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Miyazaki Y, Fujiki M, Tuul M, Khalil M, Pita A, Kim J, Schlegel A, Kwon CH, Aucejo F, Pinna AD, Miller C, Hashimoto K. Recipient 3-Hepatic Vein Technique with Graft Venoplasty to Maximize Venous Outflow in Left Lobe Living Donor Liver Transplantation. Transplant Direct 2025; 11:e1778. [PMID: 40225745 PMCID: PMC11984780 DOI: 10.1097/txd.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 12/14/2024] [Indexed: 04/15/2025] Open
Abstract
Background Augmentation of hepatic venous outflow is crucial in living donor liver transplantation (LDLT) to maximize functional graft size and prevent venous complications. We present details of our outflow augmentation technique for left lobe grafts (LLG) in adult LDLTs, which uses all recipient 3 hepatic veins and venoplasty of graft left and middle hepatic veins. This study examines the effectiveness of our technique in preventing outflow complications and the correlation between anatomical variations of the graft hepatic veins and surgical outcomes. Methods We retrospectively reviewed 88 patients who underwent LLG-LDLT between 2012 and 2023. The patients were classified into 3 groups based on the graft hepatic vein anatomy and usage of venoplasty: group 1 (n = 10, common trunk without venoplasty), group 2 (n = 62, common trunk with venoplasty), and group 3 (n = 16, no common trunk with venoplasty). Results No patient developed clinically significant venous outflow complications or graft loss related to venous outflow. There were no significant differences in complication rates or ascites production among the groups. Five-year graft survival was comparable among the groups (P = 0.43). Multiple regression analysis revealed that the model for end-stage liver disease score was the only independent risk factor for increased ascites after transplant (standardized beta, 0.546; t value,4.20; P < 0.001; 95% confidence interval, 0.287-0.804), but anatomical variations of the graft hepatic veins did not influence ascites output. Conclusions The recipient 3 hepatic vein outflow augmentation technique with graft venoplasty can be applied to various graft hepatic venous anatomy and effectively prevents outflow-related graft loss in LLG-LDLT.
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Affiliation(s)
- Yuki Miyazaki
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Masato Fujiki
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Munkhbold Tuul
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Mazhar Khalil
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Alejandro Pita
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Jaekeun Kim
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Andrea Schlegel
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Choon H.D. Kwon
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Federico Aucejo
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Antonio D. Pinna
- Abdominal Transplant Center, Cleveland Clinic Florida, Weston, FL
| | - Charles Miller
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Koji Hashimoto
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
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Gadour E. Lesson learnt from 60 years of liver transplantation: Advancements, challenges, and future directions. World J Transplant 2025; 15:93253. [PMID: 40104199 PMCID: PMC11612893 DOI: 10.5500/wjt.v15.i1.93253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 09/06/2024] [Accepted: 09/14/2024] [Indexed: 11/26/2024] Open
Abstract
Over the past six decades, liver transplantation (LT) has evolved from an experimental procedure into a standardized and life-saving intervention, reshaping the landscape of organ transplantation. Driven by pioneering breakthroughs, technological advancements, and a deepened understanding of immunology, LT has seen remarkable progress. Some of the most notable breakthroughs in the field include advances in immunosuppression, a revised model for end-stage liver disease, and artificial intelligence (AI)-integrated imaging modalities serving diagnostic and therapeutic roles in LT, paired with ever-evolving technological advances. Additionally, the refinement of transplantation procedures, resulting in the introduction of alternative transplantation methods, such as living donor LT, split LT, and the use of marginal grafts, has addressed the challenge of organ shortage. Moreover, precision medicine, guiding personalized immunosuppressive strategies, has significantly improved patient and graft survival rates while addressing emergent issues, such as short-term complications and early allograft dysfunction, leading to a more refined strategy and enhanced post-operative recovery. Looking ahead, ongoing research explores regenerative medicine, diagnostic tools, and AI to optimize organ allocation and post-transplantation car. In summary, the past six decades have marked a transformative journey in LT with a commitment to advancing science, medicine, and patient-centered care, offering hope and extending life to individuals worldwide.
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Affiliation(s)
- Eyad Gadour
- Department of Gastroenterology and Hepatology, King Abdulaziz National Guard Hospital, Ahsa 36428, Saudi Arabia
- Internal Medicine, Zamzam University College, Khartoum 11113, Sudan
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Sugawara Y. A Liver Graft Should Not Be Selected by the Side but Determined by Volume in Adult Living Donor Liver Transplantation. Transplantation 2025; 109:108-109. [PMID: 39294874 DOI: 10.1097/tp.0000000000005215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Affiliation(s)
- Yasuhiko Sugawara
- Department of Transplantation/Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Chuo-ku, Kumamoto, Japan
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Maharjan N, Sharma D, Pradhan S, Kandel BP, Lakhey PJ, Bhandari RS. Donors' Outcome After Living Donor Liver Transplantation in a University Teaching Hospital: A Case Series. Cureus 2024; 16:e71858. [PMID: 39559631 PMCID: PMC11572684 DOI: 10.7759/cureus.71858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2024] [Indexed: 11/20/2024] Open
Abstract
Background Liver transplantation is the standard treatment for end-stage liver disease. Living donor liver transplantation is more commonly performed in Asian countries as compared to the Western due to the lack of organ donation. Donor safety is the key to sustaining a liver transplant program. Thus, we aimed to evaluate the overall safety of living donors and health-related quality of life using the 12-item Short Form Health Survey (SF-12) questionnaire at our institution. Methodology We analyzed the medical records of patients who underwent donor hepatectomy at Tribhuvan University Teaching Hospital, Kathmandu, from May 31, 2019, to April 18, 2023. Demography, postoperative complications, and quality of life were analyzed. Results The mean age of the 10 live liver donors was 27.9 years. Half of them were male. One of them had a post-hepatectomy bile leak and others did not have any post-operative complications. They have good physical and mental health status after liver donation as indicated by the average physical component summary and mental component summary scores of more than 50. Conclusion The case series highlights the safety and favorable outcomes of liver donors at a low-volume liver transplant center, where stringent preoperative assessments and careful surgical techniques were employed.
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Affiliation(s)
- Narendra Maharjan
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Deepak Sharma
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Sumita Pradhan
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Bishnu P Kandel
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Paleswan Joshi Lakhey
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Ramesh S Bhandari
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
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5
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Kadohisa M, Inomata Y, Irie T, Shimata K, Kawabata S, Miura K, Isono K, Honda M, Hayashida S, Ohya Y. Right Posterior Segment Graft in Adult Living-Donor Liver Transplantation: A Report of 17 Years of Experience at a Single Institution. EXP CLIN TRANSPLANT 2024; 22:786-793. [PMID: 39588994 DOI: 10.6002/ect.2024.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
OBJECTIVES The right posterior segment graft can be selected in cases where neither the right nor left lobe graft satisfies the selection criteria for adult living donor liver transplant. However, vascular and biliary anatomy may cause technical difficulties in procurement of posterior segments in donors of living donor liver transplant and may require specific attention in vascular and biliary reconstruction in the recipient. In this study, we examined the feasibility of right posterior segment grafts in adult living donor liver transplants through donor safety and recipient outcomes and clarified the anatomic points of the surgical technique. MATERIALS AND METHODS We retrospectively reviewed 296 cases of adult living donor liver transplants treated at Kumamoto University between August 2000 and March 2017. RESULTS Among 296 cases, graft types were right lobe (n = 162), left lobe (n = 119), and right posterior segments (n = 9). Among donors, no significant differences were shown in operative time, blood loss, or incidence of postoperative complications between early and late phases among the 3 groups. Four cases ofright posterior segment had >2 biliary duct stumps, and 2 cases had 2 portal vein stumps. Among recipients, median actual graft-to-recipient weight ratio was 0.82% (range, 0.52%-1.22%), with no factors, including graft type, significantly associated with graft survival. Hepatic artery thrombosis and rupture of hepatic artery pseudoaneurysm occurred in 1 case as an early complication, and biliary anastomotic stricture occurred in 4 cases as a late complication. CONCLUSIONS The right posterior segment graft may be an effective alternative in living donor liver transplant when no eligible candidates for conventional grafts are available among families and relatives. Careful preoperative anatomic evaluations and simulations are important.
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Affiliation(s)
- Masashi Kadohisa
- From the Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan and the Department of Hepatobiliary Pancreatic and Transplantation/Pediatric Surgery, Kyoto University, Kyoto, Japan
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Pang NQ, Chan ACY, Kow AWC. Trends of liver transplantation in Asia. Updates Surg 2024:10.1007/s13304-024-01924-1. [PMID: 39046632 DOI: 10.1007/s13304-024-01924-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/18/2024] [Indexed: 07/25/2024]
Abstract
Liver transplantation (LT) in Asia started comparatively early in 1964, just 1 year after Starzl's trail-blazing first attempt. Despite the quick start, LT was slow to develop in this region. Limited access to universal healthcare, lack of public understanding and support as well as the absence of strong legislation, on a backdrop of a wide range of diverse social, religious, economic and cultural background are all contributory factors. Through strong administrative efforts, the number of DDLTs in selected Asian countries has been slowly rising in recent years. However, Asians are generally still less likely to donate organs than Caucasians after death. The strong demand for LT with limited access to deceased organs has, therefore, led to constant need for innovation in LT this region, with the pioneering of various LDLT techniques and safe expansion of donor pool being driven primarily by Asian centers. Familiarity and the development of technical expertise in donor surgery have also resulted in Asian centers repeatedly pushing the boundaries on minimally invasive donor and recipient surgery. In this article, we focus on the past and present states of LT in Asia and explore the future trends of LT in this region.
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Affiliation(s)
- Ning Qi Pang
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, NUHS Tower Block, 1E, Kent Ridge Road, Level 8, Singapore, 119228, Singapore
- National University Centre for Organ Transplantation (NUCOT), National University Hospital, National University Health System, Singapore, Singapore
| | - Albert C Y Chan
- Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Alfred Wei Chieh Kow
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, NUHS Tower Block, 1E, Kent Ridge Road, Level 8, Singapore, 119228, Singapore.
- National University Centre for Organ Transplantation (NUCOT), National University Hospital, National University Health System, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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De Carlis R, Di Lucca G, Lauterio A, Centonze L, De Carlis L. The long-term follow-up of the living liver donors. Updates Surg 2024:10.1007/s13304-024-01894-4. [PMID: 38926232 DOI: 10.1007/s13304-024-01894-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
Living donor liver transplantation (LDLT) has been proposed in many countries to reduce organ shortage. While the early postoperative outcomes have been well investigated, little is known about the long-term follow-up of the living donors. We, therefore, designed a systematic review of the literature to explore long-term complications and quality of life among living donors. We searched MEDLINE and EMBASE registries for studies published since 2013 that specifically addressed long-term follow-up following living-donor liver donation, concerning both physical and psychological aspects. Publications with a follow-up shorter than 1 year or that did not clearly state the timing of outcomes were excluded. A total of 2505 papers were initially identified. After a thorough selection, 17 articles were identified as meeting the eligibility criteria. The selected articles were mostly from North America and Eastern countries. Follow-up periods ranged from 1 to 11.5 years. The most common complications were incision site discomfort (13.2-38.8%) and psychiatric disorders (1-22%). Biliary strictures occurred in 1-14% of cases. Minimally invasive donor hepatectomy could improve quality of life, but long-term data are limited. About 30 years after the first reported LDLT, little has been published about the long-term follow-up of the living donors. Different factors may contribute to this gap, including the fact that, as healthy individuals, living donors are frequently lost during mid-term follow-up. Although the reported studies seem to confirm long-term donor safety, further research is needed to address the real-life long-term impact of this procedure.
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Affiliation(s)
- Riccardo De Carlis
- PhD Course in Clinical and Experimental Sciences, University of Padua, Via 8 Febbraio, 235122, Padua, Italy.
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Gabriele Di Lucca
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Leonardo Centonze
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Kaneko J, Hayashi Y, Kazami Y, Nishioka Y, Miyata A, Ichida A, Kawaguchi Y, Akamatsu N, Hasegawa K. Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review. Transl Gastroenterol Hepatol 2024; 9:23. [PMID: 38716218 PMCID: PMC11074493 DOI: 10.21037/tgh-23-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/10/2024] [Indexed: 02/12/2025] Open
Abstract
BACKGROUND AND OBJECTIVE As tumors invade major abdominal veins, surgical procedures are transformed from simple and basic to complicated and challenging. In this narrative review, we focus on what is currently known and not known regarding the technical aspects of major abdominal venous resection and its reconstruction, patency, and oncologic benefit in a cross-cutting perspective. METHODS A systematic literature search was performed in PubMed and Semantic Scholar from inception up to October 18, 2023. We reviewed 106 papers by title, abstract, and full text regarding resection or reconstruction of the inferior vena cava, hepatic vein confluence, portal vein (PV), and middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT) in a cross-cutting perspective. KEY CONTENT AND FINDINGS The oncologic benefit of aggressive hepatic vein resection with suitable reconstruction against adenocarcinoma remains unclear, and further studies are required to clarify this point. A superior mesenteric/PV resection is now a universal, indispensable, and effective procedure for pancreatic ductal adenocarcinoma. Although many case series using tailor-made autologous venous grafts have been reported, not only size mismatch but also additional surgical incisions and a longer operation time remain obstacles for venous reconstruction. The use of autologous alternative tissue remains only an alternative procedure because the patency rate of customized tubular conduit type to interpose or replace the resected vein is not known. Unlike arterial replacement, venous replacement using synthetic vascular grafts is still rarely reported and there are several inherent limitations except for reconstruction of tributaries of MHV in LDLT. CONCLUSIONS Various approaches to abdominal vein resection and replacement or reconstruction are technically feasible with satisfactory results. Synthetic vascular grafts may be appropriate but have a certain rate of complications.
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Affiliation(s)
- Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Hayashi
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Kazami
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yujiro Nishioka
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akinori Miyata
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiko Ichida
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Liu H, Ashwat E, Humar A. Current Status of Living Donor Liver Transplantation: Impact, Advantages, and Challenges. Curr Gastroenterol Rep 2023; 25:225-231. [PMID: 37603108 DOI: 10.1007/s11894-023-00882-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE OF THIS REVIEW This review provides an overview of the current status of Living Donor Liver Transplant (LDLT). It discusses the impact of LDLT on waitlist and post-transplantation outcomes, highlighting the technical challenges and unique advantages of LDLT. RECENT FINDINGS Recent findings show that LDLT offers several theoretical advantages over deceased donor liver transplant, including shorter wait times, better graft quality, and improved post-transplant outcomes. Non-alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC) are emerging as the leading indications for adult LDLT in the US. LDLT demonstrates comparable or better overall survival rates and organ-specific outcomes compared to deceased donor transplants. However, challenges exist, including donor and recipient risks such as biliary complications and small-for-size syndrome. Ongoing research focuses on refining surgical techniques, exploring minimally invasive approaches, utilizing predetermined donors to modulate the recipient's immune system, and ensuring ethical practices. LDLT is a valuable solution for patients with end-stage liver failure or disorders requiring transplantation. It offers advantages such as shorter wait times as well as improved waitlist and post-transplant outcomes. Continued research and advancements in LDLT will benefit patients in need of liver transplantation.
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Affiliation(s)
- Hao Liu
- Division of Transplantation, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Eishan Ashwat
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Abhinav Humar
- Division of Transplantation, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
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Kalshabay Y, Zholdybay Z, Di Martino M, Medeubekov U, Baiguissova D, Ainakulova A, Doskhanov M, Baimakhanov B. CT volume analysis in living donor liver transplantation: accuracy of three different approaches. Insights Imaging 2023; 14:82. [PMID: 37184628 DOI: 10.1186/s13244-023-01431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES The aim of this retrospective study is to compare and evaluate accuracy of three different approaches of liver volume quantification in living donor transplantations. METHODS This is a single-center, retrospective study of 60 donors. The total and right lobe liver volumes were analyzed in the portal-venous phase by two independent radiologists who estimated the volumes using manual, semi-automated and automated segmentation methods. The measured right lobe liver volume was compared to the real weight of the graft after back-table examinations. RESULTS The mean estimated overall liver volume was 1164.4 ± 137.0 mL for manual, 1277.4 ± 190.4 mL for semi-automated and 1240.1 ± 108.5 mL for automated segmentation. The mean estimated right lobe volume was 762.0 ± 122.4 mL for manual, 792.9 ± 139.9 mL for semi-automated and 765.4 ± 132.7 mL for automated segmentation. The mean graft weight was 711.2 ± 142.9 g. The manual method better correlated with the graft weight (r = 0.730) in comparison with the semi-automated (r = 0.685) and the automated (r = 0.699) methods (p < 0.001). The mean error ratio in volume estimation by each application was 12.7 ± 16.6% for manual, 17.1 ± 17.3% for semi-automated, 14.7 ± 16.8% for automated methods. There was a statistically significant difference between the mean error ratio of the manual and the semi-automated segmentations (p = 0.017), and no statistically significant difference between the manual and the automated applications (p = 0.199). CONCLUSION Volume analysis application better correlates with graft weight, but there is no obvious difference between correlation coefficients of all three methods. All three modalities had an error ratio, of which the semi-automated method showed the highest value. CRITICAL RELEVANCE STATEMENT Volume analysis application was more accurate, but there is no drastic difference between correlation coefficients of all three methods.
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Affiliation(s)
- Yerkezhan Kalshabay
- Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Republic of Kazakhstan.
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan.
| | - Zhamilya Zholdybay
- Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Republic of Kazakhstan
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
| | - Michele Di Martino
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ulykbek Medeubekov
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
| | - Dinara Baiguissova
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
| | - Akmaral Ainakulova
- Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Republic of Kazakhstan
| | - Maksat Doskhanov
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
| | - Bolatbek Baimakhanov
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
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11
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Baimas-George M, Strand MS, Davis JM, Eskind LB, Lessne M, Levi DM, Vrochides D. Future liver remnant augmentation preceding ex vivo hepatectomy with IVC replacement: a strategy to achieve R0 margins. Langenbecks Arch Surg 2023; 408:156. [PMID: 37086277 DOI: 10.1007/s00423-023-02902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Ex vivo hepatectomy with autotransplantation (EHAT) provides opportunity for R0 resection. As EHAT outcomes after future liver remnant (FLR) augmentation techniques are not well documented, we examine results of EHAT after augmentation for malignant tumors. METHODS Retrospective analysis of six cases of EHAT was performed. Of these, four occurred after preoperative FLR augmentation between 2018 and 2022. RESULTS Six patients were offered EHAT of 26 potential candidates. Indications for resection were involvement of hepatic vein outflow and inferior vena cava (IVC) with metastatic colorectal carcinoma (n = 3), cholangiocarcinoma (n = 2), or leiomyosarcoma (n = 1). Five patients were treated with neoadjuvant chemotherapy and four had preoperative liver augmentation. One hundred percent of cases achieved R0 resection. Of the augmented cases, three patients are alive after median follow-up of 28 months. Postoperative mortality due to liver failure was 25% (n = 1). CONCLUSIONS For select patients with locally advanced tumors involving all hepatic veins and the IVC for whom conventional resection is not an option, EHAT provides opportunity for R0 resection. In addition, in patients with inadequate FLR volume, further operative candidacy with acceptable results can be achieved by combined liver augmentation techniques. To better characterize outcomes in this small subset, a registry is needed.
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Affiliation(s)
- Maria Baimas-George
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Atrium Health, Charlotte, NC, 28203, USA
- Division of Abdominal Transplant Surgery, Atrium Health, Charlotte, NC, 28203, USA
| | - Matthew S Strand
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Atrium Health, Charlotte, NC, 28203, USA
| | - Joshua M Davis
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Atrium Health, Charlotte, NC, 28203, USA
| | - Lon B Eskind
- Division of Abdominal Transplant Surgery, Atrium Health, Charlotte, NC, 28203, USA
| | - Mark Lessne
- Division of Interventional Radiology, Atrium Health, Charlotte, NC, 28203, USA
| | - David M Levi
- Division of Abdominal Transplant Surgery, Atrium Health, Charlotte, NC, 28203, USA
| | - Dionisios Vrochides
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Atrium Health, Charlotte, NC, 28203, USA.
- Division of Abdominal Transplant Surgery, Atrium Health, Charlotte, NC, 28203, USA.
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12
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Ullah K, Dogar AW, Rehman IU, Abbas SH, Ullah I, Nisar H, Lee KY. Expanding the living liver donor pool in countries having limited deceased donor activity: Pakistani perspective. Transpl Immunol 2022; 75:101683. [PMID: 35952941 DOI: 10.1016/j.trim.2022.101683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 01/10/2023]
Abstract
Over the last decades, liver transplantation (LT) has evolved into a life-saving procedure. Due to limited deceased donor activities in the eastern world, living donor liver transplantation (LDLT) had flourished tremendously in most Asian countries. Yet, these LDLT activities fall short of meeting the expected demands. Pakistan, a developing country, bears a major burden of liver diseases. Currently, only few centers offer LDLT services in the country. On the other hand, deceased donor liver transplantation (DDLT) activities have not started due to social, cultural, and religious beliefs. Various strategies can be adopted successfully to overcome the scarcity of live liver donors (LLDs) and to expand the donor pool, keeping in view donor safety and recipient outcome. These include consideration of LLDs with underlying clinical conditions like G6PD deficiency and Hepatitis B core positivity. Extended donor criteria can also be utilized and relaxation can be made in various donors' parameters including upper age and body mass index after approval from the multidisciplinary board. Also, left lobe grafts, grafts with various anatomical variations, and a low graft-to-recipient ratio can be considered in appropriate situations. ABO-incompatible LT and donor swapping at times may help in expanding the LLDs pool. Similarly, legislation is needed to allow live non-blood-related donors for organ donations. Finally, community education and awareness through various social media flat forms are needed to promote deceased organ donation.
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Affiliation(s)
- Kaleem Ullah
- Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Sindh, Pakistan
| | - Abdul Wahab Dogar
- Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Sindh, Pakistan
| | | | - Syed Hasnain Abbas
- Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Sindh, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan; Institute of Public Health and Social Science (IPH&SS), Khyber Medical University, Peshawar, Pakistan
| | - Husna Nisar
- Mehboob School of Physiotherapy, Hayatabad, Peshawar, Pakistan
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
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13
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Sharma S, Saner FH, Bezinover D. A brief history of liver transplantation and transplant anesthesia. BMC Anesthesiol 2022; 22:363. [PMID: 36435747 PMCID: PMC9701388 DOI: 10.1186/s12871-022-01904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/13/2022] [Indexed: 11/28/2022] Open
Abstract
In this review, we describe the major milestones in the development of organ transplantation with a specific focus on hepatic transplantation. For many years, the barriers preventing successful organ transplantation in humans seemed insurmountable. Although advances in surgical technique provided the technical ability to perform organ transplantation, limited understanding of immunology prevented successful organ transplantation. The breakthrough to success was the result of several significant discoveries between 1950 and 1980 involving improved surgical techniques, the development of effective preservative solutions, and the suppression of cellular immunity to prevent graft rejection. After that, technical innovations and laboratory and clinical research developed rapidly. However, these advances alone could not have led to improved transplant outcomes without parallel advances in anesthesia and critical care. With increasing organ demand, it proved necessary to expand the donor pool, which has been achieved with the use of living donors, split grafts, extended criteria organs, and organs obtained through donation after cardiac death. Given this increased access to organs and organ resources, the number of transplantations performed every year has increased dramatically. New regulatory organizations and transplant societies provide critical oversight to ensure equitable organ distribution and a high standard of care and also perform outcome analyses. Establishing dedicated transplant anesthesia teams results in improved organ transplantation outcomes and provides a foundation for developing new standards for other subspecialties in anesthesiology, critical care, and medicine overall. Through a century of discovery, the success we enjoy at the present time is the result of the work of well-organized multidisciplinary teams following standardized protocols and thereby saving thousands of lives worldwide each year. With continuing innovation, the future is bright.
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Affiliation(s)
- Sonal Sharma
- Department of Anesthesiology and Perioperative Medicine, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, USA
| | - Fuat H Saner
- Department of General, Visceral, and Transplant Surgery, Medical Center University Essen, Hufeland 55, 45147, Essen, Germany
| | - Dmitri Bezinover
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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14
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Fujiki M, Hashimoto K, Quintini C, Aucejo F, Kwon CHD, Matsushima H, Sasaki K, Campos L, Eghtesad B, Diago T, Iuppa G, D'amico G, Kumar S, Liu P, Miller C, Pinna A. Living Donor Liver Transplantation With Augmented Venous Outflow and Splenectomy: A Promised Land for Small Left Lobe Grafts. Ann Surg 2022; 276:838-845. [PMID: 35894443 DOI: 10.1097/sla.0000000000005630] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Living donor liver transplantation (LDLT) using small grafts, especially left lobe grafts (H1234-MHV) (LLG), continues to be a challenge due to small-for-size syndrome (SFSS). We herein demonstrate that with surgical modifications, outcomes with small grafts can be improved. METHODS Between 2012 and 2020, we performed 130 adult LDLT using 61 (47%) LLG (H1234-MHV) in a single Enterprise. The median graft-to-recipient weight ratio was 0.84%, with graft-to-recipient weight ratio <0.7% accounting for 22%. Splenectomy was performed in 72 (56%) patients for inflow modulation before (n=50) or after (n=22) graft reperfusion. In LLG-LDLT, venous outflow was achieved using all three recipient hepatic veins. In right lobe graft (H5678) (RLG)-LDLT, the augmented graft right hepatic vein was anastomosed to the recipient's cava with a large cavotomy. Outcome measures include SFSS, early allograft dysfunction (EAD), and survival. RESULTS Graft survival rates at 1, 3, and 5 years were 94%, 90%, and 83%, respectively, with no differences between LLG (H1234-MHV) and RLG (H5678). Splenectomy significantly reduced portal flow without increasing the complication rate. Despite the aggressive use of small grafts, SFSS and EAD developed in only 1 (0.8%) and 18 (13.8%) patients, respectively. Multivariable logistic regression revealed model for end-stage liver disease score and LLG (H1234-MHV) as independent risk factors for EAD and splenectomy as a protective factor (odds ratio: 0.09; P =0.03). For LLG (H1234-MHV)-LDLT, patients who underwent prereperfusion splenectomy tended to have better 1-year graft survival than those receiving postreperfusion splenectomy. CONCLUSIONS LLG (H1234-MHV) are feasible in adult LDLT with excellent outcomes comparable to RLG (H5678). Venous outflow augmentation and splenectomy help lower the threshold of using small-for-size grafts without compromising graft survival.
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Affiliation(s)
| | | | | | | | | | | | | | - Luis Campos
- Transplant Center, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Teresa Diago
- Transplant Center, Cleveland Clinic, Cleveland, OH
| | - Giuseppe Iuppa
- Transplant Center, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Shiva Kumar
- Transplant Center, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH
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15
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Jo HS, Yu YD, Choi YJ, Kim DS. Left liver graft in adult-to-adult living donor liver transplantation with an optimal portal flow modulation strategy to overcome the small-for-size syndrome – A retrospective cohort study. Int J Surg 2022; 106:106953. [DOI: 10.1016/j.ijsu.2022.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
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16
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Understanding Local Hemodynamic Changes After Liver Transplant: Different Entities or Simply Different Sides to the Same Coin? Transplant Direct 2022; 8:e1369. [PMID: 36313127 PMCID: PMC9605796 DOI: 10.1097/txd.0000000000001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/13/2022] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Liver transplantation is an extremely complex procedure performed in an extremely complex patient. With a successful technique and acceptable long-term survival, a new challenge arose: overcoming donor shortage. Thus, living donor liver transplant and other techniques were developed. Aiming for donor safety, many liver transplant units attempted to push the viable limits in terms of size, retrieving smaller and smaller grafts for adult recipients. With these smaller grafts came numerous problems, concepts, and definitions. The spotlight is now aimed at the mirage of hemodynamic changes derived from the recipients prior alterations. This article focuses on the numerous hemodynamic syndromes, their definitions, causes, and management and interconnection with each other. The aim is to aid the physician in their recognition and treatment to improve liver transplantation success.
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17
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MELIF, a Fully Automated Liver Function Score Calculated from Gd-EOB-DTPA-Enhanced MR Images: Diagnostic Performance vs. the MELD Score. Diagnostics (Basel) 2022; 12:diagnostics12071750. [PMID: 35885653 PMCID: PMC9318040 DOI: 10.3390/diagnostics12071750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
In the management of patients with chronic liver disease, the assessment of liver function is essential for treatment planning. Gd-EOB-DTPA-enhanced MRI allows for both the acquisition of anatomical information and regional liver function quantification. The objective of this study was to demonstrate and evaluate the diagnostic performance of two fully automatically generated imaging-based liver function scores that take the whole liver into account. T1 images from the native and hepatobiliary phases and the corresponding T1 maps from 195 patients were analyzed. A novel artificial-intelligence-based software prototype performed image segmentation and registration, calculated the reduction rate of the T1 relaxation time for the whole liver (rrT1liver) and used it to calculate a personalized liver function score, then generated a unified score—the MELIF score—by combining the liver function score with a patient-specific factor that included weight, height and liver volume. Both scores correlated strongly with the MELD score, which is used as a reference for global liver function. However, MELIF showed a stronger correlation than the rrT1liver score. This study demonstrated that the fully automated determination of total liver function, regionally resolved, using MR liver imaging is feasible, providing the opportunity to use the MELIF score as a diagnostic marker in future prospective studies.
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18
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Lai Q, Giovanardi F, Mennini G, Berardi G, Rossi M. The impact of mini-invasive right hepatectomy in the setting of living donation: a meta-analysis. Updates Surg 2022; 74:23-34. [PMID: 34487336 PMCID: PMC8827159 DOI: 10.1007/s13304-021-01160-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Adult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a "risky procedure". The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578-1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.
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Affiliation(s)
- Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Francesco Giovanardi
- General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gianluca Mennini
- General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giammauro Berardi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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19
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Conzen K, Pomfret E. Ethical Issues in Living Donor Liver Transplantation. TEXTBOOK OF LIVER TRANSPLANTATION 2022:219-238. [DOI: 10.1007/978-3-030-82930-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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20
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Yang JD, Lee KW, Kim JM, Kim MS, Lee JG, Kang KJ, Choi DL, Kim BW, Ryu JH, Kim DS, Hwang S, Choi IS, Cho JY, Nah YW, You YK, Hong G, Yu HC. A comparative study of postoperative outcomes between minimally invasive living donor hepatectomy and open living donor hepatectomy: The Korean organ transplantation registry. Surgery 2021; 170:271-276. [PMID: 33846007 DOI: 10.1016/j.surg.2021.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study evaluated the safety and effectiveness of minimally invasive living donor hepatectomy in comparison with the open procedure, using Korean Organ Transplantation Registry data. METHODS We reviewed the prospectively collected data of all 1,694 living liver donors (1,071 men, 623 women) who underwent donor hepatectomy between April 2014 and December 2017. The donors were grouped on the basis of procedure type to the minimally invasive procedure group (n = 304) or to the open procedure group (n = 1,390) and analyzed the relationships between clinical data and complications. RESULTS No donors died after the procedure. The overall complication rates after operation in the minimally invasive procedure group and the open procedure group were 6.2% and 3.5%, respectively. Biliary complications were the most frequent events in both groups (minimally invasive procedure group, 2.4%; open procedure group, 1.6%). The majority of complications occurred within 7 days after surgery in both groups. The duration of hospitalization was shorter in the minimally invasive procedure group than in the open procedure group (9.04 ± 3.78 days versus 10.29 ± 4.01 days; P < .05). CONCLUSION Based on its similar outcomes in our study, minimally invasive donor hepatectomy cannot be an alternative option compared with the open procedure method. To overcome this, we need to ensure better surgical safety, such as lower complication rate and shorter duration of hospitalization.
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Affiliation(s)
- Jae Do Yang
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea. https://twitter.com/hirojawa
| | - Kwang Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Koo Jeong Kang
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Lak Choi
- Department of Surgery, Catholic University of Daegu, Daegu, Korea
| | - Bong Wan Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Je Ho Ryu
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Dong Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Daegeon, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yang Won Nah
- Department of Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Young Kyoung You
- Department of Surgery, Catholic University of Korea School of Medicine, Seoul, Korea
| | - Geun Hong
- Department of Surgery, Ewha Women's University College of Medicine and Graduate School of Medicine, Seoul, Korea
| | - Hee Chul Yu
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea.
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21
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Invited commentary on: Venous outflow reconstruction using polytetrafluoroethylene graft in right lobe living donor liver transplantation: A single center study. Surgery 2021; 169:1510-1511. [PMID: 33676730 DOI: 10.1016/j.surg.2021.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022]
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22
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Chu KKW, Wong KHC, Chok KSH. Expanding Indications for Liver Transplant: Tumor and Patient Factors. Gut Liver 2021; 15:19-30. [PMID: 32102130 PMCID: PMC7817931 DOI: 10.5009/gnl19265] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 12/16/2022] Open
Abstract
During the past few decades, liver transplant has developed from a high-mortality procedure to an almost routine procedure with good survival outcomes. The development of living donor liver transplant has increased the availability of liver grafts, and the scope of indications for liver transplant has been expanding ever since. The aim of this review is to provide an overview of such an expansion of scope. Various criteria have been proposed to expand the eligibility of patients with hepatocellular carcinoma exceeding the Milan criteria for liver transplant. Furthermore, liver transplant is increasingly performed as a treatment modality for cholangiocarcinoma, neuroendocrine liver metastasis and colorectal liver metastasis. The number of elderly patients receiving liver transplant is on the rise. Combined organ transplantation has also been adopted to treat patients with multiple organ failure. Going forward, further development of preoperative noninvasive predictors in tumor, patient and even donor factors is needed to identify patients at risk of poor outcomes and hence optimize patient management.
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Affiliation(s)
- Kevin Ka-Wan Chu
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | | | - Kenneth Siu-Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
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23
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Kiuchi T, Tanaka K. Living Donor Adult Liver Transplantation : Status Quo in Kyoto and Perspectives in the New Millennium. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2000.12098567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Tetsuya Kiuchi
- Department of Transplant Surgery, Kyoto University Hospital; Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, Kyoto, Japan
| | - Koichi Tanaka
- Department of Transplant Surgery, Kyoto University Hospital; Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, Kyoto, Japan
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24
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Park J, Kim JH, Kim JE, Park SJ, Yi NJ, Han JK. Prediction of liver regeneration in recipients after living-donor liver transplantation in using preoperative CT texture analysis and clinical features. Abdom Radiol (NY) 2020; 45:3763-3774. [PMID: 32296898 DOI: 10.1007/s00261-020-02518-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of the study is to predict the rate of liver regeneration in recipients after living-donor liver transplantation using preoperative CT texture and shape analysis of the future graft. METHODS 102 donor-recipient pairs who underwent living-donor liver transplantation using right lobe grafts were retrospectively included. We semi-automatically segmented the future graft from preoperative CT. The volume of the future graft (LVpre) was measured, and texture and shape analyses were performed. The graft liver was segmented from postoperative follow-up CT and the volume of the graft (LVpost) was measured. The regeneration index was defined by the following equation: [(LVpost-LVpre)/LVpre] × 100(%). We performed a stepwise, multivariate linear regression analysis to investigate the association between clinical, texture and shape parameters and the RI and to make the best-fit predictive model. RESULTS The mean regeneration index was 47.5 ± 38.6%. In univariate analysis, the volume of the future graft, energy, effective diameter, surface area, sphericity, roundnessm, compactness1, and grey-level co-occurrence matrix contrast as well as several clinical parameters were significantly associated with the regeneration index (p < 0.05). The best-fit predictive model for the regeneration index made by multivariate analysis was as follows: Regeneration index (%) = 127.020-0.367 × effective diameter - 1.827 × roundnessm + 47.371 × recipient body surface area (m2) + 12.041 × log(recipient white blood cell count) (× 103/μL)+ 18.034 (if the donor was female). CONCLUSION The effective diameter and roundnessm of the future graft were associated with liver regeneration. Preoperative CT texture analysis of future grafts can be useful for predicting liver regeneration in recipients after living-donor liver transplantation.
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25
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Hibi T, Wei Chieh AK, Chi-Yan Chan A, Bhangui P. Current status of liver transplantation in Asia. Int J Surg 2020; 82S:4-8. [PMID: 32535264 DOI: 10.1016/j.ijsu.2020.05.071] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/28/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Abstract
In spite of early adoption of the brain death legislation, and all efforts at promoting deceased donation, various social, economic and cultural factors have acted as road blocks to the furthering of deceased donor liver transplantation (DDLT) in most Asian societies. On the other hand, Asian liver transplant centers have been the pioneers, innovators, and technical advancement catalysts for the world to follow, especially with regards to living donor liver transplantation (LDLT). With some high volume centers performing more than 200 LDLTs a year with good outcomes in the donor and recipient, techniques to expand the living donor pool have also been adopted like ABO-incompatible, paired exchange and dual lobe living donor liver transplants. Although large multicenter, and registry data as regards safety and outcomes of minimally invasive donor hepatectomy are awaited, expert centers have pioneered, and now regularly perform purely laparoscopic and robotic living donor hepatectomies, especially in Korea.
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Affiliation(s)
- Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Alfred Kow Wei Chieh
- Division of HPB Surgery, Department of Surgery, National University of Singapore, Singapore
| | | | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi-NCR, India.
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26
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Ikegami T, Onda S, Furukawa K, Haruki K, Shirai Y, Gocho T. Small-for-size graft, small-for-size syndrome and inflow modulation in living donor liver transplantation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:799-809. [PMID: 32897590 DOI: 10.1002/jhbp.822] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023]
Abstract
The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called "small-for-size syndrome (SFSS)." The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extending to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume (GV) such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by a small-for-size graft (SFSG), such as a porto-systemic shunt or splenectomy and optimal outflow reconstruction, have been trialed with some positive results. To establish an effective strategy for transplanting SFSG and preventing SFSS, it is essential to have precise knowledge and tactics to evaluate graft quality and GV, when performing these LDLTs with portal pressure control and good venous outflow. Thus, we reviewed the updated literature on the pathogenesis of and strategies for using SFSG.
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Affiliation(s)
- Toru Ikegami
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Onda
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenei Furukawa
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichiro Haruki
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshihiro Shirai
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeshi Gocho
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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27
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Masuda Y, Yoshizawa K, Ohno Y, Mita A, Shimizu A, Soejima Y. Small-for-size syndrome in liver transplantation: Definition, pathophysiology and management. Hepatobiliary Pancreat Dis Int 2020; 19:334-341. [PMID: 32646775 DOI: 10.1016/j.hbpd.2020.06.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/20/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Since the first success in an adult patient, living donor liver transplantation (LDLT) has become an universally used procedure. Small-for-size syndrome (SFSS) is a well-known complication after partial LT, especially in cases of adult-to-adult LDLT. The definition of SFSS slightly varies among transplant physicians. The use of a partial liver graft has risks of SFSS development. Persistent portal vein (PV) hypertension and PV hyper-perfusion after LT were identified as the main factors. Hence, various approaches were explored to modulate PV flow and decrease PV pressure in order to alleviate this syndrome. Herein, the definition, clinical symptoms, pathophysiology, basic research, as well as preventive and treatment strategies for SFSS are reviewed based on an extensive review of the literature and on our own experiences. DATA SOURCES The articles were collected through PubMed using search terms "liver transplantation", "living donor liver transplantation", "living liver donation", "partial graft", "small-for-size graft", "small-for-size syndrome", "graft volume", "remnant liver", "standard liver volume", "graft to recipient body weight ratio", "sarcopenia", "porcine", "swine", and "rat". English publications published before March 31, 2020 were included in this review. RESULTS Many transplant surgeons performed PV flow modulation, including portocaval shunt, splenic artery ligation and splenectomy. With these techniques, patient outcome has been improved even when using a "small" graft. Other factors, such as preoperative recipients' nutritional and skeletal muscle status, graft congestion, and donor factors, were also identified as risk factors which all have been addressed using various strategies. CONCLUSIONS The surgical approach controlling PV flow and pressure could help to prevent SFSS especially in severely ill recipients. In the absence of efficacious medications to resolve SFSS, conservative treatments, including aggressive fluid balance correction for massive ascites, anti-microbiological therapy to prevent or control sepsis and intensive nutritional therapy, are all required if SFSS could not be prevented.
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Affiliation(s)
- Yuichi Masuda
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | - Kazuki Yoshizawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Yasunari Ohno
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Atsuyoshi Mita
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
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Ikegami T, Balci D, Jung DH, Kim JM, Quintini C. Living donor liver transplantation in small-for-size setting. Int J Surg 2020; 82S:134-137. [PMID: 32738547 DOI: 10.1016/j.ijsu.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
Small-for-Size Syndrome (SFSS) is one of the most feared complication of adult split liver and living donor liver transplantation. SFSS stems from a disproportionate/excessive portal vein flow relative to the volume of the implanted liver graft, and is currently one of the major practical limits to partial liver grafts' transplantation. In the last few decades many graft inflow modulation (GIM) techniques have been proposed to curtail the portal vein flow, allowing for successful transplantation of small partial liver grafts. Graft inflow modulation techniques span from Splenic Artery Ligation (SAL), to Splenectomy, Porto-Systemic Shunts and the lately proposed Splenic Devascularization. A patient tailored approach balancing the risk of SFSS with GIM specific morbidity, is more important than identifying the ideal GIM technique. Here we summarize the most recently published data to provide general indications in the challenging preoperative choice of a GIM techniques.
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Affiliation(s)
- Toru Ikegami
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Deniz Balci
- Department of Surgery and Transplantation, Ankara University School of Medicine, Ankara, Turkey
| | - Dong-Hwan Jung
- Department of Liver Transplantation and HBP Surgery, Ulsan University School of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Cristiano Quintini
- Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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Nagata R, Akamatsu N, Nakazawa A, Kaneko J, Ishizawa T, Arita J, Hasegawa K. Sex differences in postsurgical skeletal muscle depletion after donation of living-donor liver transplantation, although minimal, should not be ignored. BMC Surg 2020; 20:119. [PMID: 32493278 PMCID: PMC7268651 DOI: 10.1186/s12893-020-00781-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Donor safety is the top priority in living-donor liver transplantation. Splenic hypertrophy and platelet count decrease after donor surgery are reported to correlate with the extent of hepatectomy, but other aftereffects of donor surgeries are unclear. In this study, we evaluated the surgical effects of donor hepatectomy on skeletal muscle depletion and their potential sex differences. METHODS Among a total of 450 consecutive donor hepatectomies performed from April 2001 through March 2017, 277 donors who completed both preoperative and postoperative (60-119 days postsurgery) evaluation by computed tomography were the subjects of this study. Donors aged 45 years or older were considered elderly donors. Postoperative skeletal muscle depletion was assessed on the basis of the cross-sectional area of the psoas major muscle. Postoperative changes in the spleen volume and platelet count ratios were also analysed to evaluate the effects of major hepatectomy. RESULTS The decrease in the postoperative skeletal muscle mass in the overall donor population was slight (99.4 ± 6.3%). Of the 277 donors, 59 (21.3%) exhibited skeletal muscle depletion (i.e., < 95% of the preoperative value). Multivariate analysis revealed that elderly donor (OR:2.30, 95% C.I.: 1.27-4.24) and female donor (OR: 1.94, 95% C.I. 1.04-3.59) were independent risk factors for postoperative skeletal muscle depletion. Stratification of the subjects into four groups by age and sex revealed that the elderly female donor group had significantly less skeletal muscle mass postoperatively compared with the preoperative values (95.6 ± 6.8%), while the other three groups showed no significant decrease. Due to their smaller physical characteristics, right liver donation was significantly more prevalent in the female groups than in the male groups (112/144, 77.8% vs 65/133, 48.9%; p < 0.001). The estimated liver resection rate correlated significantly with the splenic hypertrophy ratio (r = 0.528, p < 0.001) and the extent of the platelet count decrease (r = - 0.314, p < 0.001), but donor age and sex did not affect these parameters. CONCLUSION Elderly female donors have a higher risk of postoperative skeletal muscle depletion. Additionally, female donors are more likely to donate a right liver graft, whose potential subclinical risks include postoperative splenic enlargement and a platelet count decrease.
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Affiliation(s)
- Rihito Nagata
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akiko Nakazawa
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Junichi Kaneko
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeaki Ishizawa
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Junichi Arita
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyoshi Hasegawa
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Lerut JP. Bilateral proficiency over time leads to reduced donor morbidity in living donor hepatectomy. Hepatobiliary Surg Nutr 2020; 9:339-341. [PMID: 32509823 PMCID: PMC7262619 DOI: 10.21037/hbsn.2019.10.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/24/2019] [Indexed: 08/29/2023]
Affiliation(s)
- Jan P Lerut
- Institut de Recherche Expérimentale et Clinique (IREC), Université catholique Louvain (UCL), Brussels, Belgium
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Kokudo N, Takemura N, Ito K, Mihara F. The history of liver surgery: Achievements over the past 50 years. Ann Gastroenterol Surg 2020; 4:109-117. [PMID: 32258975 PMCID: PMC7105847 DOI: 10.1002/ags3.12322] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022] Open
Abstract
We reviewed the progress made in the field of liver surgery over the past 50 years. The widespread use and improved outcomes of the hepatectomy were, primarily, due to pioneer surgeons who were responsible for technological advances and rapid improvements in the safety of the procedure in the last century. These advances included the hepatic functional evaluation used to determine the safety limit of liver resections, the introduction of intraoperative ultrasonography, and the development of innovative techniques such as portal vein embolization to increase the remnant liver volume. Cadaveric liver transplantation has been attempted since 1963. However, the clinical outcomes only began improving and becoming acceptable in the 1970s-1980s due to refinements in technology and the development of new immunosuppressants. Partial liver transplantation from living donors, which was first attempted in 1988, required further technological innovation and sophisticated perioperative management plans. Moreover, these developments allowed for further overall improvements to take place in the field of liver surgery. Since the turn of the century, advances in computation and imaging technology have made it possible for safer and more elaborate surgeries to be performed. In Japan, preoperative 3-dimensional simulation technology has been covered by health insurance since 2012 and is now widely used. An urgent need for real-time navigation tools will develop in the future. Indocyanine green (ICG) fluorescence imaging was first used in 2007 and has led to the creation of a new surgical concept known as fluorescence navigation surgery. Laparoscopic surgery and robotic surgery have solved the issue of large incisions, which used to be a major drawback of open liver surgery; however, further improvements are required in order to achieve the level of safety and accuracy observed during open liver resection when performing all minimally invasive procedures. In the near future, liver surgery will become more precise and less invasive due to substantial progress including the development of navigation surgery, cancer imaging, and minimally invasive surgery. This overview of the history of liver surgery over the past 50 years may provide useful insights for further innovation in the next 50 years.
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Affiliation(s)
- Norihiro Kokudo
- Department of SurgeryNational Center for Global Health and MedicineTokyoJapan
| | - Nobuyuki Takemura
- Department of SurgeryNational Center for Global Health and MedicineTokyoJapan
| | - Kyoji Ito
- Department of SurgeryNational Center for Global Health and MedicineTokyoJapan
| | - Fuminori Mihara
- Department of SurgeryNational Center for Global Health and MedicineTokyoJapan
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The Impact of Biliary Reconstruction Methods on Small Partial Liver Grafts. Transplant Direct 2020; 6:e523. [PMID: 32095509 PMCID: PMC7004631 DOI: 10.1097/txd.0000000000000966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023] Open
Abstract
Supplemental Digital Content is available in the text. Graft recipient weight ratios are lower in adult-to-adult living-donor liver transplantation than in adult-to-adult deceased-donor liver transplantation. Rapid liver regeneration is essential for increased recipient survival rates in adult-to-adult living-donor liver transplantation. However, the influence of biliary reconstruction methods, including choledocho-choledochostomy and choledocho-jejunostomy, on small partial liver grafts remains unknown. Herein, we investigate the impact of these biliary reconstruction methods on small partial liver grafts.
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Ikegami T, Kim JM, Jung DH, Soejima Y, Kim DS, Joh JW, Lee SG, Yoshizumi T, Mori M. Conceptual changes in small-for-size graft and small-for-size syndrome in living donor liver transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:65-73. [PMID: 35769983 PMCID: PMC9188939 DOI: 10.4285/jkstn.2019.33.4.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/29/2019] [Indexed: 01/10/2023] Open
Abstract
Early series in living donor liver transplantation (LDLT) in adults demonstrated a lower safe limit of graft volume standard liver volume ratio 25%–45%. A subsequent worldwide large LDLT series proposed a 0.8 graft recipient weight ratio (GRWR) to define small-for-size graft (SFSG) in adult LDLT. Thereafter, researchers identified innate and inevitable factors including changes in liver volume during imaging studies and graft shrinkage due to perfusion solution. Although the definition of small-for-size syndrome (SFSS) advocated in the 2000s was mainly based on prolonged cholestasis and ascites output, the term SFSS was inadequate to describe clinical manifestations possibly caused by multiple factors. Thus, the term “early allograft dysfunction (EAD),” characterized by total bilirubin >10 mg/dL or coagulopathy with international normalized ratio >1.6 on day 7, has become prevalent to describe graft dysfunction including SFSS after LDLT. Although various efforts have been made to overcome EAD in LDLT, graft selection to maintain an expected GRWR >0.8 and full venous drainage, as well as inflow modulation using splenic artery ligation, have become standard in recent LDLT.
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Affiliation(s)
- Toru Ikegami
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Liver Transplantation and Hepatobiliary and Pancreatic Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Yuji Soejima
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Dong-Sik Kim
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Liver Transplantation and Hepatobiliary and Pancreatic Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | | | - Masaki Mori
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
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Lerut J, Iesari S, Vandeplas G, Fabbrizio T, Ackenine K, Núñez MEI, Komuta M, Coubeau L, Ciccarelli O, Bonaccorsi-Riani E. Secondary non-resectable liver tumors: A single-center living-donor and deceased-donor liver transplantation case series. Hepatobiliary Pancreat Dis Int 2019; 18:412-422. [PMID: 31521538 DOI: 10.1016/j.hbpd.2019.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/31/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND During the last decades, deceased-donor liver transplantation (DDLT) has gained a place in the therapeutic algorithm of well-selected patients harbouring non-resectable secondary liver tumors. Living-donor LT (LDLT) might represent a valuable means to further expand this indication for LT. METHODS Between 1985 and 2016, twenty-two adults were transplanted because of neuroendocrine (n = 18, 82%) and colorectal metastases (n = 4, 18%); 50% received DDLT and 50% LDLT. In LDLT, 4 (36%) right and 7 (64%) left grafts were used; the median graft-to-recipient-weight ratios (GRWR) were 1.03% (IQR 0.86%-1.30%) and 0.59% (IQR 0.51%-0.91%), respectively. Median post-LT follow-up was 64 months (IQR 17-107) in the DDLT group and 40 months (IQR 35-116) in the LDLT group. DDLT and LDLT recipients were compared in terms of overall survival, graft survival, postoperative complications and recurrence. RESULTS The 1- and 5-year actuarial patient survivals were 82% and 55% after DDLT, 100% and 100% after LDLT, respectively (P < 0.01). One- and 5-year actuarial graft survivals were 73% and 36% after DDLT, 91% and 91% after LDLT (P < 0.01). The outcomes of right or left LDLT were comparable. Donor hepatectomy proved safe, and one donor experienced a Clavien IIIb complication. Bilirubin peak was significantly lower after left hepatectomy compared with that after right hepatectomy [1.3 (IQR 1.2-2.2) vs. 3.3 (IQR 2.3-5.2) mg/dL; P = 0.02]. CONCLUSIONS The more recent LDLT series compared favorably to our DDLT series in the treatment of secondary liver malignancies. The absence of portal hypertension and the use of smaller left grafts make recipient and donor surgeries safe. The safety of the procedures and lack of interference with the scarce allograft pool are expected to lead to a more frequent use of LDLT in the field of transplant oncology.
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Affiliation(s)
- Jan Lerut
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique [IREC], Université catholique de Louvain [UCL], Brussels, Belgium.
| | - Samuele Iesari
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique [IREC], Université catholique de Louvain [UCL], Brussels, Belgium; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gaetan Vandeplas
- Starzl Abdominal Transplant Unit, University Hospitals Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Tiziana Fabbrizio
- Starzl Abdominal Transplant Unit, University Hospitals Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Kevin Ackenine
- Starzl Abdominal Transplant Unit, University Hospitals Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Mina Komuta
- Department of Pathology, University Hospitals Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Laurent Coubeau
- Starzl Abdominal Transplant Unit, University Hospitals Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Olga Ciccarelli
- Starzl Abdominal Transplant Unit, University Hospitals Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Eliano Bonaccorsi-Riani
- Starzl Abdominal Transplant Unit, University Hospitals Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Macshut M, Kaido T, Yao S, Yagi S, Ito T, Kamo N, Nagai K, Sharshar M, Uemoto S. Older Donor Age Is a Risk Factor for Negative Outcomes After Adult Living Donor Liver Transplantation Using Small-for-Size Grafts. Liver Transpl 2019; 25:1524-1532. [PMID: 31298473 DOI: 10.1002/lt.25601] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022]
Abstract
Adult-to-adult living donor liver transplantation (ALDLT) using small-for-size grafts (SFSGs), ie, a graft with a graft-to-recipient weight ratio (GRWR) <0.8%, has been a challenge that should be carefully dealt with, and risk factors in this category are unclear. Therefore, we aimed to examine the risk factors and outcomes of ALDLT using SFSGs over a 13-year period in 121 patients who had undergone their first ALDLT using SFSGs. Small-for-size syndrome (SFSS), early graft loss, and 1-year mortality were encountered in 21.6%, 14.9%, and 18.4% of patients, respectively. By multivariate analysis, older donor age (≥45 years) was an independent risk factor for SFSS (odds ratio [OR], 4.46; P = 0.004), early graft loss (OR, 4.11; P = 0.02), and 1-year mortality (OR, 3.76; P = 0.02). Child-Pugh C class recipients were associated with a higher risk of SFSS development (P = 0.013; OR, 7.44). Despite no significant difference between GRWR categories in the multivariate outcome analysis of the whole population, in the survival analysis of the 2 donor age groups, GRWR <0.6% was associated with significantly lower 1-year survival than the other GRWR categories in the younger donor group. Moreover, in the high final portal venous pressure (PVP) group (>15 mm Hg), younger ABO-compatible donors showed 100% 1-year survival with a significant difference from the group of other donors. Older donor age was an independent risk factor for SFSS, early graft loss, and 1-year mortality after ALDLT using SFSGs. GRWR should not be <0.6%, and PVP modulation is indicated when grafts from older or ABO-incompatible donors are used.
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Affiliation(s)
- Mahmoud Macshut
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Hepato-Pancreato-Biliary Surgery, National Liver Institute, Menoufia University, Al Minufiyah, Egypt
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Siyuan Yao
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Yagi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoko Kamo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuyuki Nagai
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mohamed Sharshar
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Hepato-Pancreato-Biliary Surgery, National Liver Institute, Menoufia University, Al Minufiyah, Egypt
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Navarro JG, Choi GH, Kim MS, Jung YB, Lee JG. Right anterior section graft for living-donor liver transplantation: A case report. Medicine (Baltimore) 2019; 98:e15212. [PMID: 31083154 PMCID: PMC6531230 DOI: 10.1097/md.0000000000015212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE In living-donor liver transplantation (LDLT), the right lobe graft is commonly utilized to prevent small-for-size syndrome, despite the considerable donor morbidity. Conversely, the feasibility of the left lobe graft and the right posterior section graft in smaller-sized recipients is now commonly employed with comparable outcomes to right lobe grafts. The efficacy of the right anterior section graft has rarely been reported. PATIENT CONCERNS A 56-year-old man, a heavy alcoholic beverage drinker for 20 years, presented in the emergency department with massive ascites and lethargy. He was previously admitted twice due to bleeding esophageal varices. DIAGNOSIS He was diagnosed with hepatic encephalopathy coma due to alcoholic liver cirrhosis. The Child-Turcotte-Pugh score was 11 (class C), and the Model for End-stage Liver Disease score was 21.62. INTERVENTION A LDTL was offered to the patient as the best treatment option available. The patient's 26-year-old son was found to be the only donor-compatible candidate for the LDTL.Preoperatively, the right lobe of the donor occupied 76.2% of the total liver volume exposing the donor to a small residual liver volume. The right posterior section and left lobe volumes were insufficient, providing a graft-to-recipient weight ratio of 0.42% and 0.38%, respectively. However, the right anterior section could fulfill an acceptable GRWR of 0.83%. Thus, a living donor right anterior sectionectomy was performed. OUTCOMES Clinical signs and symptoms and liver function improved following anterior section graft transplantation without complications. LESSON The procurement of anterior section graft is technically feasible in selected patients, especially in high-volume liver centers.
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Guo HJ, Wang K, Chen KC, Liu ZK, Al-Ameri A, Shen Y, Xu X, Zheng SS. Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival. Hepatobiliary Pancreat Dis Int 2019; 18:125-131. [PMID: 30738719 DOI: 10.1016/j.hbpd.2019.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/25/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The efficacy and necessity of middle hepatic vein (MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation (LDLT) remain controversial. The present study aimed to evaluate the survival beneficiary of MHV reconstructions in LDLT. METHODS We compared the clinical outcomes of liver recipients with MHV reconstruction (n = 101) and without MHV reconstruction (n = 43) who underwent LDLT using right lobe grafts at our institution from January 2006 to May 2017. RESULTS The overall survival (OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation (P = 0.022; 5-yr OS: 76.2% vs 58.1%). The survival of two segments (segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment (segment 5 or segment 8) hepatic vein reconstruction (P = 0.034; 5-yr OS: 83.6% vs 67.4%). The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction (P = 0.020; 5-yr OS: 100% vs 75.0%). The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS (hazard ratio=0.519, 95% CI: 0.282-0.954, P = 0.035). Biliary complications were significantly increased in recipients with MHV reconstruction (28.7% vs 11.6%, P = 0.027). CONCLUSIONS MHV reconstruction ensured excellent outflow drainage and favored recipient outcome. The MHV tributaries (segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.
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Affiliation(s)
- Hai-Jun Guo
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Kun Wang
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Kang-Chen Chen
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhi-Kun Liu
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Abdulahad Al-Ameri
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yan Shen
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiao Xu
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Iesari S, Inostroza Núñez ME, Rico Juri JM, Ciccarelli O, Bonaccorsi-Riani E, Coubeau L, Laterre PF, Goffette P, De Reyck C, Lengelé B, Gianello P, Lerut J. Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain. Hepatobiliary Pancreat Dis Int 2019; 18:132-142. [PMID: 30850341 DOI: 10.1016/j.hbpd.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 02/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Liver transplantation is the treatment for end-stage liver diseases and well-selected malignancies. The allograft shortage may be alleviated with living donation. The initial UCLouvain experience of adult living-donor liver transplantation (LDLT) is presented. METHODS A retrospective analysis of 64 adult-to-adult LDLTs performed at our institution between 1998 and 2016 was conducted. The median age of 29 (45.3%) females and 35 (54.7%) males was 50.2 years (interquartile range, IQR 32.9-57.5). Twenty-two (34.4%) recipients had no portal hypertension. Three (4.7%) patients had a benign and 33 (51.6%) a malignant tumor [19 (29.7%) hepatocellular cancer, 11 (17.2%) secondary cancer and one (1.6%) each hemangioendothelioma, hepatoblastoma and embryonal liver sarcoma]. Median donor and recipient follow-ups were 93 months (IQR 41-159) and 39 months (22-91), respectively. RESULTS Right and left hemi-livers were implanted in 39 (60.9%) and 25 (39.1%) cases, respectively. Median weights of right- and left-liver were 810 g (IQR 730-940) and 454 g (IQR 394-534), respectively. Graft-to-recipient weight ratios (GRWRs) were 1.17% (right, IQR 0.98%-1.4%) and 0.77% (left, 0.59%-0.95%). One- and five-year patient survivals were 85% and 71% (right) vs. 84% and 58% (left), respectively. One- and five-year graft survivals were 74% and 61% (right) vs. 76% and 53% (left), respectively. The patient and graft survival of right and left grafts and of very small (<0.6%), small (0.6%-0.79%) and large (≥0.8%) GRWR were similar. Survival of very small grafts was 86% and 86% at 3- and 12-month. No donor died while five (7.8%) developed a Clavien-Dindo complication IIIa, IIIb or IV. Recipient morbidity consisted mainly of biliary and vascular complications; three (4.7%) recipients developed a small-for-size syndrome according to the Kyushu criteria. CONCLUSIONS Adult-to-adult LDLT is a demanding procedure that widens therapeutic possibilities of many hepatobiliary diseases. The donor procedure can be done safely with low morbidity. The recipient operation carries a major morbidity indicating an important learning curve. Shifting the risk from the donor to the recipient, by moving from the larger right-liver to the smaller left-liver grafts, should be further explored as this policy makes donor hepatectomy safer and may stimulate the development of transplant oncology.
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Affiliation(s)
- Samuele Iesari
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Olga Ciccarelli
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
| | - Eliano Bonaccorsi-Riani
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
| | - Laurent Coubeau
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
| | - Pierre-François Laterre
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Goffette
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Chantal De Reyck
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
| | - Benoît Lengelé
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Gianello
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Jan Lerut
- Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium.
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39
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Zidan A, Sturdevant M, Alkhail FA, Alabbad S, Boehnert MU, Broering D. The first two cases of living donor liver transplantation using dual grafts in Saudi Arabia. Ann Saudi Med 2019; 39:118-123. [PMID: 30955020 PMCID: PMC6464670 DOI: 10.5144/0256-4947.2019.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/02/2018] [Indexed: 01/05/2023] Open
Abstract
The concept of dual-graft liver transplantation was introduced to overcome the discrepancy between liver transplantation demand and liver donation. Dual-graft transplantation also mitigates cumulative family risk by decreasing individual donor risk through minimization of the resected liver volume from each donor. Here, we describe the first two cases performed in Saudi Arabia wherein a dual-graft living donor liver transplantation was facilitated by the use of one left lobe graft and one left lateral segment in both cases. These are the first two cases of dual-graft liver transplantation reported from Saudi Arabia and the Middle East. SIMILAR CASES PUBLISHED: Nine on the same subject in other parts of the world (Korea, Japan, Germany, China, and Brazil).
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Affiliation(s)
- Ahmed Zidan
- Dr. Ahmed Zidan Liver Transplantation,, King Faisal Specialist Hospital and Research Centre,, PO Box 3544, Riyadh 11211, Saudi Arabia, T: 966550390905, , ORCID: https://orcid.org/00000002-2423-8246
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40
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Gruessner RWG, Gruessner AC. Solid-organ Transplants From Living Donors: Cumulative United States Experience on 140,156 Living Donor Transplants Over 28 Years. Transplant Proc 2019; 50:3025-3035. [PMID: 30577162 DOI: 10.1016/j.transproceed.2018.07.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transplantation of organs from living donors helps to decrease the organ shortage and shortens waiting times. Living donor (LD) transplantation is also generally associated with better outcomes. Unfortunately, there has been no comprehensive analysis and comparison of all types of solid-organ transplantation from living donors since the inception of the United Network for Organ Sharing (UNOS). METHODS Using the UNOS/Organ Procurement and Transplantation Network (OPTN) database, all LD transplants from October 1, 1987, to December 31, 2015, were studied with univariate and multivariate analyses. RESULTS A total of 140,090 organs were transplanted from LDs, accounting for 21% of all transplants in the United States. Over 95% were kidney; 4% were liver; and <1% intestine, lung, and pancreas LDs. Only LD kidney transplant patient and graft survival rates were significantly higher compared deceased donor transplants over the period of analysis. The best long-term LD transplant results were achieved in pediatric liver recipients. Significantly more women than men donated organs and significantly more men than women received solid-organ transplants. A regional disparity was observed for LD kidney as well as for LD liver transplants. Despite improvements in outcomes and increased use of nonbiologic donors, the number of LD transplants in the United States has declined. This decline was greater in children than adults and was noted for all types of organ transplants. CONCLUSION Further efforts are needed to educate the public, health professionals, and transplant candidates on the advantages of living vs deceased donor organ transplantation. Compared with other countries, LD transplantation has yet to reach its full potential in the United States.
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Affiliation(s)
- R W G Gruessner
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY.
| | - A C Gruessner
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY
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41
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Living donor liver transplantation: looking back at my 30 years of experience. Surg Today 2018; 49:288-294. [PMID: 30483952 DOI: 10.1007/s00595-018-1744-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Abstract
Since I moved from the National Cancer Center to Shinshu University, I have been performing living donor liver transplantation (LDLT), which is the only way to save the life of patients with end-stage liver disease. In June 1990, we performed the first LDLT that case was the first successful case in Japan. The patient remains healthy and is enjoying a normal life still 28 years after the transplant. In 1993, we successfully performed adult-to-adult LDLT, which was the first successful case in the world. The patient enjoyed a normal life for 17 years until she died at 70 years of age. For small children, the left liver of adult donors is too large to close the abdomen. However, in adolescents or adults, even when the whole right liver is used, the volume of the graft is too small. The concept of the standard liver volume (SLV) has proven very important for this procedure and is calculated as follows: 706.2 × body surface area + 2.4. We proposed a method for evaluating the congestion of the liver by Doppler ultrasound. In addition, we devised the right lateral sector graft. Over the years, we have contributed to LDLT in many ways and published many papers. We feel that our findings are quite useful not only for LDLT but also for other hepatectomy procedures.
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42
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Zeytunlu M, Uğuz A, Ünalp Ö, Ergün O, Karasu Z, Günşar F, Akarca U, Yılmaz F, Turan İ, Nart D, Tekin F, Özütemiz Ö, Ulukaya S, Deniz N, Aydoğdu S, Özgenç F, Tasçı E, Sertöz R, Parıldar M, Elmas N, Harman M, Güler E, Kısmalı E, Akyol R, Yamazhan T, Taşbakan M, Tiftikcioğlu Y, Bacakoğlu F, Nalbantgil S, Noyan A, Karapınar B, Kılınç A, Uyar M, Demirağ K, Özalp S, Özdemir N, Aras S, Altuğ N. Results of 1001 liver transplantations in 23 years: Ege University experience. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:664-668. [PMID: 30381274 PMCID: PMC6284687 DOI: 10.5152/tjg.2018.18058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. MATERIALS AND METHODS Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). RESULTS A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished. CONCLUSION LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.
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Affiliation(s)
- Murat Zeytunlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Alper Uğuz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Ünalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Orkan Ergün
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Zeki Karasu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ulus Akarca
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Yılmaz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Deniz Nart
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fatih Tekin
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Özütemiz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sezgin Ulukaya
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nuri Deniz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sema Aydoğdu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Özgenç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Tasçı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rüçhan Sertöz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Parıldar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nevra Elmas
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Harman
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Erkan Kısmalı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rahmi Akyol
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Tansu Yamazhan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Meltem Taşbakan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Yiğit Tiftikcioğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Feza Bacakoğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sanem Nalbantgil
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ayşin Noyan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Bülent Karapınar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Arda Kılınç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mehmet Uyar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Kubilay Demirağ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sibel Özalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nebile Özdemir
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sinem Aras
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nurşen Altuğ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
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Kim B, Kim SY, Kim KW, Jang HY, Jang JK, Song GW, Lee SG. MRI in donor candidates for living donor liver transplant: Technical and practical considerations. J Magn Reson Imaging 2018; 48:1453-1467. [DOI: 10.1002/jmri.26257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Bohyun Kim
- Department of Radiology; Ajou University Medical Center, Ajou University School of Medicine; Suwon South Korea
| | - So Yeon Kim
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Kyoung Won Kim
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Hye Young Jang
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Jong Keon Jang
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Gi Won Song
- Department of Surgery, Division of Hepatobiliary and Liver Transplantation Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Sung Gyu Lee
- Department of Surgery, Division of Hepatobiliary and Liver Transplantation Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
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Hibi T, Eguchi S, Egawa H. Evolution of living donor liver transplantation: a global perspective. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:388-389. [DOI: 10.1002/jhbp.571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Taizo Hibi
- Department of Pediatric Surgery and Transplantation; Kumamoto University Graduate School of Medical Sciences; Kumamoto Japan
| | - Susumu Eguchi
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Hiroto Egawa
- Department of Surgery; Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan
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45
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Complications after Living Donor Hepatectomy: Analysis of 176 Cases at a Single Center. J Am Coll Surg 2018; 227:24-36. [DOI: 10.1016/j.jamcollsurg.2018.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/31/2018] [Accepted: 03/05/2018] [Indexed: 02/06/2023]
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Abstract
Living donor liver transplantation (LDLT) has found a place to serve the end-stage liver disease community as the donor safety and recipient suitability has been elucidated. Donor safety is of paramount importance and transplant programs must continue endeavors to maintain the highest possible standards. At the same time, adequacy of grafts based on recipient clinical status via their model for end-stage liver disease (MELD) score and volumetric studies to achieve a GRBWR >0.8, along with special attention to anatomic tailoring and portal venous flow optimization are necessary for successful transplantation. Technical innovations have improved sequentially the utility and availability of LDLT.
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47
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Chen KH, Siow TF, Chio UC, Wu JM, Jeng KS. Laparoscopic donor hepatectomy. Asian J Endosc Surg 2018; 11:112-117. [PMID: 29869841 DOI: 10.1111/ases.12606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022]
Abstract
Laparoscopic liver resection has been applied to treat most indications for liver resection during the past two decades. According to the literature, patient numbers have increased exponentially as a result, and surgical difficulty has increased as well. In expert centers, laparoscopic anatomical hemihepatectomy and major liver resection more than 3 segments have become the acceptable treatment. Moreover, with surgical innovations and accumulated experience, living donor liver transplantation has become an established treatment choice for patients on the transplant waiting list. It is even considered an inevitable choice in regions with limited access to organs from deceased donors. However, significant morbidity and rare but catastrophic mortality are associated with donor hepatectomy and remain major concerns. Therefore, to decrease the incidence of complications, a minimally invasive approach in donor hepatectomy was adopted in the early 2000s. Initially, a minimally invasive approach was used for left lateral sectionectomy for pediatric liver transplant, then for laparoscopy-assisted hemihepatectomy and pure laparoscopic/robotic right donor hepatectomy, and more recently, for adult living donor liver transplantation. The extent of procedure complexity and potential complications depends on the approach and the size of the graft to be harvested. Early results from expert teams have seemed promising in terms of shortened donor recovery and improved perioperative outcomes. However, the combination of these two highly sophisticated surgical procedures raise more concerns about donor safety, especially with regard to unexpected events during the operation. A high level of evidence is very difficult to achieve in this highly specialized surgical practice with limited penetration. Therefore, an international registry has been suggested to determine the risks and benefits before the use of laparoscopic right donor hepatectomy spreads.
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Affiliation(s)
- Kuo-Hsin Chen
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Division of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Tiing Foong Siow
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - U-Chon Chio
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiann-Ming Wu
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Shyang Jeng
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Zamora-Valdes D, Leal-Leyte P, Kim P, Testa G. Fighting Mortality in the Waiting List: Liver Transplantation in North America, Europe, and Asia. Ann Hepatol 2018; 16:480-486. [PMID: 28612751 DOI: 10.5604/01.3001.0010.0271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Liver disease is a major cause of mortality worldwide. Liver transplantation (LT) is the most effective treatment for end stage liver disease. Available resources and social circumstances have led to different ways of implementing LT around the world. The experience with pediatric LT corroborates the hypothesis that a combination of surgical strategies can be beneficial. The goal of this manuscript is to describe the strategies used by LT centers in North America, Europe and Asia and how these strategies can be applied to reduce waitlist mortality and increase access to LT.
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Affiliation(s)
- Daniel Zamora-Valdes
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Pilar Leal-Leyte
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Peter Kim
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Giuliano Testa
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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49
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Kasahara M, Umeshita K, Sakamoto S, Fukuda A, Furukawa H, Sakisaka S, Kobayashi E, Tanaka E, Inomata Y, Kawasaki S, Shimada M, Kokudo N, Egawa H, Ohdan H, Uemoto S. Living donor liver transplantation for biliary atresia: An analysis of 2085 cases in the registry of the Japanese Liver Transplantation Society. Am J Transplant 2018; 18:659-668. [PMID: 28889651 DOI: 10.1111/ajt.14489] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 02/07/2023]
Abstract
Biliary atresia (BA) is the most common indication for liver transplantation (LT) in pediatric population. This study analyzed the comprehensive factors that might influence the outcomes of patients with BA who undergo living donor LT by evaluating the largest cohort with the longest follow-up in the world. Between November 1989 and December 2015, 2,085 BA patients underwent LDLT in Japan. There were 763 male and 1,322 female recipients with a mean age of 5.9 years and body weight of 18.6 kg. The 1-, 5-, 10-, 15-, and 20-year graft survival rates for the BA patients undergoing LDLT were 90.5%, 90.4%, 84.6%, 82.0%, and 79.9%, respectively. The donor body mass index, ABO incompatibility, graft type, recipient age, center experience, and transplant era were found to be significant predictors of the overall graft survival. Adolescent age (12 to <18 years) was associated with a significantly worse long-term graft survival rate than younger or older ages. We conclude that LDLT for BA is a safe and effective treatment modality that does not compromise living donors. The optimum timing for LT is crucial for a successful outcome, and early referral to transplantation center can improve the short-term outcomes of LT for BA. Further investigation of the major cause of death in liver transplanted recipients with BA in the long-term is essential, especially among adolescents.
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Affiliation(s)
- Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Koji Umeshita
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroyuki Furukawa
- Department of Gastroentrologic and General Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology and Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Eiji Kobayashi
- Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Tanaka
- Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yukihiro Inomata
- Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Seiji Kawasaki
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Norihiro Kokudo
- Department of Surgery, Graduate School of Medicine, Hepatobiliary Pancreatic Surgery Division, The University of Tokyo, Tokyo, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences Institute of Biochemical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Uemoto
- Department of Hepatobiliary-Pancreatic Surgery and Transplantation, Kyoto University, Kyoto, Japan
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Yang JD, Yu HC. Donor Complication in Living Donor Liver Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2017. [DOI: 10.4285/jkstn.2017.31.4.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jae Do Yang
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Hee Chul Yu
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
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