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Madeira-Cardoso MJ, Alexandrino H, Oliveira P, Rodrigues F, Oliveira AS, Vieira V, Oliveiros B, Tralhão JG, Carvalho H, Furtado E. Is Cholecystectomy Really Harmful? A Long-Term Quality of Life Study in Living Donor Liver Transplantation. Transplant Proc 2020; 52:873-880. [PMID: 32139276 DOI: 10.1016/j.transproceed.2020.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/18/2020] [Accepted: 01/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) is an accepted option for patients with end-stage liver disease. However, it potentially carries the risk of donor morbi-mortality, as well as long-term functional impairment. Cholecystectomy is performed routinely in the donor intervention, but the long-term effect on gastrointestinal (GI)-related quality of life (QoL) has never been explored previously. This study evaluated living donors' overall, abdominal wall-related, activity-level, and GI-related QoL. MATERIALS AND METHODS In total, 21 living liver donors (LLD) (57% women, mean age 45 ± 9 years) were compared to a control group (29 patients) undergoing cholecystectomy for gallbladder polyps (45% women, mean age of 46 ± 7 years). LLD and controls (Ctl) were divided into 2 age groups: LLD-Y and Ctl-Y (25-45 years); and LLD-O and Ctl-O (46-65 years). Generic SF-36, Gastrointestinal Quality of Life Index, EuraHS for abdominal wall status assessment, and International Physical Activity Questionnaire were performed. Standard age-adjusted Portuguese population SF-36 scores were used. RESULTS Global QoL results were better than Portuguese population scores and not inferior when compared to controls, scoring higher in the LLD-Y group in domains as vitality and mental health (P < .05). The abdominal wall impact was minimal among LLD. The activity level was significantly higher in LLD-Y than in Ctl-Y. Overall GI-related QoL was very close to the maximum score, and GI symptoms were significantly less in LLD-O compared with Ctl-O. CONCLUSION LDLT had no impact on donors' general, abdominal wall-related QoL or activity level. The performance of cholecystectomy apparently had no impact on the development of GI-related symptoms.
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Affiliation(s)
| | - Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Surgery Department, University Hospital of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research, University of Coimbra, Coimbra, Portugal
| | - Pedro Oliveira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pediatric and Adult Liver Transplantation Department, University Hospital of Coimbra, Coimbra, Portugal
| | | | - Ana Sofia Oliveira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Surgery Department, University Hospital of Coimbra, Coimbra, Portugal
| | - Vera Vieira
- Surgery Department, Hospital of Figueria da Foz, Figueria da Foz, Portugal
| | - Bárbara Oliveiros
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research, University of Coimbra, Coimbra, Portugal
| | - José Guilherme Tralhão
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Surgery Department, University Hospital of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research, University of Coimbra, Coimbra, Portugal
| | - Hélder Carvalho
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Surgery Department, University Hospital of Coimbra, Coimbra, Portugal
| | - Emanuel Furtado
- Pediatric and Adult Liver Transplantation Department, University Hospital of Coimbra, Coimbra, Portugal
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Tanaka M, Kido M, Kuramitsu K, Komatsu S, Awazu M, Gon H, Tsugawa D, Mukubo H, Toyama H, Fukumoto T. Efficacy of the bile leak test using contrast-enhanced intraoperative ultrasonic cholangiography in liver resection: a study protocol for a non-randomised, prospective, off-label, single-arm trial. BMJ Open 2019; 9:e029330. [PMID: 31182455 PMCID: PMC6561446 DOI: 10.1136/bmjopen-2019-029330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Bile leak is still a major complication after liver resection to be improved. To intraoperatively detect this adverse complication, leak test is commonly performed after hepatic resection. However, by the conventional leak test, it is often difficult to know whether the test reagent reaches to intrahepatic bile duct near cut surface of liver with adequate volume and pressure to identify the existence of bile leak. Thus, in order to perform leak test more accurately, this study aims to evaluate the efficacy and safety of the leak test using contrast-enhanced intraoperative ultrasonic cholangiography (CE-IOUSC), which was reported by our group as a procedure for detection of bile duct. METHODS AND ANALYSIS The current study is a non-randomised, prospective, off-label, single-arm clinical trial for patients who undergo liver resection. A total of 100 patients will be enrolled. After completion of liver resection, the leak test is performed with CE-IOUSC using Sonazoid as a contrast agent to visualise dye injection into the intrahepatic bile duct. The primary endpoint is the success of the leak test, defined as clear visualisation of intrahepatic bile duct around cut surface by ultrasonography that indicates enough volume of dye injection. Secondary endpoints are postoperative bile leak and all adverse events related to CE-IOUSC. The findings obtained through this study will establish this procedure to assist surgeons for adequately performing the leak test, precisely detecting intraoperative biliary leak strictly and reducing postoperative bile leak. ETHICS AND DISSEMINATION The protocol is approved by Institutional Review Boards of Kobe University Hospital (No.290069). Our findings will be widely disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER UMIN000031236 and jRCTs051180027.
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Affiliation(s)
- Motofumi Tanaka
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | - Masahiro Kido
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | - Kaori Kuramitsu
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | - Shohei Komatsu
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | - Masahide Awazu
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | - Hidetoshi Gon
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | - Daisuke Tsugawa
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | - Hideyo Mukubo
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | | | - Takumi Fukumoto
- Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
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Living Donor Liver Transplantation: Overview, Imaging Technique, and Diagnostic Considerations. AJR Am J Roentgenol 2019; 213:54-64. [PMID: 30973783 DOI: 10.2214/ajr.18.21034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this article is to discuss the process of becoming a liver donor, describe the surgical methods used for transplantation, and critically review preoperative and intraoperative imaging techniques. CONCLUSION. Radiologists play a vital role in ensuring the safety of living liver donors; however, consensus guidelines do not exist for imaging protocol or reporting. Standardization would provide more consistent image quality across centers, improve communication with the transplant team, and facilitate data mining for quality assurance and research.
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Urade T, Fukumoto T. Intraoperative ultrasonic cholangiography for biliary system identification. Can J Surg 2018; 61:E1. [PMID: 29368680 DOI: 10.1503/cjs.1861011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Takeshi Urade
- From the Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan (Urade, Fukumoto); and the Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, Ono, Japan (Urade)
| | - Takumi Fukumoto
- From the Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan (Urade, Fukumoto); and the Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, Ono, Japan (Urade)
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