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Calogero Cammà
- Section of Gastroenterology & Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Marco Canzonieri
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- *Correspondence: Salvatore Gruttadauria,
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Wang X, Lei Y, Huan H, Chen S, Ma K, Feng K, Lau WY, Xia F. Bisegmentectomy 7-8 for Small-for-Size Remanant Liver for Cirrhotic Patients Under Right Hemi-hepatectomy With Hepatocellular Carcinoma: A Case-Matched Comparative Study. Front Surg 2021; 8:675666. [PMID: 34336916 PMCID: PMC8319602 DOI: 10.3389/fsurg.2021.675666] [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: 03/03/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
Aim: To compare the short- and long-term treatment outcomes of bisegmentectomy 7-8 vs. right hepatectomy for patients with hepatocellular carcinoma and cirrhosis. Methods: Thirty six cirrhotic HCC patients with infiltration of right hepatic vein in segments 7-8 underwent bisegmentectomy 7-8 for small-for-size remanant liver under right hemi-hepatectomy. Its outcome was compared with a case-matched control group of cirrhotic HCC patients who underwent right hemi-hepatectomy during the study period. Results: The study group consisted of 36 patients and the control group 36 patients selected from 1,526 patients matched with age, tumor size, tumor location, and Pugh-Child staging. There were no significant differences between the two groups in operative parameters and in perioperative main complications which included hemorrhage, bile leakage, ascites, pleural effusion, and liver failure. The overall morbidity rate and morbidity rate classified according to Clavien's classification were similar. There was no in-hospital mortality or 90 day post-operative mortality. The mean follow-up was 30 and 32 months for the study group and control group, respectively. The disease free survival rate (DFS) for the study group was just significantly better than the control group. The median DFS was 24 months for the study group and 8 months for the control group (P = 0.049). Meanwhile, the median cumulative overall survival was 35 months for the study group and 27 months for the control group (P = 0.494). Conclusion: Bisegmentectomy 7-8 was safe and feasible for selected cirrhosis patients, and did not increase the perioperative risk and inferior long-term overall survival outcomes. It extended the indications for liver resection in patients with borderline volumes of future liver remnant for HCC cirrhotic liver.
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Affiliation(s)
- Xishu Wang
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Yongrong Lei
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Hongbo Huan
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Shu Chen
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Kai Feng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Wan Yee Lau
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China.,Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, China
| | - Feng Xia
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
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Gruttadauria S, Tropea A, Pagano D, Calamia S, Ricotta C, Bonsignore P, Li Petri S, Cintorino D, di Francesco F. Case report: Trans-papillary free stenting of the cystic duct and of the common bile duct in a double biliary ducts anastomoses of a right lobe living donor transplantation. BMC Surg 2021; 21:44. [PMID: 33468113 PMCID: PMC7816360 DOI: 10.1186/s12893-020-01045-7] [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: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background One of the major issues related to the living donor liver transplantation recipient outcome is still the high rate of biliary complication, especially when multiple biliary ducts are present and multiple anastomoses have to be performed. Case presentation and conclusion We report a case of adult-to-adult right lobe living donor liver transplantation performed for a recipient affected by alcohol-related cirrhosis with MELD score of 17. End-stage liver disease was complicated by refractory ascites, portal hypertension, small esophageal varices and portal gastropathy, hypersplenism, and abundant right pleural effusion. Here in the attached video we described the adult-to-adult LDLT procedures, where a right lobe with two biliary ducts draining respectively the right anterior and the right posterior segments has been transplanted. LDLT required a biliary reconstruction using the native cystic and common bile ducts stented trans-papillary with two 5- French 6 cm long soft silastic catheter. None major complications were detected during post-operative clinical courses. Actually, the donor and the recipient are alive and well. The technique we describe in the video, allow to keep the biliary anastomoses protected and patent without having the risk of creating cholestasis and the need of invasive additional procedure. No living donor right lobe transplantation should be refused because of the presence of multiple biliary ducts.
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Affiliation(s)
- Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy. .,Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy.
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Sergio Calamia
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Calogero Ricotta
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Pasquale Bonsignore
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Sergio Li Petri
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Davide Cintorino
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Di Ricovero E Cura a Carattere Scientifico-Istituto Mediterraneo Per I Trapianti E Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
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7
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Kitamura M, Hidaka M, Muta K, Miuma S, Miyaaki H, Takatsuki M, Nakao K, Eguchi S, Mukae H, Nishino T. Prediction of Liver Prognosis from Pre-Transplant Renal Function Adjusted by Diuretics and Urinary Abnormalities in Adult-to-Adult Living Donor Liver Transplantation. Ann Transplant 2020; 25:e924805. [PMID: 32895363 PMCID: PMC7501738 DOI: 10.12659/aot.924805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Renal function is strongly associated with patient survival after liver transplantation. However, the estimated glomerular filtration rate (eGFR) after liver transplantation changes, especially in patients who receive diuretics or have urinary abnormalities. We aimed to elucidate how adjusting for these factors affecting eGFR predicted liver graft prognosis. MATERIAL AND METHODS This retrospective study included patients who underwent adult-to-adult living donor liver transplantation (LDLT) between 2000 and 2017. The factors affecting eGFR were assessed, and the association between eGFR and prognosis was investigated using Cox regression models after adjusting for factors affecting renal function. RESULTS We enrolled 244 patients. The median observation period was 4.6 years, and 88 patients reached graft loss or death with a functioning graft. One year after transplantation, 193 patients were living, and one-third of these showed improved eGFR; most of the patients with improved eGFR had taken diuretics before transplantation. A Cox regression model adjusted for the classical risk factors showed that donor age (P<0.001) and lower eGFR (P=0.02) were the independent risk factors associated with poor prognosis. After adjusting for diuretics and urinary abnormalities, eGFR was more strongly associated with liver graft prognosis (P=0.003). CONCLUSIONS Pre-transplant eGFR was associated with prognosis following LDLT and had a stronger effect on prognosis after adjusting for factors affecting eGFR.
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Affiliation(s)
- Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Satoshi Miuma
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Hisamitsu Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
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8
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Pagano D, Ricotta C, Barbàra M, Cintorino D, di Francesco F, Tropea A, Calamia S, Lomaglio L, Terzo D, Gruttadauria S. ERAS Protocol for Perioperative Care of Patients Treated with Laparoscopic Nonanatomic Liver Resection for Hepatocellular Carcinoma: The ISMETT Experience. J Laparoendosc Adv Surg Tech A 2020; 30:1066-1071. [PMID: 32716674 DOI: 10.1089/lap.2020.0445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Liver resection (LR) remains the best therapeutic option for patients with early-stage hepatocellular carcinoma (HCC) with preserved hepatic function and who are not eligible for liver transplantation. After its inception, the enhanced recovery after surgery (ERAS) protocol was widely used for treating patients with liver cancer, although there are still no clear indications for improving upon it in both open and laparoscopic surgery. Objective: This study aims to describe our institute's experience in the application of the ERAS protocol in a cohort of HCC patients, and to explore possible factors that could have an impact on postoperative outcomes. Materials and Methods: We retrospectively analyzed our experience with LR performed from September 2017 to January 2020 in patients treated with ERAS protocol, focusing on describing impact on postoperative nutrition, analgesic requirements, and length of hospitalization. Demographics, operative factors, and postoperative complications of patients were reviewed. Results: During the study period, 89 HCC patients were eligible for LR, and 75% of patients presented with liver cirrhosis. The most prevalent among etiologic factors was hepatitis C virus infection (53 patients out of 89, 60%), followed by nonalcoholic steatohepatitis (18 patients, 20%). The median age was 70 years. Liver cirrhosis did not have an impact on postoperative course of patients. Patients who underwent laparoscopic surgery and nonanatomic LR experienced low complication rates, shorter length of stay, and shorter time of intravenous analgesic requirements. Conclusions: Continual refinement with ERAS protocol for treating HCC patients based on perioperative counseling and surgical decision-making is crucial to guarantee low complication rates, and reduce patient morbidity and time for recovery.
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Affiliation(s)
- Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Calogero Ricotta
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Marco Barbàra
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Davide Cintorino
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Sergio Calamia
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Laura Lomaglio
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Danilo Terzo
- Rehabilitation Service, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, and IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy.,Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy
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9
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Pagano D, Calamia S. Merits and differences between single-site robotic and laparoscopic cholecystectomy: What is unfair? Commentary on "Propensity score-matching analysis for single-site robotic cholecystectomy versus single-incision laparoscopic cholecystectomy: A retrospective cohort study". Int J Surg 2020; 79:136-137. [PMID: 32442692 DOI: 10.1016/j.ijsu.2020.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per I Trapianti e Terapie Ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy.
| | - Sergio Calamia
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per I Trapianti e Terapie Ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Via E. Tricomi 5, 90127, Palermo, Italy
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10
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Yang QJ, Kluger M, Goryński K, Pawliszyn J, Bojko B, Yu AM, Noh K, Selzner M, Jerath A, McCluskey S, Pang KS, Wąsowicz M. Comparing early liver graft function from heart beating and living-donors: A pilot study aiming to identify new biomarkers of liver injury. Biopharm Drug Dispos 2017; 38:326-339. [DOI: 10.1002/bdd.2066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/28/2016] [Accepted: 01/16/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Qi Joy Yang
- Leslie Dan Faculty of Pharmacy; University of Toronto; Canada
| | - Michael Kluger
- Department of Anesthesia and Pain Management, Toronto General Hospital; University Health Network; Toronto Ontario Canada
| | - Krzysztof Goryński
- Department of Chemistry; University of Waterloo; Canada
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz; Nicolaus Copernicus University in Toruń; Poland
| | | | - Barbara Bojko
- Department of Chemistry; University of Waterloo; Canada
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz; Nicolaus Copernicus University in Toruń; Poland
| | - Ai-Ming Yu
- Departments of Biochemistry and Molecular Medicine; Comprehensive Cancer Center; UC Davis; Davis CA 95817 USA
| | - Keumhan Noh
- Leslie Dan Faculty of Pharmacy; University of Toronto; Canada
| | - Markus Selzner
- Department of Surgery, Toronto General Hospital; University Health Network; Toronto ON M5G 2N2 Canada
| | - Angela Jerath
- Department of Anesthesia and Pain Management, Toronto General Hospital; University Health Network; Toronto Ontario Canada
- Department of Anesthesia, Faculty of Medicine; University of Toronto; Toronto ON M5G 1E2 Canada
| | - Stuart McCluskey
- Department of Anesthesia and Pain Management, Toronto General Hospital; University Health Network; Toronto Ontario Canada
- Department of Anesthesia, Faculty of Medicine; University of Toronto; Toronto ON M5G 1E2 Canada
| | - K. Sandy Pang
- Leslie Dan Faculty of Pharmacy; University of Toronto; Canada
| | - Marcin Wąsowicz
- Department of Anesthesia and Pain Management, Toronto General Hospital; University Health Network; Toronto Ontario Canada
- Department of Anesthesia, Faculty of Medicine; University of Toronto; Toronto ON M5G 1E2 Canada
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11
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Abstract
The relationship between postoperative percentage fall of platelet (PLT) counts and graft dysfunction after living donor liver transplantation (LDLT) in recipients with small-for-size (SFS) graft has not been fully evaluated. We retrospectively studied 50 adult-to-adult LDLT recipients with a graft-to-recipient weight ratio of <0.8% between 1999 and 2011. Graft dysfunction was defined as the presence of hyperbilirubinemia, coagulopathy, or ascites on 3 consecutive days during the first postoperative week. Each clinical sign of dysfunction was assigned 1 point. Postoperative percentage fall in PLT counts, graft dysfunction score, and postoperative complications according to the Clavien-Dindo classification were investigated. Overall, 31 patients (62%) exhibited a PLT count fall of more than 50%, and 19 (38%) patients exhibited a PLT count fall of less than 50% at postoperative day (POD) 3. Receiver operating characteristic curve analysis indicated that at POD 3, the cutoff value of PLT count fall was 56% for a graft dysfunction score of 2 or 3 (sensitivity, 70%; specificity, 63.3%). Fourteen of 20 patients (70%) with a dysfunction score of 2 or 3 and 11 of 30 patients (37%) with a dysfunction score of 0 or 1 showed a fall in PLT count >56% at POD 3 (P = 0.021). Grade 2 to 5 complications were more observed in patients with a dysfunction score of 2 or 3 than in patients with a dysfunction score of 0 or 1 (P < 0.001). The fall of PLT count at POD 3 >56% is an ominous sign that can predict the graft dysfunction after LDLT in recipients with SFS graft.
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12
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Assessment of Graft Selection Criteria in Living-Donor Liver Transplantation: The Jikei Experience. Int Surg 2015; 100:1229-32. [PMID: 26595498 DOI: 10.9738/intsurg-d-14-00300.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In living-donor liver transplantation, graft selection is especially important for the safety of the live donor and an acceptable outcome for the recipient. The essential medical requirements for living liver donation at Jikei University Hospital are as follows: an adult aged 65 years or younger, in good general condition, with partial liver volume of more than 35% of the standard liver volume (SLV) for the recipient, and without severe liver steatosis. Based on our criteria, we performed 13 living-donor liver transplantations between 2007 and 2013, including 1 retransplantation. Three cases were outside our standard donor criteria, including age (18 and 66 years) and 33% graft volume (GV) to SLV ratio for the recipient on preoperative volumetry using computed tomography. In 2 cases, the actual GV to SLV ratio at transplantation was less than 35%. Median postoperative hospital stay was 11 days for the donors, and 29 days for the recipients. All donors returned to their preoperative status, and all recipients were discharged in good condition. Our medical requirements for living liver donation seem to be acceptable because of the good outcome.
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13
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Cardoso NM, Silva T, Basile-Filho A, Mente ED, Castro-e-Silva O. A new formula as a predictive score of post-liver transplantation outcome: postoperative MELD-lactate. Transplant Proc 2015; 46:1407-12. [PMID: 24935305 DOI: 10.1016/j.transproceed.2013.12.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/06/2013] [Accepted: 12/16/2013] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Liver transplantation (OLT) involves a 5% to 10% 30-day mortality rate. Multiple scores have been used as predictors of early postoperative mortality, such as the original Model for End-stage Liver Disease (MELD) and MELD sodium. Investigations have been conducted over the last 5 years to find new predictors of early post-OLT mortality. OBJECTIVE The aim of this study was to develop a new mathematical model to predict the individual chance of 30-day mortality after OLT. METHODS The study was conducted on 58 patients submitted to OLT at the University Hospital, between October 2008 and March 2012. The 29 latest survivor and 29 latest nonsurvivor cases were selected. Arterial blood sodium, lactate, international normalized ratio, total bilirubin, and creatinine values were determined 1 hour after the end of surgery. The MELD original equation, MELD sodium, and new MELD lactate were also elaborated. The results were analyzed by the Mann-Whitney and Wilcoxon tests. The level of significance was set at .05. RESULTS The new formula elaborated was as follows: MELD lactate = 5.68 × loge (lactate) + 0.64 × (Original MELD) + 2.68. The MELD lactate values were significantly higher than the MELD sodium and original MELD values (P < .05). The area under the receiver operating characteristic curve of MELD lactate in predicting the outcome of patients submitted to OLT was 0.80, as opposed to 0.71 for the original MELD and 0.72 for MELD sodium (P < .05). CONCLUSION The postoperative MELD lactate score proved to be more specific and sensitive than the original MELD and MELD sodium as a predictive model of the outcome of patients submitted to OLT.
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Affiliation(s)
- N M Cardoso
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - T Silva
- Illinois Institute of Technology, Department of Applied Mathematics, Chicago, Illinois, United States
| | - A Basile-Filho
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - E D Mente
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - O Castro-e-Silva
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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14
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Gruttadauria S, Pagano D, Cintorino D, Arcadipane A, Traina M, Volpes R, Luca A, Vizzini G, Gridelli B, Spada M. Right hepatic lobe living donation: a 12 years single Italian center experience. World J Gastroenterol 2013; 19:6353-9. [PMID: 24151353 PMCID: PMC3801305 DOI: 10.3748/wjg.v19.i38.6353] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/21/2013] [Accepted: 08/28/2013] [Indexed: 02/06/2023] Open
Abstract
Mini invasive techniques are taking over conventional open liver resections in the setting of left lateral segmentectomy for living liver donation, and hydride procedure are being implemented for the living related right hepatectomy. Our center routinely performs laparoscopic left lateral segmentectomy for pediatric recipient and has been the first in the Europe performing an entirely robotic right hepatectomy. Great emphasis is posed on living donor safety which is the first priority during the entire operation, then the most majority of our procedures are still conventional open right hepatectomy (RHLD), defined as removal of a portion of liver corresponding to Couinaud segments 5-8, in order to obtain a graft for adult to adult living related liver transplant. During this 10 years period some changes, herein highlighted, have occurred to our surgical techniques. This study reports the largest Italian experience with RHLD, focused on surgical technique evolution over a 10 years period. Donor safety must be the first priority in right-lobe living-related donation: the categorization of complications of living donors, specially, after this "highly sensitive" procedure, reflects the need for prompt and detailed reports.
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15
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Hong SH, Kwak JA, Jeon JY, Park CS. Prediction of early allograft dysfunction using serum phosphorus level in living donor liver transplantation. Transpl Int 2013; 26:402-10. [DOI: 10.1111/tri.12058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/26/2012] [Accepted: 12/23/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Sang Hyun Hong
- Department of Anaesthesiology and Pain Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul; Korea
| | - Jung Ah Kwak
- Department of Anaesthesiology and Pain Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul; Korea
| | - Jin Yeong Jeon
- Department of Anaesthesiology and Pain Medicine; Yeouido St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul; Korea
| | - Chul Soo Park
- Department of Anaesthesiology and Pain Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul; Korea
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Alves RCP, Fonseca EAD, Mattos CALD, Abdalla S, Gonçalves JE, Waisberg J. Predictive factors of early graft loss in living donor liver transplantation. ARQUIVOS DE GASTROENTEROLOGIA 2012; 49:157-61. [PMID: 22767004 DOI: 10.1590/s0004-28032012000200011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 03/16/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT Living donor liver transplantation has become an alternative to reduce the lack of organ donation. OBJECTIVE To identify factors predictive of early graft loss in the first 3 months after living donor liver transplantation. METHODS Seventy-eight adults submitted to living donor liver transplantation were divided into group I with 62 (79.5%) patients with graft survival longer than 3 months, and group II with 16 (20.5%) patients who died and/or showed graft failure within 3 months after liver transplantation. The variables analyzed were gender, age, etiology of liver disease, Child-Pugh classification, model of end-stage liver disease (MELD score), pretransplantation serum sodium level, and graft weight-to-recipient body weight (GRBW) ratio. The GRBW ratio was categorized into < 0.8 and MELD score into >18. The chi-square test, Student t-test and uni- and multivariate analysis were used for the evaluation of risk factors for early graft loss. RESULTS MELD score <18 (P<0.001) and serum sodium level > 135 mEq/L (P = 0.03) were higher in group II than in group I. In the multivariate analysis MELD scores > 18 (P<0.001) and GRBW ratios < 0.8 (P<0.04) were significant. CONCLUSIONS MELD scores >18 and GRBW < 0.8 ratios are associated with higher probability of graft failure after living donor liver transplantation.
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17
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Zhang M, Yin F, Chen B, Li Y, Yan L, Wen T, Li B. Posttransplant mortality risk assessment for adult-to-adult right-lobe living donor liver recipients with benign end-stage liver disease. Scand J Gastroenterol 2012; 47:842-52. [PMID: 22546008 DOI: 10.3109/00365521.2012.682089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE A model for living donor liver transplantation (LDLT) outcomes, in concert with pretransplant disease severity assessment, would facilitate informed decision-making on both sides considering donation and transplantation. So far, however, few of studies have focused on models specifically for adult-to-adult right-lobe LDLT recipients with benign end-stage liver diseases. Therefore, we aimed to develop such a prognostic model based on easily obtainable and objective pretransplant characteristics. METHODS With data retrospectively collected on 120 recipients, we used Cox proportional-hazards regression to analyze six donor characteristics and 33 pretransplant recipient variables for correlation with posttransplant mortality. In both a modeling set and a prospective validation set with 30 recipients, the performances of the new Cox model, MELD, and MELD-Na+ were assessed by measuring both calibration ability and discriminative power with the Hosmer-Lemeshow test and receiver operating characteristic analysis, respectively. RESULTS By univariate and multivariate analysis, donor age, serum total bilirubin, creatinine, and HBV-DNA level were significantly associated with posttransplant mortality. The Cox model, employing these four variables, yielded good calibration ability in the modeling set χ² = 2.465, p = 0.653) and the validation set χ² = 2.836, p = 0.586), and high discriminative power in the modeling set (c-statistic = 0.826, p = 0.001) and validation set (c-statistic = 0.816, p = 0.028). The calibration ability and discriminative power of MELD and MELD-Na+ in both sets were poor. CONCLUSIONS The newly derived Cox model was valuable in posttransplant mortality risk assessment for adult-to-adult right-lobe LDLT recipients with benign end-stage liver diseases.
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Affiliation(s)
- Ming Zhang
- Liver Transplantation Center, West China Hospital, Sichuan University Medical School, Chengdu, P.R. China
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18
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Gruttadauria S, Pagano D, Luca A, Gridelli B. Small-for-size syndrome in adult-to-adult living-related liver transplantation. World J Gastroenterol 2010; 16:5011-5. [PMID: 20976835 PMCID: PMC2965275 DOI: 10.3748/wjg.v16.i40.5011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Small-for-size syndrome (SFSS) in adult-to-adult living-related donor liver transplantation (LRLT) remains the greatest limiting factor for the expansion of segmental liver transplantation from either cadaveric or living donors. Portal hyperperfusion, venous pathology, and the arterial buffer response significantly contribute to clinical and histopathological manifestations of SFSS. Here, we review the technical aspects of surgical and radiological procedures developed to treat SFSS in LRLT, along with the pathophysiology of this condition.
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19
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Truty MJ, Vauthey JN. Uses and limitations of portal vein embolization for improving perioperative outcomes in hepatocellular carcinoma. Semin Oncol 2010; 37:102-9. [PMID: 20494702 DOI: 10.1053/j.seminoncol.2010.03.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatic resection remains the only curative option for the majority of patients with hepatocellular carcinoma (HCC) who do not meet criteria for transplantation or local ablative options. As the majority of patients with HCC also have underlying chronic liver disease and cirrhosis, post-hepatectomy complications can be significant, and in some prohibitive. The technique of portal vein embolization (PVE) has evolved to increase the candidacy of patients for major hepatectomy, as well as improve postoperative outcomes and safety. This review will focus on PVE and discuss our institution's experience with uses and limitations of this technique for HCC.
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Affiliation(s)
- Mark J Truty
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
Heme oxygenase-1 (HO-1) system catabolizes heme into three products: carbon monoxide, biliverdin/bilirubin and free iron. It is involved in many physiological and pathophysiological processes. A great deal of data has demonstrated the roles of HO-1 in the formation, growth and metastasis of tumors. The interest in this system by investigators involved in gastrointestinal tumors is fairly recent, and few papers on HO-1 have touched upon this subject. This review focuses on the current understanding of the physiological significance of HO-1 induction and its possible roles in the gastrointestinal tumors studied to date. The implications for possible therapeutic manipulation of HO-1 in gastrointestinal tumors are also discussed.
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