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Gopal K, Chaudhary A, Thorat A. Computational Characterization of Xyloketal B with Human C-Reactive Protein For Management of Kawasaki Disease (KD). CM 2023. [DOI: 10.18137/cardiometry.2023.26.398403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
The most common underlying cause of acquired cardiovascular disease in developed countries is Kawasaki disease (KD), a systemic vasculitis. The most serious and common consequence of KD is the growth of coronary artery involvement, however therapy with intravenous gammaglobulin can minimized this issue. There are various limitations of using intravenous gammaglobulin which further make researchers to look for alternative medicine. It has been found that marine natural products and compounds from natural sources are having cardioprotective nature. The present research aims at filling the gap with computational analysis to explore the target ability y of Xyloketal B on human C-Reactive Protein having vital role in Kawasaki disease. It has been found that the marine compound has the ability to inhibit CRP with considerable negative biding energy of-8.47Kcal/mol. The present stdy may aid researchers to explore new invention having the potential for enzymatic and chemical modification of the molecule for the management of KD. Patients having a history of coronary artery disease, involvement are encouraged to have long-term follow-up.
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Sonavane A, Raut V, Marar S, Sawant A, Shah K, Raj A, Thorat A, Chaksota H, Bagde A, Verma R, Dharmapalan D, Vasanth S, Nagral A, Mirza D, Yewale V. Preoperative successful thrombectomy and thrombolysis of acute extensive splanchnic venous system and TIPSS thrombosis in a child with Budd-Chiari syndrome-Creating a window to enable living donor liver transplantation. Pediatr Transplant 2021; 25:e13857. [PMID: 33232561 DOI: 10.1111/petr.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
Preoperative extensive PV thrombosis can pose a technical challenge during liver transplantation surgery. Several strategies adopted to mitigate this problem include creation of a superior mesenteric vein-PV jump graft, use of a polytetrafluoroethylene graft, renoportal anastomosis, or cavoportal hemitransposition. Extensive and diffuse thrombosis of the splanchnic venous system may even necessitate multivisceral transplantation. We describe the case of a pediatric patient with Budd-Chiari syndrome and decompensated cirrhosis, who developed extensive thrombosis of the porto-spleno-mesenteric venous system prior to liver transplantation. We used a combination technique of thrombus aspiration by a novel trans-TIPPS approach followed by thrombolysis. Complete preoperative resolution of the extensive thrombosis was achieved. This allowed the creation of a brief window to enable planned LDLT. In prudently selected patients, performing an early mechanical and chemical thrombolysis of an extensive acute splanchnic venous thrombosis can thus help expedite a planned LDLT.
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Affiliation(s)
- Amey Sonavane
- Department of Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Vikram Raut
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Shaji Marar
- Department of Interventional Radiology, Apollo Hospitals, Navi Mumbai, India
| | - Ambreen Sawant
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Ketul Shah
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Amruth Raj
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Ashok Thorat
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Harshit Chaksota
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Abhijit Bagde
- Department of Paediatrics, Apollo Hospitals, Navi Mumbai, India
| | - Rahul Verma
- Department of Paediatrics, Apollo Hospitals, Navi Mumbai, India
| | | | - Suresh Vasanth
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Aabha Nagral
- Department of Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Darius Mirza
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Vijay Yewale
- Department of Paediatrics, Apollo Hospitals, Navi Mumbai, India.,Head, Institute of Child Health, Apollo Hospitals, Navi Mumbai, India
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Raut V, Sonavane A, Shah K, Raj C A, Thorat A, Sawant A, Chaksota H, Mandot A, Vasanth S, Nagral A, Mirza D. Successful liver transplantation immediately after recovery from COVID-19 in a highly endemic area. Transpl Int 2021; 34:376-377. [PMID: 33253449 PMCID: PMC7753267 DOI: 10.1111/tri.13790] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Vikram Raut
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Amey Sonavane
- Department of Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Ketul Shah
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Amruth Raj C
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Ashok Thorat
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Ambreen Sawant
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Harshit Chaksota
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Ameet Mandot
- Department of Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Suresh Vasanth
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Aabha Nagral
- Department of Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Darius Mirza
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
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Hsu SC, Thorat A, Jeng LB, Li PC, Chen TH, Yang HR, Poon KS. ABO-Incompatible Living Donor Liver Transplantation with Reduced Rituximab Dose: A Retrospective Analysis of 65 Patients - Can We Fast-Track Liver Transplant Surgery and Improve Long-Term Survival? Ann Transplant 2020; 25:e923502. [PMID: 32943600 PMCID: PMC7526337 DOI: 10.12659/aot.923502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND ABO-incompatible (ABO-i) living donor liver transplantation (LDLT) is a feasible alternative for donor liver allograft in emergency situations, especially in Asia, where deceased-donor organs remain scarce. The reported outcomes of ABO-i LDLT after optimal desensitization are comparable to those of ABO-compatible LDLT. In this retrospective study, we found improved outcomes after ABO-i LDLT with a low-dose rituximab in combination with double-filtration plasmapheresis (DFPP) and prophylactic antibiotic therapy. MATERIAL AND METHODS Between January 2006 and December 2018, a total of 65 recipients underwent ABO-i LDLT surgeries at our center. The study cohort consisted of 50 recipients (Era III) who underwent ABO-i LDLT using the recently updated desensitization protocol, which included rituximab 200 mg intravenous injection once a week prior to LDLT, 4 sessions of DFPP in all patients, and prophylactic antibiotics for 3 months. RESULTS The 3-year overall survival rate achieved in ABO-i LDLT patients was 72.7% (66.6% for Era I and 33.3% for Era II patients). In the study population, 11 patients developed complications due to infection. Five of these patients (10%) died due to overwhelming sepsis. Four patients (8%) were diagnosed with multiple strictures and diffusely scattered dilatation of intrahepatic bile ducts on computed tomography, without vascular complications. Three of them had evidence of antibody-mediated rejection (AMR). CONCLUSIONS Our experience shows that the ABO-i LDLT protocol of lowered rituximab combined with pre-transplant sessions of plasmapheresis and a quadruple immunosuppressive regimen can be effective in chronic liver failure patients with clinical urgency in the absence of an ABO-compatible donor. Fast-tracking the use of ABO-i LDLT is feasible in patients with an acute liver failure (ALF) and can safely increase the donor liver pool, with an acceptable outcome.
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Affiliation(s)
- Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University Hospital, Taiwan.,China Medical University, Taichung, Taiwan
| | - Ping-Chun Li
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan.,Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Kin-Shing Poon
- China Medical University, Taichung, Taiwan.,Department of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
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Sonavane AD, Bagde A, Raut V, Marar S, Sawant A, Shah K, Raj A, Thorat A, Chaksota H, Biradar V, Vasanth S, Nagral A, Mirza D. Therapeutic coil embolization of dominant shunt in hepatopulmonary syndrome enhances post-liver transplant respiratory recovery. Pediatr Transplant 2020; 24:e13729. [PMID: 32436643 DOI: 10.1111/petr.13729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/15/2020] [Accepted: 04/15/2020] [Indexed: 12/23/2022]
Abstract
Coil embolization of the atypical enlarged pulmonary artery/arteriole with visible shunting may improve hypoxemia in patients with hepatopulmonary syndrome (HPS). When used selectively in cases with large shunts, either pre- or post-liver transplantation (LT), it can aid an early recovery and reduce morbidity. We present a case where a large intrapulmonary shunt was embolized preoperatively to improve hypoxemia associated with HPS and enhance post-operative recovery.
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Affiliation(s)
- Amey D Sonavane
- Department of Adult and Pediatric Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Abhijit Bagde
- Department of Adult and Pediatric Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Vikram Raut
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Shaji Marar
- Department of Interventional Radiology, Apollo Hospitals, Navi Mumbai, India
| | - Ambreen Sawant
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Ketul Shah
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Amruth Raj
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Ashok Thorat
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
| | - Harshit Chaksota
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Vishnu Biradar
- Department of Adult and Pediatric Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Suresh Vasanth
- Department of Anaesthesiology, Apollo Hospitals, Navi Mumbai, India
| | - Aabha Nagral
- Department of Adult and Pediatric Hepatology, Apollo Hospitals, Navi Mumbai, India
| | - Darius Mirza
- Department of Liver Transplantation and HPB Surgery, Apollo Hospitals, Navi Mumbai, India
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Sonavane A, Shah K, Raut V, Thorat A, Raj CA, Ambekar A, Parmar T, Sen S, Sawant A, Chaksota H, Vasanth S, Nagral A, Mirza D. Splenic peliosis and spontaneous splenic rupture: A rare complication following liver transplantation. Indian J Transplant 2020. [DOI: 10.4103/ijot.ijot_71_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Elobu A, Thorat A, Kweyamba V, Rai R. Gastric cancer and intrahepatic cholangiocarcinoma: Gastrectomy followed by left hepatectomy to achieve R0 resection. Formos J Surg 2019. [DOI: 10.4103/fjs.fjs_112_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Yang HR, Thorat A, Jeng LB, Hsu SC, Li PC, Yeh CC, Chen TH, Poon KSH. Living Donor Liver Transplantation in Acute Liver Failure Patients with Grade IV Encephalopathy: Is Deep Hepatic Coma Still an Absolute Contraindication? A Successful Single-Center Experience. Ann Transplant 2018. [PMID: 29531210 PMCID: PMC6248027 DOI: 10.12659/aot.907274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background The prognosis of the patients of acute liver failure (ALF) with onset of hepatic coma is often dismal. ALF is a well-accepted indication for liver transplantation (LT) and has markedly improved the prognosis of these patients. However, its role in ALF patients with onset of hepatic coma has never been elucidated before. The aim of our study was to analyze the outcome in patients of ALF with hepatic coma who underwent LT. Material/Methods From January 2002 to December 2015, a total of 726 liver transplantations were done at China Medical University Hospital, Taiwan. The hospital database of 59 recipients that underwent LT for ALF was analyzed. Eleven ALF patients with the onset of hepatic coma (grade IV encephalopathy) requiring mechanical ventilatory support were retrospectively analyzed. The patients were sub-grouped in 2 groups depending on the timing of LT after the onset of hepatic coma: Group A had LT within 48 h of onset of coma (n=7) and Group B had LT after 48 h of onset of coma (n=4). Results The study cohort (group A and B) comprised 8 males and 3 females, with an average age of 39.63±13.95 years (range, 13 to 63). Ten patients received living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) was done in 1 recipient. All the patients in group A had complete neurological recovery and were extubated within 48 h after LT, whereas extubation was delayed for various reasons for group B patients. At a mean follow up of 36 months (range, 20 to 76 months), the overall survival of all the recipients (group A and B) was 72%. Three-year survival for Group A (n=7) was 85% and for Group B (n=4) it was 50%. There were no acute rejection episodes. Conclusions LT is an acceptable modality of treatment for patients of ALF with new onset of hepatic coma. Neurological recovery is expected in all patients if LT can be done within 48 h of onset of hepatic coma without increasing the risk of morbidity. Due to shortage of deceased donor organs in Asia, LDLT can be used proactively, with a success rate comparable to that of non-ALF patients undergoing LT.
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Affiliation(s)
- Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Ping-Chun Li
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan.,Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Kin-SHing Poon
- China Medical University, Taichung, Taiwan.,Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
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Thorat A, Jeng LB, Hsu SC, Li PC, Yeh CC, Chen TH, Yang HR, Poon KS. Management of Hepatic Artery Thrombosis after Living Donor Liver Transplantation: Endovascular Thrombolytic Therapy or Surgical Intervention? Role of Hepatic Arterial Urokinase Infusion. ACTA ACUST UNITED AC 2018. [DOI: 10.21614/sgo-23-3-159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Thorat A, Jeng LB, Yang HR, Yeh CC, Hsu SC, Chen TH, Poon KS. Assessing the role of everolimus in reducing hepatocellular carcinoma recurrence after living donor liver transplantation for patients within the UCSF criteria: re-inventing the role of mammalian target of rapamycin inhibitors. Ann Hepatobiliary Pancreat Surg 2017; 21:205-211. [PMID: 29264583 PMCID: PMC5736740 DOI: 10.14701/ahbps.2017.21.4.205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/15/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023] Open
Abstract
Backgrounds/Aims The protective effect of everolimus (EVR) in hepatocellular carcinoma (HCC) patients who receive liver transplantation in terms of reducing the recurrence has not been sufficiently investigated in clinical trials. In this second stage of our ongoing study, we intend to analyze the effects of EVR as an immunosuppressant, when it is started in the early phase after living donor liver transplantation (LDLT), on HCC recurrence in patients with HCC within the University of California at San Francisco (UCSF) criteria. Methods From January 2011 to June 2013, a total of 250 patients underwent LDLT for HCC at our institute. The patients with HCC within the UCSF criteria were included in the study and divided in two groups depending upon the postoperative immunosuppression. Group A: HCC patients that received EVR+TAC based immunosuppressive regimen (n=37). Group B: HCC patients that received standard TAC based immunosuppressive regimen without EVR (n=29). The target trough level for EVR was 3 to 5 ng/ml while for TAC it was 8–10 ng/ml. Results For group A patients, the mean trough level of the EVR was 3.47±1.53 ng/ml (range, 1.5–11.2) with a daily dose of 1.00±0.25 mg/day. For group A and B, the average TAC trough levels were 6.97±3.98 ng/ml (range, 2.50 to 11.28 ng/ml) and 6.93±2.58 (range, 2–16.30), respectively. The 1-year, 3-year and 4-year overall survival achieved for Group A patients was 94.95%, 86.48% and 86.48%, respectively while for Group B patients it was 82.75%, 68.96%, and 62.06%, respectively (p=0.0217). Conclusions EVR use in liver transplant recipients in the early stage after transplantation reduces the HCC recurrence rates in HCC patients within the UCSF criteria.
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Affiliation(s)
- Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Shing Poon
- Department of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
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11
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Affiliation(s)
- Ping-Chun Li
- Department of Cardiovascular Surgery and, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
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12
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Li PC, Thorat A, Hsu SC, Poon KS, Yang HR, Chen TH, Yeh CC, Jeng LB. Extracorporeal Membrane Oxygenation Support for Rituximab-Induced Acute Respiratory Distress Syndrome in an ABO-Incompatible Living Donor Liver Transplant Recipient: Successful Management of a Rare Complication and a Review of the Literature. Ann Transplant 2017; 22:463-467. [PMID: 28751632 DOI: 10.12659/aot.903788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Rituximab is commonly used to reduce the agglutinin titer in ABO-incompatible liver transplant recipients. Although well-tolerated, rituximab infusion therapy may result in severe pulmonary adverse effects such as drug-induced pneumonitis, leading to acute respiratory distress syndrome (ARDS), which has a high mortality rate. Management of such rare cases in an ABO-incompatible patient has never been described before. Herein, we present successful use of extracorporeal membrane oxygenation (ECMO) support for rituximab-induced ARDS in an ABO-incompatible living donor liver transplantation (LDLT) recipient. CASE REPORT A 57-year-old man patient presented with acute-on-chronic hepatic failure. Due to worsening clinical condition and unavailability of a deceased donor organ, ABO-incompatible LDLT was considered. The patient received rituximab therapy and plasmapheresis 1 week before the transplantation to reduce the B cell count. However, he suddenly developed acute respiratory distress-like symptoms, with a chest X-ray suggesting organized pneumonia. Infectious etiology was excluded as evidenced from negative sputum and blood culture, which were repeated after 48 h. LDLT was performed and ECMO support was instituted in the immediate postoperative period due to worsening of the ARDS. The pulmonary signs improved, with a chest X-ray showing clear lung fields on the 5th postoperative day. The patient recovered well and was discharged with normal liver functions in the 4th postoperative month. CONCLUSIONS This is first reported experience of successful use of ECMO in an ABO-incompatible liver transplant recipient with rituximab-induced ARDS. This experience shows the feasibility and effectiveness of ECMO support in liver transplant recipients with poor respiratory functions.
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Affiliation(s)
- Ping-Chun Li
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Shing Poon
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
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13
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Hsu SC, Thorat A, Yang HR, Poon KS, Li PC, Yeh CC, Chen TH, Jeng LB. Assessing the Safety of Expanded Polytetrafluoroethylene Synthetic Grafts in Living Donor Liver Transplantation: Graft Migration Into Hollow Viscous Organs - Diagnosis and Treatment Options. Med Sci Monit 2017; 23:3284-3292. [PMID: 28683053 PMCID: PMC5510995 DOI: 10.12659/msm.902636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Our recent studies have highlighted the importance and safety of backtable venoplasty for middle hepatic vein (MHV) and inferior right hepatic veins (IRHV) reconstruction using expanded polytetrafluoroethylene (ePTFE) vascular grafts. In this study, we aim to analyze the complications associated with ePTFE graft use and discuss the management of the rare, but, potentially life threatening complications directly related to ePTFE conduits. Material/Methods From January 2012 to October 2015 a total of 397 patients underwent living donor liver transplantation (LDLT). The ePTFE vascular grafts were used during the backtable venoplasty for outflow reconstruction in 262 of the liver allografts. Recipients who developed ePTFE-related complications were analyzed. Results ePTFE-related complications developed in 1.52% (4/262) of the patients. One patient (0.38%) developed complete thrombosis with sepsis at 24 months post-transplantation and died due to multiorgan failure. Three patients (1.1%) developed graft migration into the second portion of the duodenum, without overt peritonitis. Surgical exploration and ePTFE graft removal was done in all the patients. One patient died due to overwhelming sepsis. Conclusions ePTFE graft migration into the duodenum causing perforation is a new set of complications that has been recently described in LDLT and can be treated effectively by surgical removal of the infected vascular graft and duodenal perforation closure. Despite of such complications, in our experience, ePTFE use in LDLT continues to have wide safety margin, with a complication rate of only 1.52%.
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Affiliation(s)
- Shih-Chao Hsu
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Shing Poon
- Department of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Ping-Chun Li
- Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
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14
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Li PC, Thorat A, Jeng LB, Yang HR, Li ML, Yeh CC, Chen TH, Hsu SC, Poon KS. Successful application of supraceliac aortohepatic conduit using saphenous venous graft in right Lobe living donor liver transplantation. Liver Transpl 2017; 23:976-980. [PMID: 28073174 DOI: 10.1002/lt.24720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/08/2016] [Accepted: 12/20/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Ping-Chun Li
- Organ Transplantation Center.,Departments of Cardiovascular Surgery, China Medical University, Taichung, Taiwan
| | | | - Long-Bin Jeng
- Organ Transplantation Center.,Departments of Surgery
| | | | - Ming-Li Li
- Organ Transplantation Center.,Departments of Cardiovascular Surgery, China Medical University, Taichung, Taiwan
| | | | - Te-Hung Chen
- Organ Transplantation Center.,Departments of Surgery
| | - Shih-Chao Hsu
- Organ Transplantation Center.,Departments of Surgery
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15
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Li PC, Thorat A, Jeng LB, Yang HR, Li ML, Yeh CC, Chen TH, Hsu SC, Poon KS. Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients-tips and tricks to overcome the poor hepatic arterial flow. Liver Transpl 2017; 23:887-898. [PMID: 28422392 DOI: 10.1002/lt.24775] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/09/2017] [Accepted: 04/13/2017] [Indexed: 12/17/2022]
Abstract
The reconstruction of the hepatic artery (HA) is the most complex step in living donor liver transplantation (LDLT) because of the smaller diameter of the artery and the increased risk of HA-related complications. Because of the smaller diameter of the HA, many centers use a microsurgical technique with interrupted sutures for arterial anastomosis. The aim of our study was to retrospectively investigate the outcomes after HA reconstruction performed under magnifying loupes using the "parachute technique." From August 1, 2002 to August 31, 2016, LDLT was performed in 766 recipients. HA reconstruction for the initial 25 LDLT surgeries was performed using a microsurgery technique (era 1). From May 2007 until the end date, HA reconstruction was performed in 741 recipients by a "parachute technique" under surgical loupes (era 2). HA reconstruction was performed using surgical loupes in 737 adults (male:female, 526:211) and 4 pediatric patients (male:female, 3:1). The average diameter of the donor graft HA was 2.8 mm (range, 1-6.5 mm). The most notable factor in this era was the quick HA anastomosis procedure with a mean time of 10 ± 5 minutes (range, 5-30 minutes). In era 2, 9 (1.21%) patients developed hepatic artery thrombosis (HAT), whereas 2 patients developed nonthrombotic HA-related complications. Extra-anatomic HA reconstruction was performed in 14 patients due to either primary HA anastomosis failure or a poor caliber recipient HA. The use of magnifying surgical loupes to perform HA reconstruction is safe, feasible, and yields a low incidence of HA-related complications. The "parachute technique" for HA reconstruction can achieve a speedy reconstruction without increasing the risk of HAT. Liver Transplantation 23 887-898 2017 AASLD.
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Affiliation(s)
- Ping-Chun Li
- Organ Transplantation Center.,Departments of Cardiovascular Surgery
| | | | | | | | - Ming-Li Li
- Organ Transplantation Center.,Departments of Cardiovascular Surgery
| | | | | | | | - Kin-Shing Poon
- Organ Transplantation Center.,Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
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16
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Hsu SC, Thorat A, Poon KS, Yeh CC, Chen TH, Yang HR, Jeng LB. Management of Liver Allograft Trauma Resulting in Massive Subcapsular Hematoma After Living Donor Liver Transplantation: Can We Salvage the Liver Allograft? Ann Transplant 2017; 22:1-8. [PMID: 28053303 DOI: 10.12659/aot.901006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Liver allograft trauma resulting in subcapsular hematoma after living donor liver transplantation (LDLT), although rare, is a life-threatening condition and requires prompt management to avoid any catastrophe. Herein we describe our successful experience in dealing with liver allograft hematoma that developed in the post-operative period after LDLT. MATERIAL AND METHODS From January 2002 to May 2015, a total of 616 recipients underwent LDLT at our institute. The intra-operative and postoperative records of these patients were analyzed to study the cases of liver allograft hematoma. Four patients (n=4) who developed liver allograft subcapsular hematoma during the intra-operative and post-operative periods were included in study. The outcomes of these patients were studied after the administration of the medical, surgical, or combined modalities of treatment. RESULTS Out of 616 LDLT recipients, 4 (0.64%) developed subcapsular hematoma. Patients were managed by a stepwise approach: Initial non-operative management with transarterial embolization (if extravasation of the contrast was noticed during imaging studies) was performed (n=1). Three patients developed hemodynamic instability with signs of hematoma rupture and were successfully treated by surgical exploration. CONCLUSIONS Timely diagnosis and suitable management can successfully salvage a liver allograft even in the presence of massive subcapsular hematoma. Our emphasis is on perihepatic packing rather than open surgical drainage if exploration is required, which can achieve a 100% success rate.
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Affiliation(s)
- Shih-Chao Hsu
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Shing Poon
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
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17
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Poon KS, Yang HR, Thorat A, Yeh CC, Chiang YY, Chen TH, Hsu SC, Jeng LB. Living donor hepatectomy in female donors with ongoing menstruation: Safety and ethical issues. Formos J Surg 2017. [DOI: 10.4103/fjs.fjs_42_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Thorat A, Hsu SC, Yang HR, Li PC, Li ML, Yeh CC, Chen TH, Poon KS, Jeng LB. Reconstruction of Isolated Inferior Right Hepatic Vein(s) in Right Lobe Living Donor Liver Transplantation Using Polytetrafluoroethylene Grafts: A New Feasible Concept, Technique of ‘Bridging Conduit Venoplasty’ and Outcomes. Ann Transplant 2016; 21:735-744. [PMID: 27909288 DOI: 10.12659/aot.900871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Ping-Chun Li
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Li Li
- China Medical University, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Shing Poon
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
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19
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Thorat A, Jeng LB. Management of renal dysfunction in patients with liver cirrhosis: role of pretransplantation hemodialysis and outcomes after liver transplantation. Semin Vasc Surg 2016; 29:227-235. [DOI: 10.1053/j.semvascsurg.2017.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Thorat A, Jeng LB, Yang HR, Li PC, Li ML, Yeh CC, Chen TH, Hsu SC, Poon KS. Outflow reconstruction for right liver allograft with multiple hepatic veins: "V-plasty" of hepatic veins to form a common outflow channel versus 2 or more hepatic vein-to-inferior vena cava anastomoses in limited retrohepatic space. Liver Transpl 2016; 22:192-200. [PMID: 26390259 DOI: 10.1002/lt.24342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/30/2015] [Accepted: 09/10/2015] [Indexed: 12/20/2022]
Abstract
Outflow reconstruction in living donor liver transplantation (LDLT) is certainly difficult in limited retrohepatic space with using right liver grafts with venous anomalies. Venoplasty of the inferior right hepatic veins (IRHVs) and middle hepatic vein (MHV) reconstruction using synthetic grafts to form a common outflow channel or a second venocaval anastomosis are available options. We aim to compare outcomes of LDLT recipients who underwent outflow reconstruction with a "V-Plasty" technique and outcomes of patients who underwent a second venocaval anastomosis. Out of 325 recipients who underwent LDLT from March 2011 to September 2014, 45 received right liver allografts that were devoid of MHV with multiple draining IRHVs (2 or more). Group A (n = 16) comprised the recipients with outflow reconstruction with a V-Plasty, and group B (n = 29) included the recipients with a second venocaval anastomosis. Group A recipients (male:female, 10:6; median age, 50.5 years) had a mean Model for End-Stage Liver Disease score of 14.7, whereas for group B recipients (male:female, 20:9; median age, 52.0 years) it was 17.2. The mean IRHV diameter for group A and B grafts was 8.3 mm each. Mean warm ischemia time for group A was significantly lower (25.2 minutes) as compared to group B recipients (34.6 minutes) with P < 0.001. The 2-month patency rates of vascular grafts were 100% for group A recipients with no evidence of thrombosis. In conclusion, the V-Plasty technique of MHV and IRHV reconstruction to form a common outflow is a new concept that proves to be a safe and feasible alternative for second venocaval anastomosis.
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Affiliation(s)
- Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Departments of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Departments of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ping-Chun Li
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Departments of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Li Li
- Departments of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Departments of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Departments of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.,Departments of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Shing Poon
- Departments of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
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21
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Jeng LB, Thorat A, Yang HR, Yeh CC, Chen TH, Hsu SC, Poon KS, Li PC. “Rooftop and Skeletonization Technique” of Hepatic Transection to Include or Exclude the Middle Hepatic Vein During Donor Hepatectomy in Living Donor Liver Transplantation: Solving the Middle Hepatic Vein Controversy – Experience in 397 Sequential Live Donors. ACTA ACUST UNITED AC 2016. [DOI: 10.12659/mst.897205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Shing Poon
- Department of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Ping-Chung Li
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
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22
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Jeng LB, Thorat A, Yang HR, Li PC. Venous outflow reconstruction in living donor liver transplantation: Dealing with venous anomalies. World J Transplant 2015; 5:145-153. [PMID: 26722643 PMCID: PMC4689926 DOI: 10.5500/wjt.v5.i4.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/10/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
The reconstruction of the vascular outflow tract of partial liver grafts has received considerable attention in the past, especially in the setting of right liver grafts with undrained segments. Hepatic venous outflow reconstruction is an important factor for successful living donor liver transplantation outcome. However, in presence of undrained anterior sector and presence of multiple short hepatic veins that drain substantial portions of liver, outflow reconstruction without backtable venoplasty may lead to severe graft congestion and subsequent graft dysfunction. Various backtable venoplasty techniques in presence of multiple hepatic veins that can be used in either right- or left-lobe liver transplantation are devised to ensure a single, wide outflow channel. In this overview, various techniques to overcome the hepatic venous variations of liver allograft and outflow reconstruction are discussed.
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23
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Yang HR, Thorat A, Gesakis K, Li PC, Kiranantawat K, Chen HC, Jeng LB. Living donor liver transplantation with abdominal wall reconstruction for hepatocellular carcinoma with needle track seeding. World J Transplant 2015; 5:360-5. [PMID: 26722665 PMCID: PMC4689948 DOI: 10.5500/wjt.v5.i4.360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/17/2015] [Accepted: 11/10/2015] [Indexed: 02/05/2023] Open
Abstract
Malignant cell seeding in subcutaneous tissues along the needle track and/or percutaneous biliary drainage catheters is rare complication, but pose various technical issues in planning surgical treatment of such patients. If underlying primary hepatic malignancy can be treated, an aggressive resection of subcutaneous tissue bearing cancer cell with subsequent abdominal wall reconstruction has been sporadically reported. But, when hepatic resection is not possible due to underlying advanced cirrhosis, liver transplantation along with abdominal wall resection and subsequent reconstruction remains only feasible option. Herein, we describe our successful experience of living donor liver transplantation for hepatocellular carcinoma with full-thickness abdominal wall resection bearing the tumor seeding followed by reconstruction in single stage surgery.
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24
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Thorat A, Jeng LB, Li PC, Li ML, Yang HR, Yeh CC, Chen TH, Hsu SC. "Single Oval Ostium Technique" using Polytetrafluoroethylene Graft for Outflow Reconstruction in Right Liver Grafts with venous Anomalies in Living Donor Liver Transplantation. Hepatogastroenterology 2015; 62:698-702. [PMID: 26897957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Right lobe living donor liver transplantation form a major source of liver allografts in Asia because of the scarcity of deceased donation. However, the transplant surgeons often face challenges while managing right lobe liver allografts due to variations in vascular anatomy. Such variations have led the transplant team to adopt modifications in existing techniques of inflow and outflow reconstruction. One of such variations is presence of multiple draining inferior right hepatic veins (IRHVs). This hepatic venous anomaly pose a lot of technical difficulties in the outflow reconstruction as second and/or third anastomosis to inferior vena cava is not always possible in limited retrohepatic space. Herein, we describe the "Single oval ostium technique" using dual synthetic vascular grafts ensuring a common outflow channel for all the hepatic veins.
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25
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Jeng LB, Thorat A, Li PC, Li ML, Yang HR, Yeh CC, Chen TH, Hsu CH, Hsu SC, Poon KS. "V-Plasty" technique using dual synthetic vascular grafts to reconstruct outflow channel in living donor liver transplantation. Surgery 2015; 158:1272-82. [PMID: 25920910 DOI: 10.1016/j.surg.2015.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/28/2015] [Accepted: 03/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The reconstruction of outflow is a crucial step in living donor liver transplantation. This study describes a suitable technique that uses synthetic vascular conduits in presence of multiple draining veins of right lobe of liver and the outcome of the recipients to evaluate safety of using multiple synthetic grafts. METHODS From March 2011 to September 2014, 325 patients underwent right lobe living donor liver transplantation. Expanded polytetra-fluoroethylene (ePTFE) grafts were used in total 155 of the liver allografts. Among these, 16 liver grafts required dual ePTFE grafts to reconstruct the outflow due to presence of multiple hepatic veins. RESULTS The mean diameters for venous branches of segment 5 (V5) and 8 (V8) were 5 mm (range, 4-8 mm) and 7 mm (range, 5-9 mm). The mean diameter of inferior right hepatic veins was 8 mm (7-10 mm). All the recipients who received the right liver with dual ePTFE grafts showed satisfactory inflow and outflow immediately after reconstruction as measured by Doppler flowmetry. Postoperative ultrasonographic studies showed no disturbances in outflow. Protocol dynamic computed tomography performed in the second postoperative month showed 100% patency rates of the artificial grafts. At median follow-up of 24 months graft survival was achieved in 88%, whereas the patency rates of the ePTFE grafts were 100%. CONCLUSION The use of "V-Plasty" technique using dual artificial vascular grafts is a safe and feasible technique in the presence of various allograft venous anomalies & ensures a single venous channel for outflow reconstruction. Our study also suggests that ePTFE graft may be a useful interposition material without serious complications.
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Affiliation(s)
- Long-Bin Jeng
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
| | - Ashok Thorat
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Ping-Chun Li
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Li Li
- College of Medicine, China Medical University, Taichung, Taiwan; Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan
| | - Chia-Hao Hsu
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Centre, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan
| | - Kin-Shing Poon
- College of Medicine, China Medical University, Taichung, Taiwan; Department of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
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26
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Jeng LB, Thorat A, Yang HR, Yeh CC, Chen TH, Hsu CH, Hsu SC, Poon KS, Li PC, Lai HC, Su WP, Peng CY. Successful use of hepatitis B surface antigen-positive liver grafts - an effective source for donor organs in endemic areas: a single-center experience. Ann Transplant 2015; 20:103-11. [PMID: 25703063 DOI: 10.12659/aot.893032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Due to high prevalence of hepatitis B virus (HBV) infection in Taiwan, liver grafts from donors positive for hepatitis B surface antigen (HBsAg) without progressive disease can be effective alternative source of donor organs. This study aims to prove the safety of living donor liver transplantation (LDLT) using HBsAg-positive liver grafts and its long-term outcome. MATERIAL AND METHODS We studied 14 consecutive LDLT recipients that received HBsAg-positive grafts from November 2009 to December 2013 for various indications. All donors were chronic HBsAg carriers with normal liver function tests. Median follow-up was 46 months (range, 35-59). RESULTS All the donors and recipients recovered well post-transplant with no reactivation of HBV to date. Two of the recipients died due to extra-hepatic recurrence of HCC. At median follow-up of 46 months, 4-year cumulative survival of recipients was 77.38%. CONCLUSIONS In endemic areas, HBsAg-positive donor organs can clearly be used effectively under viral immunoprophylaxis. HBV disease reactivation does not appear to be a threat even with hepatitis B immunoglobulin (HBIG)-free antiviral monoprophylaxis regimen. This study thus proves the safety and feasibility of the option of using HBsAg-positive grafts in high-prevalence areas.
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Affiliation(s)
- Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Shing Poon
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Ping-Chung Li
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsueh-Chou Lai
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Pang Su
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Yuan Peng
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Jeng LB, Thorat A, Hsieh YW, Yang HR, Yeh CC, Chen TH, Hsu SC, Hsu CH. Experience of using everolimus in the early stage of living donor liver transplantation. Transplant Proc 2015; 46:744-8. [PMID: 24767339 DOI: 10.1016/j.transproceed.2013.11.068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/22/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of our study was to review the experience of early use of everolimus for recipients after adult-to-adult living donor liver transplantation. METHODS From February 2012 to December 2012, 80 recipients underwent living donor liver transplantation. Forty-three of them used everolimus as an adjunct to the calcineurin inhibitors (CNIs) in the early postoperative period. Thirty-nine patients had hepatocellular carcinoma (HCC) and poor renal function was noted in 9 patients. Ten of them were females and 33 were males. The age varied from 39 to 75 years old. The starting date of use was within 1 week in 33 patients, 2 weeks in 9 patients, and 1 patient was administered on postoperative day 20. The initial doses of everolimus were 0.25 mg every 12 hours and increased to 0.5 mg every 12 hours to target the level at 3-5 ng/mL. Doppler ultrasound was performed regularly postoperative days 1, 4, and 14. RESULTS The mean time between liver transplantation and everolimus treatment was 12 ± 8 days. The maximum dose of everolimus used was 1 mg/d with a target trough level between 3 and 5 ng/mL. At 3 months, a target trough level of 3 ng/mL was achieved. Six of 9 renal failure patients showed significant recovery of renal function, whereas 3 of them showed further deterioration and 1 required hemodialysis. During the follow-up period of 9 ± 6 months, all showed good patency of hepatic artery without thrombosis. Three patients (7%) developed HCC recurrence, whereas 1 patient died at the 10th month postoperative due to sepsis. Elevation of lipid profile was noted in 5 patients. Stomatitis was the most frequent side effect and occurred in 15 patients. CONCLUSIONS The early use of everolimus was safe and feasible. Also, it can be safely used in patients with prior renal failure while reducing the doses of CNIs. Although the recurrence rate of HCC was reduced, further study is ongoing to evaluate the long-term impact of everolimus on prevention of HCC recurrence.
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Affiliation(s)
- L-B Jeng
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
| | - A Thorat
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Y-W Hsieh
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - H-R Yang
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan
| | - C-C Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan
| | - T-H Chen
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - S-C Hsu
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - C-H Hsu
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
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28
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Hsu SC, Jeng LB, Thorat A, Li PC, Poon KS, Hsu CH, Yeh CC, Chen TH, Yang HR. Management of extensive retrohepatic vena cava defect in recipients of living donor liver transplantation. Transplant Proc 2015; 46:699-704. [PMID: 24767328 DOI: 10.1016/j.transproceed.2013.11.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/07/2013] [Indexed: 01/03/2023]
Abstract
Certain complexities, such as extensive vena caval injury, unexpected dense adhesions between liver and retrohepatic vena cava, and liver tumor abutting retrohepatic vena cava, sometimes warrant resection of vena cava during living-donor liver transplantation. Because the donor graft is devoid of vena cava, reconstruction of the retrohepatic cava is required, which can be done with the use of either a cryopreserved venous graft or an artificial conduit. With only a few published reports, the experience in vena cava reconstruction with the use of expanded polytetrafluoroethylene (ePTFE) during living-donor liver transplantation remains limited. We present our experience of 4 patients who successfully underwent vena caval resection during liver transplantation for various indications, which was subsequently reconstructed with the use of ePTFE grafts. All of these patients except 1 recovered well without any undue complications, such as thrombosis or outflow inadequacies, thus proving this extensive surgical treatment to be a successful and life-saving procedure, though meticulous skills are prerequisite.
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Affiliation(s)
- S-C Hsu
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan
| | - L-B Jeng
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan; China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | - A Thorat
- Organ Transplantation Center, China Medical University, Taichung, Taiwan
| | - P-C Li
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan; China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - K-S Poon
- Department of Anesthesiology, China Medical University, Taichung, Taiwan
| | - C-H Hsu
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan
| | - C-C Yeh
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan; China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - T-H Chen
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan
| | - H-R Yang
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan; China Medical University Hospital, China Medical University, Taichung, Taiwan
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Poon KS, Chen CC, Thorat A, Chiang YY, Jeng LB, Yang HR, Chen TH, Yeh CC, Chen KB. Fibrinolysis after reperfusion of liver graft. ACTA ACUST UNITED AC 2015; 53:41-3. [PMID: 25649273 DOI: 10.1016/j.aat.2014.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/23/2014] [Indexed: 01/17/2023]
Abstract
From September 2012 to March 2013, a total of 63 adult-to-adult living donor liver transplantations were performed at our institution. All the patients were monitored for their coagulation functions using rotation thromboelastometry (ROTEM, Tem Innovations GmbH) during the procedure at the following points: preoperative baseline, 5 minutes, 30 minutes, and 120 minutes, respectively, after reperfusion of the liver graft. A total of 84.13% of cases (n = 53) revealed fibrinolysis after reperfusion of the graft and the condition was reversed after 30 minutes without any need for additional treatment. No significant coagulopathy was observed during this period in all of the cases. The result of the ROTEM finding must correlate with the clinical situation before instituting any management to avoid the risk of thrombosis of the hepatic artery.
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Affiliation(s)
- Kin-Shing Poon
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chia-Chen Chen
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ashok Thorat
- Organ Transplantation Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Ying Chiang
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | - Horng-Ren Yang
- Organ Transplantation Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Te-Hung Chen
- Organ Transplantation Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Organ Transplantation Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Kuen-Bao Chen
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Thorat A, Huang WH, Yeh TS, Jan YY, Hwang TL. Pancreatic ductal adenocarcinoma presenting with acute and chronic pancreatitis as initial presentation: is prognosis better? A comparison study. Hepatogastroenterology 2014; 61:2110-2116. [PMID: 25713917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) may present with acute and /or chronic pancreatitis due to pancreatic ductal obstruction causing diagnostic dilemma. The aim of this retrospective study was to investigate the outcome and prognosis of the patients of PDAC presenting with pancreatitis. METHODS From 1991 to 2009, 298 patients with PDAC that underwent surgical treatment were retrospectively studied and divided in two groups depending upon initial symptomatic presentation. Group A (n=254) comprised patients without pancreatitis while group B (n=44) patients presented with acute and/or chronic pancreatitis initially. RESULTS All the patients in studied cohort were surgically treated. Mean age of group A was 63.1 years & for group B it was 62.9 years. Location of tumor was in head of the pancreas in 66.14% of group A patients (n=168) and 61.36% of group B patients (n=27). Although statistically insignificant, the patients in group B had overall better 5-year survival than the patients in group A (20% vs 15.9%). CONCLUSIONS This retrospective study highlights the overall better survival of PDAC patients presenting with acute and/or chronic pancreatitis than those without as contrary to previous reports which stated the poor prognosis of PDAC patients if associated with underlying pancreatitis.
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Thorat A, Lee CF, Wu TH, Pan KT, Chu SY, Chou HS, Chan KM, Wu TJ, Lee WC. Endovascular treatment for pseudoaneurysms arising from the hepatic artery after liver transplantation. Asian J Surg 2014; 40:227-231. [PMID: 25183291 DOI: 10.1016/j.asjsur.2014.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 07/06/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022] Open
Abstract
Hepatic artery pseudoaneurysm after liver transplantation is an uncommon but potentially lethal complication. Early diagnosis and treatment are essential to avoid life-threatening hemorrhage in these patients. We herein report the case of three patients who developed hepatic artery pseudoaneurysms after living donor liver transplantation. Two patients presented with massive duodenal bleeding secondary to erosion of the hepatic artery into the bile duct, and one patient presented with intra-abdominal bleeding. These patients were managed by catheter-based minimal invasive endovascular procedures including coil embolization and stent grafting. All the patients were treated successfully with uneventful recovery. This technique can be considered as an effective treatment option for hepatic artery pseudoaneurysms instead of a difficult surgical intervention.
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Affiliation(s)
- Ashok Thorat
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chen-Fang Lee
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Tsung-Han Wu
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Kuang-Tse Pan
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Sung-Yu Chu
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Hong-Shiue Chou
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Ting-Jung Wu
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.
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Hwang TL, Lee LY, Chen TC, Thorat A, Hsu JT, Yeh CN, Yeh TS, Jan YY. Prognosis of ductal adenocarcinoma of pancreatic head with overexpression of CD44. Formosan Journal of Surgery 2014. [DOI: 10.1016/j.fjs.2014.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Jeng LB, Thorat A, Li PC, Li ML, Yang HR, Yeh CC, Chen TH, Hsu CH, Hsu SC, Poon KS. Raising-flap technique for outflow reconstruction in living donor liver transplantation. Liver Transpl 2014; 20:490-2. [PMID: 24347307 DOI: 10.1002/lt.23810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/11/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Long-Bin Jeng
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Surgery and Organ Transplantation Center, China Medical University, Taichung, Taiwan
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Thorat A, Lee CF, Wu TH, Chan KM, Chou HS, Lee WC. Safety of transarterial chemoembolization as bridging therapy in HCC patients with hyperbilirubinemia on the waiting list for liver transplantation: a centre experience. Hepatogastroenterology 2013; 60:2076-2079. [PMID: 24719950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIMS Untreated hepatocellular carcinoma (HCC) has a notoriously poor prognosis, with a median survival of 1-8 months and a 5-year survival of -3%. Potentially curative surgical therapeutic options include partial hepatic resection with adequate margins and liver transplantation (LT). By current guidelines, transarterial chemoembolization (TACE) is the standard of care for the intermediate stage HCC, namely unresectable, multifocal disease confined to the liver in the absence of portal vein thrombosis and is used as bridging therapy for LT wait-listed candidates with HCC to limit tumour progression and dropout rate. TACE is contraindicated in patients with poor liver reserve with hyperbilirubinemia (bilirubin > or = 2 mg/ dL). METHODOLOGY In this study, 13 sequential HCC patients waitlisted for LT with total bilirubin level > or = 2 mg/dL, that underwent TACE prior to LT, were included. A mean of 4 TACE sessions were performed in each patient; 10 patients were either child A or B while 3 were in child C class. RESULTS The 30-day mortality rate was nil with minimal adverse effects and none of the patients showed procedure related morbidity such as hepatic decompensation. Hyperbilirubinemia did not affect outcomes significantly and tumour response rate was 54.8%. Thus, with careful selection of patients TACE can still be performed even in presence of hyperbilirubinemia thus preventing disease progression while they are waitlisted for LT.
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