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Banach-Ambroziak E, Jankowska M, Grzywińska M, Szurowska E, Dębska-Ślizień A. Application of Total Kidney Volume and Its Predictive Value in Assessment of Kidney Transplant Waitlist Candidates With Autosomal Dominant Polycystic Kidney Disease. Transplant Proc 2020; 52:2273-2277. [PMID: 32312534 DOI: 10.1016/j.transproceed.2020.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/15/2020] [Accepted: 02/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is one of the most prevalent causes of kidney transplantation (KTx) worldwide. About 40% of ADPKD patients require peritransplant native kidney nephrectomy (NKN). The decision regarding qualification for NKN usually relies on the surgeon's expertise. Currently used qualification criteria are subjective and incomparable between clinical centers. There is a need to identify the indications for NKN by applying radiologically based methods to the decision-making process. AIM To assess the usefulness of radiologic parameters in the qualification process of ADPKD waitlist candidates for the NKN procedure. METHOD A retrospective, observational study in a cohort of ADPKD patients in a single institution was conducted. The study included the participation of waitlist candidates and kidney transplant recipients with computed tomography (CT) or magnetic resonance imaging (MRI) obtained in the peritransplant period. The correlation of imaging-based measurements with the results of clinical qualification for the NKN procedure was assessed. RESULTS In the years 2012 to 2019, 19 patients completed the inclusion criteria. Total kidney volume (TKV) values were statistically more significant in the NKN group (n = 10) than in the non-NKN group (n = 9), with medians of 3351 mL and 1654 mL, respectively (P = .016). There were no significant differences between the groups in terms of the ratio of complex cyst volume to TKV, with the NKN group having a ratio of 19.2% and the non-NKN group 15.6% (P = .095). Venous compression was found only in the NKN group (n = 2). CONCLUSIONS TKV highly correlates with the results of clinical qualification for NKN. Radiologic assessment enables the detection of complicated cysts or clinically silent states of venous compression. Pretransplant imaging should be routinely obtained.
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Affiliation(s)
| | - Magdalena Jankowska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Edyta Szurowska
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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2
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Foresto RD, Uenishi LT, Pestana RC, Neves RFDCA, Aguiar WF, Tedesco Silva H, Pestana JM. Budd-Chiari Syndrome after Bilateral Nephrectomy for Polycystic Kidney Disease in a Kidney Transplant Recipient. Urol Int 2020; 104:330-332. [PMID: 31896110 DOI: 10.1159/000504514] [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: 10/01/2019] [Accepted: 10/28/2019] [Indexed: 11/19/2022]
Abstract
We report a rare case of Budd-Chiari syndrome (BCS) as a postoperative complication after bilateral nephrectomy in a kidney transplant recipient with polycystic liver and kidneys. Contrast-enhanced computed tomography of the abdomen showed a narrowed inferior vena cava, compressed by the polycystic liver that moved downwards after nephrectomy. A stenting angioplasty was performed, resulting in remarkable clinical improvement. This case highlights the need for careful evaluation of polycystic kidneys and their anatomic relationship with the liver before nephrectomy, as well as for considering BCS as a differential diagnosis in similar cases.
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Affiliation(s)
- Renato Demarchi Foresto
- Division of Nephrology, Hospital do Rim, Federal University of São Paulo, São Paulo, Brazil,
| | | | | | | | - Wilson Ferreira Aguiar
- Division of Urology, Hospital do Rim, Federal University of São Paulo, São Paulo, Brazil
| | - Hélio Tedesco Silva
- Division of Nephrology, Hospital do Rim, Federal University of São Paulo, São Paulo, Brazil
| | - José Medina Pestana
- Division of Nephrology, Hospital do Rim, Federal University of São Paulo, São Paulo, Brazil
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3
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Bernts LHP, Drenth JPH, Tjwa ETTL. Management of portal hypertension and ascites in polycystic liver disease. Liver Int 2019; 39:2024-2033. [PMID: 31505092 PMCID: PMC6899472 DOI: 10.1111/liv.14245] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
Patients suffering from polycystic liver disease may develop Hepatic Venous Outflow Obstruction, Portal Vein Obstruction and/or Inferior Caval Vein Syndrome because of cystic mass effect. This can cause portal hypertension, leading to ascites, variceal haemorrhage or splenomegaly. For this review, we evaluate the evidence to provide clinical guidance for physicians faced with this complication. Diagnosis is made with imaging such as ultrasound, computed tomography or magnetic resonance imaging. Therapy includes conventional therapy with diuretics and paracentesis, and medical therapy using somatostatin analogues. Based on disease phenotype various (non-)surgical liver-volume reducing therapies, hepatic or portal venous stenting, transjugular intrahepatic portosystemic shunts and liver transplantation may be considered. Because of complicated anatomy, use of high-risk interventions and lack of empirical evidence, patients should be treated in expert centres.
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Affiliation(s)
- Lucas H. P. Bernts
- Department of Gastroenterology and HepatologyRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Joost P. H. Drenth
- Department of Gastroenterology and HepatologyRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Eric T. T. L. Tjwa
- Department of Gastroenterology and HepatologyRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenThe Netherlands
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4
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Barbier L, Ronot M, Aussilhou B, Cauchy F, Francoz C, Vilgrain V, Soubrane O, Paradis V, Belghiti J. Polycystic liver disease: Hepatic venous outflow obstruction lesions of the noncystic parenchyma have major consequences. Hepatology 2018; 68:652-662. [PMID: 29023812 DOI: 10.1002/hep.29582] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 08/31/2017] [Accepted: 09/30/2017] [Indexed: 01/22/2023]
Abstract
UNLABELLED In patients with polycystic liver disease (PLD), development of cysts induces hepatic venous outflow obstruction (HVOO) and parenchymal modifications, challenging the paradigm of a normal noncystic liver parenchyma. The aims were to reappraise the pathology of the noncystic parenchyma, by focusing on HVOO lesions; and to investigate the association with outflow obstruction at imaging and perioperative course after liver resection. This is a retrospective study conducted in one tertiary center between 1993 and 2014. PLD patients (n = 125) who underwent resection (n = 90) or transplantation (n = 35) were included. HVOO parenchymal lesions were assessed for all patients and a liver congestion score was built. Imaging was analysed for 45 patients with computed tomography scan, and perioperative course was assessed in resected patients. At pathology, 92% of patients had HVOO lesions, with sinusoidal dilatation being the most common feature. HVOO was more severe in patients who underwent transplantation compared to liver resection, as assessed by the congestion score. At imaging, all patients had HVOO with at least two hepatic veins involved. Mosaic enhancement pattern of the parenchyma was associated with the severity of hepatic vein obstruction (P = 0.045) and the compression of the inferior vena cava (P = 0.014). In case of liver resection, intraoperative course was characterized by hemorrhage, related to HVOO at imaging. Ascites (44%) and liver failure (9%) in the postoperative period were associated with blood losses and transfusions. CONCLUSION Hepatic venous outflow obstruction, including development of venous collaterality and parenchymal changes, is frequent in PLD and has major consequences on intraoperative bleeding and postoperative ascites and liver failure. Hepatic venous outflow obstruction should be taken into account to choose the most appropriate surgical treatment. (Hepatology 2017).
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Affiliation(s)
- Louise Barbier
- Department of HPB surgery, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
| | - Béatrice Aussilhou
- Department of HPB surgery, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
| | - François Cauchy
- Department of HPB surgery, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
| | - Claire Francoz
- Department of Hepatology, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
| | - Olivier Soubrane
- Department of HPB surgery, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
| | - Valérie Paradis
- Department of Pathology, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
| | - Jacques Belghiti
- Department of HPB surgery, Beaujon Hospital, Paris 7 Diderot University, DHU Unity Federation, France
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5
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de Menezes Neves PDM, Balbo BEP, Watanabe EH, Rocha-Santos V, Andraus W, D'Albuquerque LAC, Onuchic LF. Functional Budd-Chiari Syndrome Associated With Severe Polycystic Liver Disease. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2017; 10:1179552217713003. [PMID: 28611533 PMCID: PMC5466357 DOI: 10.1177/1179552217713003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022]
Abstract
A 50-year-old woman with end-stage renal disease secondary to autosomal dominant polycystic kidney disease was referred to a quaternary care center due to significantly increased abdominal girth. Her physical examination revealed tense ascites and abdominal collateral veins. A 10-L paracentesis improved abdominal discomfort and disclosed a transudate, suggestive of portal hypertension. A computed tomographic scan revealed massive hepatomegaly caused by multiple cysts of variable sizes, distributed throughout all hepatic segments. Contrast-enhanced imaging uncovered extrinsic compression of hepatic and portal veins, resulting in functional Budd-Chiari syndrome and portal hypertension. Although image-guided drainage followed by sclerosis of dominant cysts could potentially lead to alleviation of the extrinsic compression, the associated significant risk of cyst hemorrhage and infection precluded this procedure. In this scenario, the decision was to submit the patient to a liver-kidney transplantation. After 1 year of this procedure, the patient maintains normal liver and kidney function and refers significant improvement in quality of life.
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Affiliation(s)
| | - Bruno Eduardo Pedroso Balbo
- Divisions of Nephrology and Molecular Medicine, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elieser Hitoshi Watanabe
- Divisions of Nephrology and Molecular Medicine, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vinicius Rocha-Santos
- Liver Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Wellington Andraus
- Liver Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Luiz Fernando Onuchic
- Divisions of Nephrology and Molecular Medicine, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
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6
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Onuigbo MAC, Agbasi N, Achebe J, Odenigbo C, Oguejiofor F. Pleuritic chest pain from portal hypertensive gastropathy in ESRD patient with autosomal dominant polycystic kidney disease misdiagnosed as pericarditis. J Renal Inj Prev 2016; 5:48-52. [PMID: 27069969 PMCID: PMC4827387 DOI: 10.15171/jrip.2016.11] [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: 11/17/2015] [Accepted: 01/22/2016] [Indexed: 11/19/2022] Open
Abstract
Portal hypertensive gastropathy (PHG) is a gastric mucosal lesion complicating portal hypertension, with higher prevalence in decompensated cirrhosis. PHG can sometimes complicate autosomal dominant polycystic kidney disease (ADPKD) due to the presence of multiple liver cysts. Besides, PHG is known to present as chest pain, with or without hematemesis. Other causes of chest pain in ADPKD include referred chest pain from progressively enlarging kidney cysts, and rare pericardial cysts. Chest pain, especially if pleuritic, in end-stage renal disease (ESRD) patients, is often ascribed to uremic pericarditis. We present recurrent pleuritic chest pain in a 24-year old ESRD patient with ADPKD that was initially misdiagnosed as uremic pericarditis. It was ultimately shown to represent symptomatic PHG with excellent therapeutic response to proton pump inhibitors.
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Affiliation(s)
- Macaulay Amechi Chukwukadibia Onuigbo
- Mayo Clinic College of Medicine, Rochester, USA
- Department of Nephrology, Mayo Clinic Health System, Eau Claire, USA
- Corresponding author: Macaulay Amechi Chukwukadibia Onuigbo,
| | | | | | - Charles Odenigbo
- Department of Medicine, Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Fidelis Oguejiofor
- Department of Medicine, Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Nigeria
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7
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Grams J, Teh SH, Torres VE, Andrews JC, Nagorney DM. Inferior vena cava stenting: a safe and effective treatment for intractable ascites in patients with polycystic liver disease. J Gastrointest Surg 2007; 11:985-90. [PMID: 17508255 DOI: 10.1007/s11605-007-0182-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We performed a retrospective study of seven patients with polycystic liver disease who underwent stenting of the inferior vena cava for intractable ascites. All patients had symptomatic ascites and inferior vena cava stenosis demonstrable by venography. The mean pressure gradient across the inferior vena cava stenosis before stenting was 14.5 mm Hg (range 6-25 mm Hg) and significantly decreased to a mean pressure gradient of 2.8 mm Hg (range 0-6 mm Hg, p = 0.008) after stenting. Two patients also had stenting of hepatic venous stenoses after unsuccessful inferior vena cava stenting. After a mean follow-up of 12.2 months (range 0.5-39.1 months), five of the seven patients have had maintained clinical improvement, defined as decreased symptoms, diuretic requirements, and frequency of paracentesis. Four patients have required no further intervention. The other patient was lost in follow-up. Patients with clinical improvement had an overall larger mean pressure gradient before stenting (19.2 vs. 9.8 mm Hg) and a larger Delta pressure gradient (15.8 vs. 7.8 mm Hg) compared to those in whom stenting was unsuccessful. These results suggest inferior vena cava stenting is safe and effective and should be considered as a first-line intervention in the treatment of medically intractable ascites in select patients with polycystic liver disease.
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Affiliation(s)
- Jayleen Grams
- Department of Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
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8
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Sze DY, Strobel N, Fahrig R, Moore T, Busque S, Frisoli JK. Transjugular Intrahepatic Portosystemic Shunt Creation in a Polycystic Liver Facilitated by Hybrid Cross-sectional/Angiographic Imaging. J Vasc Interv Radiol 2006; 17:711-5. [PMID: 16614155 DOI: 10.1097/01.rvi.0000208984.17697.58] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Polycystic liver disease (PCLD) has long been considered to represent a contraindication to transjugular intrahepatic portosystemic shunt (TIPS) creation, primarily because of the risk of hemorrhage. Three-dimensional (3D) navigation within the enlarged and potentially disorienting parenchyma can now be performed during the procedure with the development of C-arm cone-beam computed tomography, which relies on the same equipment already used for angiography. Such a hybrid 3D reconstruction-enabled angiography system was used for safe image guidance of a TIPS procedure in a patient with PCLD. This technology has the potential to expedite any image-guided procedure that requires 3D navigation.
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Affiliation(s)
- Daniel Y Sze
- Department of Radiology, Stanford University Medical Center, H-3646, Stanford, California 94305-5642, USA.
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9
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Abstract
Adult polycystic liver disease (APLD) is an autosomal dominant condition most commonly associated with polycystic kidney disease. However, over the last decade it has come to be recognized that APLD is a genetically heterogeneous disorder involving derangements on at least three different chromosomes. Mutations involving chromosomes 16 and 4 accounting for autosomal dominant polycystic kidney disease (ADPKD) type 1 and type 2 have been well described as have their gene products, polycystin-1 and polycystin-2. These have since been joined by a more recently recognized mutation in the short arm of chromosome 19 thought to be responsible for a much rarer form of autosomal dominant polycystic liver disease without any associated renal involvement. Despite the sometimes impressive physical and radiologic findings, only a minority of patients will progress to advanced liver disease or develop complications as a result of massive hepatomegaly. In these patients, medical management alone has proved ineffectual. Therefore, in the symptomatic APLD patient, surgical therapy remains the mainstay of therapy and includes cyst aspiration and sclerosis, fenestration with and without hepatic resection and orthotopic liver transplantation. The surgical literature on treatment of APLD, to include outcome measurements and complication rates are summarized. Additionally, we review other potential organ involvement and resultant complications.
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Affiliation(s)
- Hays L Arnold
- Gastroenterology Service, Department of Medicine, Brooke Army Medical Center, Fort Sam, Houston, Texas 78234-6200, USA
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10
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Iguchi S, Kasai A, Kishimoto H, Suzuki K, Ito S, Ogawa Y, Nishi S, Gejyo F, Ohno Y. Thrombosis in inferior vena cava (IVC) due to intra-cystic hemorrhage into a hepatic local cyst with autosomal dominant polycystic kidney disease (ADPKD). Intern Med 2004; 43:209-12. [PMID: 15098602 DOI: 10.2169/internalmedicine.43.209] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old man with autosomal dominant polycystic kidney disease (ADPKD) was admitted complaining of severe edema of bilateral lower extremities. Computed tomography (CT) of his abdomen revealed an enlarged hepatic cyst with intra-cystic hemorrhage, and massive thrombosis in the inferior vena cava (IVC). The extrinsic mechanical stress on the IVC seemed to induce thrombosis within the IVC, and the thrombosis was likely the cause of severe edema in lower extremities. In this report, we present a rare case of IVC thrombosis due to an enlarged cyst in ADPKD successful treated with anticoagulant therapy.
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Affiliation(s)
- Seitaro Iguchi
- Department of Internal Medicine, Niigata Prefectural Muikamachi Hospital, Muikamachi
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11
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Chauveau D, Fakhouri F, Grünfeld JP. Liver involvement in autosomal-dominant polycystic kidney disease: therapeutic dilemma. J Am Soc Nephrol 2000; 11:1767-1775. [PMID: 10966503 DOI: 10.1681/asn.v1191767] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Fadi Fakhouri
- Department of Nephrology, INSERM U507, Hôpital Necker, Paris, France
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12
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Norby SM, Torres VE. Complications of autosomal dominant polycystic kidney disease in hemodialysis patients. Semin Dial 2000; 13:30-5. [PMID: 10740669 DOI: 10.1046/j.1525-139x.2000.00010.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S M Norby
- Department of Nephrology/Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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13
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Affiliation(s)
- R D Perrone
- New England Medical Center, Boston, Massachusetts, USA
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14
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Gigot JF, Jadoul P, Que F, Van Beers BE, Etienne J, Horsmans Y, Collard A, Geubel A, Pringot J, Kestens PJ. Adult polycystic liver disease: is fenestration the most adequate operation for long-term management? Ann Surg 1997; 225:286-94. [PMID: 9060585 PMCID: PMC1190679 DOI: 10.1097/00000658-199703000-00008] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the immediate and long-term results in a retrospective series of patients with highly symptomatic adult polycystic liver disease (APLD) treated by extensive fenestration techniques. A classification of APLD was developed as a stratification scheme to help surgeons conceptualize which operation to offer to patients with APLD. SUMMARY BACKGROUND DATA Treatment options for APLD remain controversial, with partisans of fenestration techniques or combined liver resection-fenestration. METHODS Clinical symptoms, performance status, liver volume measurement by computed tomography (CT), and morbidity were recorded before surgery and after surgery. Adult polycystic liver disease was classified according to the number, size, and location of liver cysts and the amount of remaining liver parenchyma. Follow-up was obtained by clinical and CT examinations in all patients. RESULTS Ten patients with highly symptomatic APLD were operated on using an extensive fenestration technique (by laparotomy in 8 patients and by laparoscopy in 2 patients, 1 of whom conversion to laparotomy was required). The mean preoperative liver volume was 7761 cm3. There was no mortality. Postoperative morbidity occurred in 50%, mainly from biliary complications, requiring reintervention in two cases. Massive intraoperative hemorrhage occurred in one patient. During a mean follow-up time of 71 months (range, 17 to 239 months), all patients were improved clinically according to their estimated performance status. The mean postoperative liver volume was 4596 cm3, which represents a mean liver volume reduction rate of 43%. However, in type III APLD, despite absence of clinical symptoms, a significant increase in liver volume was observed in 40% of the patients. CONCLUSIONS Extensive fenestration is effective in relieving symptoms in patients with APLD. Hemorrhage and biliary complications are possible consequences of such an aggressive attempt to reduce liver volume. The procedure can be performed laparoscopically in type I APLD. A longer follow-up period is mandatory in type II APLD, to confirm the usefulness of the fenestration procedure. In type III APLD, significant disease progression was observed in 40% of the patients during long-term follow-up. Fenestration may not be the most appropriate operation for long-term management of all types of APLD.
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Affiliation(s)
- J F Gigot
- Department of Digestive Surgery, St-Luc University Hospital, Louvain Medical School, Brussels, Belgium
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15
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Abstract
Budd-Chiari syndrome is the generic term for different forms of hepatic venous outflow obstruction resulting in a clinical picture of portal hypertension and hepatomegaly. Three levels of venous outflow obstruction may be recognized, affecting respectively the small intrahepatic (IVC). Each level of obstruction is related to a different aetiology. Clinical manifestations range from mild symptoms to acute or chronic end-stage liver disease. Treatment is surgical in the great majority of patients. Occlusion of the IVC may be treated by removal of the caval obstruction in selected patients. Hepatic outflow obstruction may be circumvented by different forms of shunting from the portal or upper mesenteric vein to the IVC or right atrium, depending on the level of obstruction and the difference in venous pressure. For the rare patient presenting with acute or chronic end-stage liver failure, hepatic transplantation may be a life-saving procedure.
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Affiliation(s)
- H W Tilanus
- Department of Surgery, Erasmus University Hospital Dijkzigt, Rotterdam, The Netherlands
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16
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Que F, Nagorney DM, Gross JB, Torres VE. Liver resection and cyst fenestration in the treatment of severe polycystic liver disease. Gastroenterology 1995; 108:487-94. [PMID: 7835591 DOI: 10.1016/0016-5085(95)90078-0] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIMS There is limited information on treatment options for massive, highly symptomatic polycystic liver disease. The aim of the study was to analyze the immediate and long-term outcome of combined liver resection and fenestration. METHODS Information was abstracted from medical records. Follow-up was obtained by mailed questionnaire. Liver volume was quantified by computed tomography. RESULTS Thirty-one patients underwent liver resection and fenestration between July 1985 and June 1993. Mean liver volume was 9357 mL before and 3567 mL after surgery. There was one death from postoperative intracerebral bleed. Eighteen patients experienced complications, usually transient pleural effusions or transient ascites. Twenty-eight of 29 surviving patients with adequate follow-up have experienced immediate and sustained relief of symptoms and improvement in quality of life. After median follow-up of 2.4 years (range, 0.2 to 7.9 years), most patients have not had clinically significant enlargement of the liver. Sequential computed tomography scans before and after surgery suggest that hepatic enlargement in the age range of the patients in the study mainly resulted from the expansion of existing cysts rather than from the development of new cysts. CONCLUSIONS Selected patients with severe symptomatic polycystic liver disease and favorable anatomy benefit from liver resection and fenestration with acceptable morbidity and mortality. The extent of hepatic resection and fenestration is important for the long-term effectiveness of this procedure.
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Affiliation(s)
- F Que
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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