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Shu W, Song Y, Lin Z, Yang M, Pan B, Su R, Yang M, Lu Z, Zheng S, Xu X, Yang Z, Wei X. Evaluation of liver regeneration after hemi-hepatectomy by combining computed tomography and post-operative liver function. Heliyon 2024; 10:e30964. [PMID: 38803961 PMCID: PMC11128876 DOI: 10.1016/j.heliyon.2024.e30964] [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: 07/02/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Background Accurate evaluation of postoperative liver regeneration is essential to prevent postoperative liver failure. Aims To analyze the predictors that affect liver regeneration after hemi-hepatectomy. Method Patients who underwent hemi-hepatectomy in Hangzhou First People's Hospital and Hangzhou Shulan Hospital from January 2016 to December 2021 were enrolled in this study. The regeneration index (RI) was calculated by the following equation: RI = [(postoperative total liver volume {TLVpost} - future liver remnant volume {FLRV}/FLRV] × 100 %. Hepatic dysfunction was defined according to the "TBilpeak>7" standard, which was interpreted as (peak) total bilirubin (TBil) >7.0 mg/dL. Good liver regeneration was defined solely when the RI surpassed the median with hepatic dysfunction. Logistic regression analyses were performed to estimate prognostic factors affecting liver regeneration. Result A total of 153 patients were enrolled, with 33 in the benign group and 120 patients in the malignant group. In the entire study population, FLRV% [OR 4.087 (1.405-11.889), P = 0.010], international normalized ratio (INR) [OR 2.763 (95%CI, 1.008-7.577), P = 0.048] and TBil [OR 2.592 (95%CI, 1.177-5.710), P = 0.018] were independent prognostic factors associated with liver regeneration. In the benign group, only the computed tomography (CT) parameter FLRV% [OR, 11.700 (95%CI, 1.265-108.200), P = 0.030] predicted regeneration. In the malignant group, parenchymal hepatic resection rate (PHRR%) [OR 0.141 (95%CI, 0.040-0.499), P = 0.002] and TBil [OR 3.384 (95%CI, 1.377-8.319), P = 0.008] were independent prognostic factors. Conclusion FLRV%, PHRR%, TBil and INR were predictive factors associated with liver regeneration.
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Affiliation(s)
- Wenzhi Shu
- Zhejiang University School of Medicine, Hangzhou First People's Hospital, Hangzhou, 310006, China
- Zhejiang University School of Medicine, Hangzhou, 310058, China
- Department of Hepatobiliary and Pancreatic Surgery, Hangzhou First People's Hospital, Hangzhou, 310006, China
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Yisu Song
- Zhejiang University School of Medicine, Hangzhou First People's Hospital, Hangzhou, 310006, China
- Zhejiang University School of Medicine, Hangzhou, 310058, China
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Zuyuan Lin
- Zhejiang University School of Medicine, Hangzhou First People's Hospital, Hangzhou, 310006, China
- Zhejiang University School of Medicine, Hangzhou, 310058, China
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Mengfan Yang
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Binhua Pan
- Zhejiang University School of Medicine, Hangzhou First People's Hospital, Hangzhou, 310006, China
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Renyi Su
- Zhejiang University School of Medicine, Hangzhou First People's Hospital, Hangzhou, 310006, China
- Zhejiang University School of Medicine, Hangzhou, 310058, China
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Modan Yang
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Zhengyang Lu
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Shusen Zheng
- Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou, 310022, China
| | - Xiao Xu
- Zhejiang University School of Medicine, Hangzhou, 310058, China
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
| | - Zhe Yang
- Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou, 310022, China
| | - Xuyong Wei
- Department of Hepatobiliary and Pancreatic Surgery, Hangzhou First People's Hospital, Hangzhou, 310006, China
- Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, 310006, China
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Villeret F, Dharancy S, Erard D, Abergel A, Barbier L, Besch C, Boillot O, Boudjema K, Coilly A, Conti F, Corpechot C, Duvoux C, Faitot F, Faure S, Francoz C, Giostra E, Gugenheim J, Hardwigsen J, Hilleret M, Hiriart J, Houssel‐Debry P, Kamar N, Lassailly G, Latournerie M, Pageaux G, Samuel D, Vanlemmens C, Saliba F, Dumortier J. Liver transplantation for NAFLD cirrhosis: Age and recent coronary angioplasty are major determinants of survival. Liver Int 2022; 42:2428-2441. [PMID: 35924452 PMCID: PMC9804523 DOI: 10.1111/liv.15385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Liver transplantation (LT) is the treatment of end-stage non-alcoholic liver disease (NAFLD), that is decompensated cirrhosis and/or complicated by hepatocellular carcinoma (HCC). Few data on long-term outcome are available. The aim of this study was to evaluate overall patient and graft survivals and associated predictive factors. METHOD This retrospective multicentre study included adult transplant patients for NAFLD cirrhosis between 2000 and 2019 in participating French-speaking centres. RESULTS A total of 361 patients (69.8% of male) were included in 20 centres. The median age at LT was 62.3 years [57.4-65.9] and the median MELD score was 13.9 [9.1-21.3]; 51.8% of patients had HCC on liver explant. Between 2004 and 2018, the number of LT for NAFLD cirrhosis increased by 720%. A quarter of the patients had cardiovascular history before LT. Median follow-up after LT was 39.1 months [15.8-72.3]. Patient survival at 1, 5 and 10 years after LT was 89.3%, 79.8% and 68.1% respectively. The main causes of death were sepsis (37.5%), malignancies (29.2%) and cardiovascular events (22.2%). In multivariate analysis, three risk factors for overall mortality after LT were recipient pre-LT BMI < 32 kg/m2 at LT time (OR: 2.272; p = .012), pre-LT angioplasty during CV check-up (OR: 2.916; p = .016), a combined donor and recipient age over 135 years (OR: 2.020; 95%CI: p = .035). CONCLUSION Survival after LT for NAFLD cirrhosis is good at 5 years. Donor and recipient age, and cardiovascular history, are major prognostic factors to consider.
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Affiliation(s)
- François Villeret
- Service d'hépatologie et de transplantation hépatiqueHôpital de la Croix Rousse, Hospices Civils de LyonLyonFrance,Université Claude Bernard Lyon 1LyonFrance
| | - Sébastien Dharancy
- Service des Maladies de l'Appareil DigestifHôpital Claude Huriez, CHRU LilleLilleFrance
| | - Domitille Erard
- Service d'hépatologie et de transplantation hépatiqueHôpital de la Croix Rousse, Hospices Civils de LyonLyonFrance,Université Claude Bernard Lyon 1LyonFrance
| | - Armand Abergel
- Département de Médecine digestiveCHU EstaingClermont‐FerrandFrance
| | - Louise Barbier
- Service de chirurgie digestive, oncologique et Transplantation hépatiqueHôpital Trousseau, CHU ToursToursFrance
| | - Camille Besch
- Service de chirurgie hépato‐bilio‐pancréatique et transplantation hépatiqueCHRU HautepierreStrasbourgFrance
| | - Olivier Boillot
- Université Claude Bernard Lyon 1LyonFrance,Fédération des Spécialités DigestivesHôpital Edouard Herriot, Hospices civils de LyonLyonFrance
| | - Karim Boudjema
- Service de chirurgie hépatobiliaire et digestive et des maladies du foieHôpital Universitaire de PontchaillouRennesFrance
| | - Audrey Coilly
- Centre Hépato‐BiliaireHôpital Paul Brousse, AP‐HP, Université Paris Saclay, Unité Inserm 1193VillejuifFrance
| | - Filomena Conti
- Service de Chirurgie Digestive, Hépato‐Biliaire et de Transplantation HépatiqueHôpital Pitié Salpêtrière, AP‐HPParisFrance
| | | | | | - François Faitot
- Service de chirurgie hépato‐bilio‐pancréatique et transplantation hépatiqueCHRU HautepierreStrasbourgFrance
| | - Stéphanie Faure
- Département d'hépatologie et transplantation hépatiqueCHU Saint EloiMontpellierFrance
| | - Claire Francoz
- Service d'Hépatologie et Transplantation HépatiqueHôpital Beaujon, APHPClichyFrance
| | - Emiliano Giostra
- Service de Gastroentérologie et HépatologieHôpitaux Universitaires de GenèveGenèveSwitzerland
| | - Jean Gugenheim
- Service de Chirurgie Digestive et de Transplantation HépatiqueCHU Archet IINiceFrance
| | - Jean Hardwigsen
- Service chirurgie générale et transplantation hépatiqueHôpital La Timone, APHMMarseilleFrance
| | | | | | - Pauline Houssel‐Debry
- Service de chirurgie hépatobiliaire et digestive et des maladies du foieHôpital Universitaire de PontchaillouRennesFrance
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'OrganesCHU RangueilToulouseFrance
| | - Guillaume Lassailly
- Service des Maladies de l'Appareil DigestifHôpital Claude Huriez, CHRU LilleLilleFrance
| | | | | | - Didier Samuel
- Centre Hépato‐BiliaireHôpital Paul Brousse, AP‐HP, Université Paris Saclay, Unité Inserm 1193VillejuifFrance
| | - Claire Vanlemmens
- Service d'Hépatologie et Soins Intensifs DigestifsHôpital Jean MinjozBesançonFrance
| | - Faouzi Saliba
- Centre Hépato‐BiliaireHôpital Paul Brousse, AP‐HP, Université Paris Saclay, Unité Inserm 1193VillejuifFrance
| | - Jérôme Dumortier
- Université Claude Bernard Lyon 1LyonFrance,Fédération des Spécialités DigestivesHôpital Edouard Herriot, Hospices civils de LyonLyonFrance
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Lee O, Kim JM, Kim SJ, Rhu J, Choi GS, Joh JW. Healthy Spouses can be Considered as Living Liver Donors. World J Surg 2022; 46:1474-1484. [PMID: 35316397 DOI: 10.1007/s00268-022-06518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spousal donors have gradually been accepted as an alternative living liver donors to alleviate the organ shortage and prevent donations from children. No information is available regarding the effects of spousal donation on donor safety and recipient outcomes. Our purpose in this study was to determine how spousal liver grafts in living donor liver transplantation (LDLT) affect donor safety and recipient outcomes compared with those of LDLT from children. METHODS We retrospectively analyzed 656 patients, including spouses and children, who underwent a right or extended right hepatectomy for living liver donation between January 2009 and December 2018. RESULTS Spouses represented 18.8% (n = 123) of living liver donors. Female donors comprised 78.9% (n = 97) of spousal donors, and the proportion of male donors in the children group was 72.6% (n = 387). The mean donor operation time of the spousal group was shorter than that of the children group (330 min vs. 358 min; P = 0.011), and the complication rate in the spousal group was lower than that in the children group (12.2% vs. 22.9%; P = 0.006). However, there were no differences in severe complication rates, hospitalization, or liver function tests between the 2 groups at 3 months after donor surgery. The overall survival of recipients in the spousal group was not reduced compared to that of recipients in the children group. CONCLUSION The present study suggests that, with careful selection, spousal donation is feasible and safe in LDLT.
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Affiliation(s)
- Okjoo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Sang Jin Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
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Park J, Lim SJ, Choi HJ, Hong SH, Park CS, Choi JH, Chae MS. Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study. PLoS One 2019; 14:e0226369. [PMID: 31821367 PMCID: PMC6903745 DOI: 10.1371/journal.pone.0226369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/25/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study was performed to determine the association between the ratio of C-reactive protein to albumin (CRP/ALB) and the risk of early allograft dysfunction (EAD) in patients undergoing living donor liver transplantation (LDLT). PATIENTS AND METHODS A total of 588 adult patients undergoing LDLT were retrospectively investigated, after 22 were excluded because of signs of overt infection or history of ALB infusion. The study population was classified into high and low CRP/ALB ratio groups according to EAD. All laboratory variables, including CRP and ALB, had been collected on the day before surgery. A percentage value for the CRP/ALB ratio (%) was calculated as CRP/ALB × 100. RESULTS After LDLT, 83 patients (14.1%) suffered EAD occurrence. A higher CRP/ALB ratio was independently associated with risk of EAD, Model for End-stage Liver Disease score, fresh frozen plasma transfusion, and donor age. Based on a cutoff CRP/ALB ratio (i.e., > 20%), the probability of EAD was significantly (2-fold) higher in the high versus low CRP/ALB group. The predictive utility of CRP/ALB ratio for EAD was greater than those of other inflammatory markers. In addition, patients with a high CRP/ALB ratio had poorer survival than those with a low CRP/ALB ratio during the follow-up period. CONCLUSIONS The easily calculated CRP/ALB ratio may allow estimation of the risk of EAD after LDLT and can provide additional information that may facilitate the estimation of a patient's overall condition.
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Affiliation(s)
- Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Soo Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Ho Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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