|
1
|
Puri P, Kumar A, Qaleem M. Donor Evaluation Protocol for Live and Deceased Donors. J Clin Exp Hepatol 2024; 14:101217. [PMID: 38076356 PMCID: PMC10709134 DOI: 10.1016/j.jceh.2023.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/09/2023] [Indexed: 01/05/2025] Open
Abstract
Donor evaluation is a critical step before proceeding with liver transplantation (LT) in both deceased donor LT (DDLT) and living donor LT (LDLT). A good, healthy graft is necessary for the success of the transplantation. Other issues in selecting a donor include the transmission of infections and malignancies from the donor. Because of the scarcity of cadaver organs, an increasing number of extended-criteria donors, or 'marginal donors', are being utilized. LDLT also has potential risks to the donor, and donor safety needs to be kept in mind before proceeding with LT. The current review highlights the factors to be considered during donor evaluation for living and deceased donors before LT.
Collapse
Affiliation(s)
- Pankaj Puri
- Fortis Escorts Liver and Digestive Diseases Institute, Fortis Escorts Hospital, New Delhi-110025, India
| | - Abhinav Kumar
- Fortis Escorts Liver and Digestive Diseases Institute, Fortis Escorts Hospital, New Delhi-110025, India
| | - Mohd Qaleem
- Department of Liver Transplantation, Minimal Access & GI Surgery, Fortis Escorts Hospital, New Delhi-110025, India
| |
Collapse
|
|
2
|
Lin J, Ko CJ, Lin KH, Lin PY, Hsieh CE, Chou CT, Chen YL, Hung YJ. Using Glissonian sheath as an alternative way to prevent biliary stricture in living-donor liver transplantation. Asian J Surg 2021; 44:742-748. [PMID: 33468384 DOI: 10.1016/j.asjsur.2020.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/13/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND /Objective: The aim of this study was to report a single-institution experience involving a Glissonian sheath-to-duct method for biliary reconstruction in living donor liver transplantation, focusing on the association between surgical techniques and biliary stricture rates. METHODS Three hundred and twenty adult right lobar living donor liver transplantation procedures were analyzed through a comparison of 200 Glissonian sheath-to-duct (GD) reconstructions and 120 duct-to-duct (DD) reconstructions in biliary anastomosis. RESULTS At a mean follow-up period of 60.8 months, the GD group had a significantly lower biliary stricture rate (13.5%, 27/200) than the DD group (26.7%, 32/120) (p = 0.003). In biliary anastomosis with single duct anastomosis, the incidence of biliary stricture was significantly greater for the DD group (17/79, 21.5%) than for the GD group (14/141, 9.9%) (p = 0.018). CONCLUSION This study has shown that GD anastomosis of the bile duct produced outstanding results with respect to the reduction of biliary stricture. The GD technique can therefore be suggested as an alternative method for biliary reconstruction in LDLT.
Collapse
Affiliation(s)
- Joseph Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Jan Ko
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Yi Lin
- Transplant Medicine & Surgery Research Centre, Changhua Christian Hospital, Changhua City, Taiwan
| | - Chia-En Hsieh
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chen-Te Chou
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Molecular Biotechnology, College of Biotechnology and Bioresources, Dayeh University, Changhua City, Taiwan; Department of Radiology, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yao-Li Chen
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Transplant Medicine & Surgery Research Centre, Changhua Christian Hospital, Changhua City, Taiwan; College of Nursing and Health Sciences, Dayeh University, Changhua City, Taiwan.
| | - Yu-Ju Hung
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| |
Collapse
|
|
3
|
Ko YC, Tsai HI, Lee CW, Lin JR, Lee WC, Yu HP. A nomogram for prediction of early allograft dysfunction in living donor liver transplantation. Medicine (Baltimore) 2020; 99:e22749. [PMID: 33080739 PMCID: PMC7571974 DOI: 10.1097/md.0000000000022749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Liver transplantation is the treatment of choice for end-stage liver diseases. However, early allograft dysfunction (EAD) is frequently encountered and associated with graft loss or mortality after transplantation. This study aimed to establish a predictive model of EAD after living donor liver transplantation. A total of 77 liver transplants were recruited to the study. Multivariate analysis was utilized to identify significant risk factors for EAD. A nomogram was constructed according to the contributions of the risk factors. The predictive values were determined by discrimination and calibration methods. A cohort of 30 patients was recruited to validate this predictive model. Four independent risk factors, including donor age, intraoperative blood loss, preoperative alanine aminotransferase (ALT), and reperfusion total bilirubin, were identified and used to build the nomogram. The c-statistics of the primary cohort and the validation group were 0.846 and 0.767, respectively. The calibration curves for the probability of EAD presented an acceptable agreement between the prediction by the nomogram and the actual incidence. In conclusion, the study developed a new nomogram for predicting the risk of EAD following living donor liver transplantation. This model may help clinicians to determine individual risk of EAD following living donor liver transplantation.
Collapse
Affiliation(s)
- Yu-Chen Ko
- Department of Anesthesiology, Chang Gung Memorial Hospital
| | - Hsin-I Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
| | - Chao-Wei Lee
- College of Medicine, Chang Gung University
- Department of General Surgery, Chang Gung Memorial Hospital
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University
| | - Wei-Chen Lee
- College of Medicine, Chang Gung University
- Department of General Surgery, Chang Gung Memorial Hospital
- Department of Liver and Transplantation Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
- Department of Anesthesiology, Xiamen Chang Gung Hospital, Xiamen, China
| |
Collapse
|
|
4
|
Abu-Gazala S, Olthoff KM. Status of Adult Living Donor Liver Transplantation in the United States: Results from the Adult-To-Adult Living Donor Liver Transplantation Cohort Study. Gastroenterol Clin North Am 2018; 47:297-311. [PMID: 29735025 DOI: 10.1016/j.gtc.2018.01.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This article reviews the Adult-to-Adult Living Donor Liver Transplant Cohort Study (A2ALL). The findings show that the number of adult-to-adult living donor liver transplants is consistently increasing. Living donor liver transplantation has an important benefit for patients with acute liver failure, does not compromise donor safety, and has lower rates of acute cellular rejection in biologically related donor and recipient. The conclusions from the A2ALL consortium have been critical in transplant advancement, supporting increased use to help decrease waitlist death and improve long-term survival of transplant recipients.
Collapse
Affiliation(s)
- Samir Abu-Gazala
- Department of Surgery, Transplantation Unit, Hadassah Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
| | - Kim M Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| |
Collapse
|
|
5
|
Ali MA, Elshobari MM, Salah T, Kandeel AR, Sultan AM, Elghawalby AN, Shehta A, Elsayed U, Fathy O, Yassen A, Wahab MA. Impact of donor-recipient genetic relationship on outcome of living donor liver transplantation. Liver Transpl 2017; 23:43-49. [PMID: 27516392 DOI: 10.1002/lt.24599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/28/2016] [Indexed: 02/06/2023]
Abstract
Living donor liver transplantation (LDLT) is a valuable option for expanding the donor pool, especially in localities where deceased organ harvesting is not allowed. In addition, rejection rates were found to be lower in LDLT, which is attributed to the fact that LDLT is usually performed between relatives. However, the impact of genetic relation on the outcome of LDLT has not been studied. In this study, we examined the difference in rejection rates between LDLT from genetically related (GR) donors and genetically unrelated (GUR) donors. All cases that underwent LDLT during the period from May 2004 until May 2014 were included in the study. The study group was divided into 2 groups: LDLT from GR donors and LDLT from GUR donors. A total of 308 patients were included in the study: 212 from GR donors and 96 from GUR donors. Human leukocyte antigen (HLA) typing was not included in the workup for matching donors and recipients. GUR donors were wives (36; 11.7%), sons-in-law (7; 2.3%), brothers-in-law (12; 3.9%), sisters-in-law (1; 0.3%), and unrelated (38; 12.3%). The incidence of acute rejection in the GR group was 17.4% and 26.3% in the GUR group (P value = 0.07). However, there was a significant difference in the incidence of chronic rejection (CR) between the 2 groups: 7% in GR group and 14.7% in the GUR group (P value = 0.03). In terms of overall survival, there was no significant difference between both groups. LDLT from the GUR donors is not associated with a higher incidence of acute cellular rejection. However, CR was significantly lower when grafts were procured from GR donors. HLA matching may be recommended before LDLT from GUR donors. Liver Transplantation 23:43-49 2017 AASLD.
Collapse
Affiliation(s)
- Mahmoud Abdelwahab Ali
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Mohamed Morsi Elshobari
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Tarek Salah
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Al-Refaey Kandeel
- Anesthesia and Intensive Care Department, Mansoura University, Mansoura City, Egypt
| | - Ahmad Mohammad Sultan
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Ahmad Nabieh Elghawalby
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Ahmed Shehta
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Usama Elsayed
- Anesthesia and Intensive Care Department, Mansoura University, Mansoura City, Egypt
| | - Omar Fathy
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Amr Yassen
- Anesthesia and Intensive Care Department, Mansoura University, Mansoura City, Egypt
| | - Mohamed Abdel Wahab
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| |
Collapse
|
|
6
|
Pantanowitz L, Pomfret EA, Pomposelli JJ, Lewis WD, Gordon FD, Jenkins RL, Khettry U. Pathologic Analysis of Right-Lobe Graft Failure in Adult-to-Adult Live Donor Liver Transplantation. Int J Surg Pathol 2016; 11:283-94. [PMID: 14615823 DOI: 10.1177/106689690301100405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Live donor adult liver transplantation (LDALT) utilizing right-lobe grafts is now acceptable as an alternative to cadaveric orthotopic liver transplantation (OLT). However, some LDALTs fail and require urgent OLT or result in recipient death. Our aim was to determine the basis of LDALT failure. Liver specimens from 49 LDALT recipients were evaluated and the findings correlated with clinical outcome. Ten patients (20.4%) had either early (< 1 month) or late (> 1 month) graft failure. Eight early failures, 7 of which occurred among our first 25 cases, were due to extensive liver parenchymal necrosis as a result of hepatic artery thrombosis (n=3), portal vein thrombosis (n= 1), hyperperfusion syndrome (n= 1), complete graft thrombosis (n= 1) with Factor V Leiden on a regimen of therapeutic heparin (n=1), sepsis and concomitant graft dysfunction with venous outflow tract injury (n=I), and venous outflow tract thrombosis and parenchymal thermal injury with sepsis (n=1). Preoperative, intraoperative, or postoperative severe vessel wall injury was evident in 6/8 early failures. TWo patients had late graft failure, 1 from recurrent hepatitis C and 1 with sepsis/multisystem organ failure. There were no significant differences in graft size, rejection episodes, or operative or ischemic times between patients with and without graft failure. In conclusion, LDALT failed in 10/49 (20%) of our patients, with 8/10 occurring within 1 month post-LDALT owing to vascular/thrombotic complications experienced during the early phase of our institutional experience. Perioperative vessel wall injury appeared to be a major factor in predicting early graft loss.
Collapse
Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 01805, USA
| | | | | | | | | | | | | |
Collapse
|
|
7
|
Kinner S, Steinweg V, Maderwald S, Radtke A, Sotiropoulos G, Forsting M, Schroeder T. Comparison of different magnetic resonance cholangiography techniques in living liver donors including Gd-EOB-DTPA enhanced T1-weighted sequences. PLoS One 2014; 9:e113882. [PMID: 25426932 PMCID: PMC4245231 DOI: 10.1371/journal.pone.0113882] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/30/2014] [Indexed: 12/19/2022] Open
Abstract
Objectives Preoperative evaluation of potential living liver donors (PLLDs) includes the assessment of the biliary anatomy to avoid postoperative complications. Aim of this study was to compare T2-weighted (T2w) and Gd-EOB-DTPA enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) techniques in the evaluation of PLLDs. Materials and Methods 30 PLLDs underwent MRC on a 1.5 T Magnetom Avanto (Siemens, Erlangen, Germany) using (A) 2D T2w HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo) fat saturated (fs) in axial plane, (B) 2D T2w HASTE fs thick slices in coronal plane, (C) free breathing 3D T2w TSE (turbo spin echo) RESTORE (high-resolution navigator corrected) plus (D) maximum intensity projections (MIPs), (E) T2w SPACE (sampling perfection with application optimized contrasts using different flip angle evolutions) plus (F) MIPs and (G) T2w TSE BLADE as well as Gd-EOB-DTPA T1w images without (G) and with (H) inversion recovery. Contrast enhanced CT cholangiography served as reference imaging modality. Two independent reviewers evaluated the biliary tract anatomy on a 5-point scale subjectively and objectively. Data sets were compared using a Mann-Whitney-U-test. Kappa values were also calculated. Results Source images and maximum intensity projections of 3D T2w TSE sequences (RESTORE and SPACE) proved to be best for subjective and objective evaluation directly followed by 2D HASTE sequences. Interobserver variabilities were good to excellent (k = 0.622–0.804). Conclusions 3D T2w sequences are essential for preoperative biliary tract evaluation in potential living liver donors. Furthermore, our results underline the value of different MRCP sequence types for the evaluation of the biliary anatomy in PLLDs including Gd-EOB-DTPA enhanced T1w MRC.
Collapse
Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- * E-mail:
| | - Verena Steinweg
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Stefan Maderwald
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg Essen, Essen Germany
| | - Arnold Radtke
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Georgios Sotiropoulos
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Tobias Schroeder
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| |
Collapse
|
|
8
|
Imakuma E, Bordini A, Millan L, Massarollo P, Caldini E. Comparative Morphometric Analysis of 5 Interpositional Arterial Autograft Options for Adult Living Donor Liver Transplantation. Transplant Proc 2014; 46:1784-8. [DOI: 10.1016/j.transproceed.2014.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
|
9
|
Combination of increased flip angle, radial k-space trajectory, and free breathing acquisition for improved detection of a biliary variant at living donor liver transplant evaluation using gadoxetic acid-enhanced MRCP. J Comput Assist Tomogr 2014; 38:277-80. [PMID: 24625601 DOI: 10.1097/rct.0000000000000071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Gadoxetic acid-enhanced magnetic resonance cholangiopancreatography (MRCP) was performed for evaluation of living donor liver transplantation. T2-weighted MRCP and hepatobiliary-phase postcontrast MRCP showed an aberrant right posterior bile duct, although the precise variant was uncertain. Optimized hepatobiliary-phase MRCP was obtained using 3 sequence modifications: increased flip angle to improve contrast between the biliary tree and surrounding tissues; radial k-space sampling to minimize motion artifact; and free-breathing acquisition to improve signal-to-noise ratio and, in turn, spatial resolution (resolution of 1.28 × 1.28 × 1.5 mm). The optimized sequence demonstrated that the right posterior bile duct drained into the cystic duct, consistent with type 3C biliary variant, thus modifying surgical planning.
Collapse
|
|
10
|
Chen PX, Yan LN, Wang WT. Outcome of patients undergoing right lobe living donor liver transplantation with small-for-size grafts. World J Gastroenterol 2014; 20:282-289. [PMID: 24415883 PMCID: PMC3886020 DOI: 10.3748/wjg.v20.i1.282] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/06/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the outcome of living donor liver transplantation (LDLT) recipients transplanted with small-for-size grafts (SFSGs).
METHODS: Between November 2001 and December 2010, 196 patients underwent LDLT with right lobe liver grafts at our center. Recipients were divided into 2 treatment groups: group A with an actuarial graft-to-recipient weight ratio (aGRWR) < 0.8% (n = 45) and group B with an aGRWR ≥ 0.8% (n = 151). We evaluated serum liver function markers within 4 wk after transplantation. We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients, the donors and the transplantation procedures based upon a review of their medical records.
RESULTS: Small-for-size syndrome (SFSS) developed in 7 of 45 patients (15.56%) in group A and 9 of 151 patients (5.96%) in group B (P = 0.080). The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation, albeit not significantly. The cumulative 1-, 3- and 5-year liver graft survival rates were 82.22%, 71.11% and 71.11% for group A and 81.46%, 76.82%, and 75.50% for group B patients, respectively (P = 0.623). However, univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival (P < 0.001). Furthermore, multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival.
CONCLUSION: Our study suggests that LDLT recipients with an aGRWR < 0.8% may have liver graft outcomes comparable to those who received larger size grafts. Further studies are required to ascertain the safety of using SFSGs.
Collapse
|
|
11
|
Hegab B, Abdelfattah MR, Azzam A, Mohamed H, Al Hamoudi W, Alkhail FA, Bahili HA, Khalaf H, Sofayan MA, Sebayel MA. Day-of-surgery rejection of donors in living donor liver transplantation. World J Hepatol 2012; 4:299-304. [PMID: 23293715 PMCID: PMC3536836 DOI: 10.4254/wjh.v4.i11.299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 10/31/2012] [Accepted: 11/07/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To study diagnostic laparoscopy as a tool for excluding donors on the day of surgery in living donor liver transplantation (LDLT). METHODS This study analyzed prospectively collected data from all potential donors for LDLT. All of the donors were subjected to a three-step donor evaluation protocol at our institution. Step one consisted of a clinical and social evaluation, including a liver profile, hepatitis markers, a renal profile, a complete blood count, and an abdominal ultrasound with Doppler. Step two involved tests to exclude liver diseases and to evaluate the donor's serological status. This step also included a radiological evaluation of the biliary anatomy and liver vascular anatomy using magnetic resonance cholangiopancreatography and a computed tomography (CT) angiogram, respectively. A CT volumetric study was used to calculate the volume of the liver parenchyma. Step three included an ultrasound-guided liver biopsy. Between November 2002 and May 2009, sixty-nine potential living donors were assessed by open exploration prior to harvesting the planned part of the liver. Between the end of May 2009 and October 2010, 30 potential living donors were assessed laparoscopically to determine whether to proceed with the abdominal incision to harvest part of the liver for donation. RESULTS Ninety-nine living donor liver transplants were attempted at our center between November 2002 and October 2010. Twelve of these procedures were aborted on the day of surgery (12.1%) due to donor findings, and eighty-seven were completed (87.9%). These 87 liver transplants were divided into the following groups: Group A, which included 65 transplants that were performed between November 2002 and May 2009, and Group B, which included 22 transplants that were performed between the end of May 2009 and October 2010. The demographic data for the two groups of donors were found to match; moreover, no significant difference was observed between the two groups of donors with respect to hospital stay, narcotic and non-narcotic analgesia requirements or the incidence of complications. Regarding the recipients, our study clearly revealed that there was no significant difference in either the incidence of different complications or the incidence of retransplantation between the two groups. Day-of-surgery donor assessment for LDLT procedures at our center has passed through two eras, open and laparoscopic. In the first era, sixty-nine LDLT procedures were attempted between November 2002 and May 2009. Upon open exploration of the donors on the day of surgery, sixty-five donors were found to have livers with a grossly normal appearance. Four donors out of 69 (5.7%) were rejected on the day of surgery because their livers were grossly fatty and pale. In the laparoscopic era, thirty LDLT procedures were attempted between the end of May 2009 and October 2010. After the laparoscopic assessment on the day of surgery, twenty-two transplantation procedures were completed (73.4%), and eight were aborted (26.6%). Our data showed that the levels of steatosis in the rejected donors were in the acceptable range. Moreover, the results of the liver biopsies of rejected donors were comparable between the group A and group B donors. The laparoscopic assessment of donors presents many advantages relative to the assessment of donors through open exploration; in particular, the laparoscopic assessment causes less pain, requires a shorter hospital stay and leads to far superior cosmetic results. CONCLUSION The laparoscopic assessment of donors in LDLT is a safe and acceptable procedure that avoids unnecessary large abdominal incisions and increases the chance of achieving donor safety.
Collapse
Affiliation(s)
- Bassem Hegab
- Bassem Hegab, Mohamed Rabei Abdelfattah, Ayman Azzam, Hazem Mohamed, Waleed Al Hamoudi, Faisal Aba Alkhail, Hamad Al Bahili, Hatem Khalaf, Mohammed Al Sofayan, Mohammed Al Sebayel, Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
12
|
Moon JI, Kwon CHD, Joh JW, Jung GO, Choi GS, Park JB, Kim JM, Shin M, Kim SJ, Lee SK. Safety of small-for-size grafts in adult-to-adult living donor liver transplantation using the right lobe. Liver Transpl 2010; 16:864-9. [PMID: 20583075 DOI: 10.1002/lt.22094] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The problem of graft size is one of the critical factors limiting the expansion of adult-to-adult living donor liver transplantation (LDLT). We compared the outcome of LDLT recipients who received grafts with a graft-to-recipient weight ratio (GRWR) < 0.8% or a GRWR > or = 0.8%, and we analyzed the risk factors affecting graft survival after small-for-size grafts (SFSGs) were used. Between June 1997 and April 2008, 427 patients underwent LDLT with right lobe grafts at the Department of Surgery of Samsung Medical Center. Recipients were divided into 2 groups: group A with a GRWR < 0.8% (n = 35) and group B with a GRWR > or = 0.8% (n = 392). We retrospectively evaluated the recipient factors, donor factors, and operative factors through the medical records. Small-for-size dysfunction (SFSD) occurred in 2 of 35 patients (5.7%) in group A and in 14 of 392 patients (3.6%) in group B (P = 0.368). Graft survival rates at 1, 3, and 5 years were not different between the 2 groups (87.8%, 83.4%, and 74.1% versus 90.7%, 84.5%, and 79.4%, P = 0.852). However, when we analyzed risk factors within group A, donor age and middle hepatic vein tributary drainage were significant risk factors for graft survival according to univariate analysis (P = 0.042 and P = 0.038, respectively). Donor age was the only significant risk factor for poor graft survival according to multivariate analysis. The graft survival rates of recipients without SFSD tended to be higher than those of recipients with SFSD (85.3% versus 50.0%, P = 0.074). The graft survival rates of recipients with grafts from donors < 44 years old were significantly higher than those of recipients with grafts from donors > or = 44 years old (92.2% versus 53.6%, P = 0.005). In conclusion, an SFSG (GRWR < 0.8%) can be used safely in adult-to-adult right lobe LDLT when a recipient is receiving the graft from a donor younger than 44 years.
Collapse
Affiliation(s)
- Ju Ik Moon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
13
|
Bekker J, Ploem S, de Jong KP. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant 2009; 9:746-57. [PMID: 19298450 DOI: 10.1111/j.1600-6143.2008.02541.x] [Citation(s) in RCA: 368] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To clarify inconsistencies in the literature we performed a systematic review to identify the incidence, risk factors and outcome of early hepatic artery thrombosis (eHAT) after liver transplantation. We searched studies identified from databases (MEDLINE, EMBASE, Science Citation Index) and references of identified studies. Seventy-one studies out of 999 screened abstracts were eligible for this systematic review. The incidence of eHAT was 4.4% (843/21, 822); in children 8.3% and 2.9% in adults (p < 0.001). Doppler ultrasound screening (DUS) protocols varied from 'no routine' to 'three times a day.' The median time to detection was at day seven. The overall retransplantation rate was 53.1% and was higher in children (61.9%) than in adults (50%, p < 0.03). The overall mortality rate of patients with eHAT was 33.3% (range: 0-80%). Mortality in adults (34.3%) was higher than in children (25%, p < 0.03). The reported risk factors for eHAT were, cytomegalovirus mismatch (seropositive donor liver in seronegative recipient), retransplantation, arterial conduits, prolonged operation time, low recipient weight, variant arterial anatomy, and low volume transplantation centers. eHAT is associated with significant graft loss and mortality. Uniform definitions of eHAT and uniform treatment modalities are obligatory to confirm these results and to obtain a better understanding of this disastrous complication.
Collapse
Affiliation(s)
- J Bekker
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | |
Collapse
|
|
14
|
Northup PG, Abecassis MM, Englesbe MJ, Emond JC, Lee VD, Stukenborg GJ, Tong L, Berg CL, Adult-to-Adult Living Donor Liver Transplantation Cohort Study Group. Addition of adult-to-adult living donation to liver transplant programs improves survival but at an increased cost. Liver Transpl 2009; 15:148-62. [PMID: 19177435 PMCID: PMC3222562 DOI: 10.1002/lt.21671] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Collaborators] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Using outcomes data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, we performed a cost-effectiveness analysis exploring the costs and benefits of living donor liver transplantation (LDLT). A multistage Markov decision analysis model was developed with treatment, including medical management only (strategy 1), waiting list with possible deceased donor liver transplantation (DDLT; strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over 10 years. Decompensated cirrhosis with medical management offered survival of 2.0 quality-adjusted life years (QALYs) while costing an average of $65,068, waiting list with possible DDLT offered 4.4-QALY survival and a mean cost of $151,613, and waiting list with possible DDLT or LDLT offered 4.9-QALY survival and a mean cost of $208,149. Strategy 2 had an incremental cost-effectiveness ratio (ICER) of $35,976 over strategy 1, whereas strategy 3 produced an ICER of $106,788 over strategy 2. On average, strategy 3 cost $47,693 more per QALY than strategy 1. Both DDLT and LDLT were cost-effective compared to medical management of cirrhosis over our 10-year study period. The addition of LDLT to a standard waiting list DDLT program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost.
Collapse
Affiliation(s)
- Patrick G Northup
- Department of Medicine, University of Virginia, Charlottesville, VA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
Collaborators
Jean C Emond, Robert S Brown, Rudina Odeh-Ramadan, Scott Heese, Michael M I Abecassis, Andreas Blei, Patrice Al-Saden, Abraham Shaked, Kim M Olthoff, Mary Kaminski, Mary Shaw, James F Trotter, Igal Kam, Carlos Garcia, Ronald W Busuttil, Sammy Saab, Janet Mooney, Chris E Freise, Norah A Terrault, Dulce MacLeod, Robert M Merion, Anna S F Lok, Akinlolu O Ojo, Brenda W Gillespie, Margaret Hill-Callahan, Terese Howell, Lan Tong, Tempie H Shearon, Karen A Wisniewski, Monique Lowe, Paul H Hayashi, Carrie A Nielsen, Carl L Berg, Timothy L Pruett, Jaye Davis, Robert A Fisher, Mitchell L Shiffman, Ede Fenick, April Ashworth, James E Everhart, Leonard B Seeff, Patricia R Robuck, Jay H Hoofnagle,
Collapse
|
|
15
|
Luo Y, Zhang A, Huang H, Zheng S. Haemolytic Uraemic Syndrome after Living-donor Liver Transplantation: Is Small-for-size Graft a Potential Risk Factor? J Int Med Res 2008; 36:599-604. [PMID: 18534145 DOI: 10.1177/147323000803600328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Haemolytic uraemic syndrome (HUS) is a rare complication of solid organ transplantation. Immunosuppressive drugs, including cyclosporin A and tacrolimus, have frequently been incriminated. Here we report a case of tacrolimus-induced HUS in a woman with small-for-size syndrome after living-donor liver transplantation. Hypertension, microangiopathic anaemia and end-stage renal failure occurred in the immediate post-transplant period; all other risk factors that might be implicated in the development of HUS were investigated and excluded if no evidence was found. A possible association between small-for-size syndrome, which frequently results in a high blood concentration of tacrolimus post-operatively, and the occurrence of HUS is discussed.
Collapse
Affiliation(s)
- Y Luo
- Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - A Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - H Huang
- Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - S Zheng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
|
16
|
Wilczek HE, Larsson M, Yamamoto S, Ericzon BG. Domino liver transplantation. ACTA ACUST UNITED AC 2008; 15:139-48. [DOI: 10.1007/s00534-007-1299-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 12/10/2007] [Indexed: 11/29/2022]
|
|
17
|
Savas N, Coskun M, Bilezikci B, Uruc I, Karakayali H, Yilmaz U, Haberal M. Value of an individual liver biopsy in the preoperative evaluation of apparently healthy potential liver donors. Liver Transpl 2008; 14:541-6. [PMID: 18383083 DOI: 10.1002/lt.21410] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Living donor liver transplantation has acquired widespread acceptance. A thorough workup of the potential living donor is guided by 2 objectives: the first is ensuring the safety of the surgical procedure for the donor, and the second is identifying donor grafts that pose potential risks for the recipient. Of 305 living-related liver donors, liver biopsy was performed in 201. The results of those patients' liver function tests and serologic tests were within normal limits. Forty-one of the 201 patients had steatosis on abdominal ultrasonography or tomography. Of 201 liver biopsies, 94 (46.8%) demonstrated normal findings, whereas 107 (53.2%) showed abnormal findings on pathology. Of 107 patients with abnormal pathological findings, 32 (29.9%) had fatty changes, 4 (3.7%) had steatohepatitis, and 71 (66.4%) had nonsteatotic histologic findings including fibrosis, hepatitis, and granulomatous reactions. In conclusion, our data show that half of the living-related liver donors, appearing absolutely healthy, had biopsies with abnormal pathology results. As it is well known that increasing percentages of steatosis may reduce the functional mass of the graft and occult liver diseases may not be detected without liver biopsy, we recommend that liver biopsies be part of the routine evaluation protocol for living-related liver donors in all transplantation institutions.
Collapse
Affiliation(s)
- Nurten Savas
- Department of Gastroenterology, Baskent University, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
|
18
|
Vinceneux P, Valla D, Durand F, Belghiti J. Les greffes à donneur vivant. Éthique du don. Rev Med Interne 2008; 29:259-62. [DOI: 10.1016/j.revmed.2007.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 09/15/2007] [Indexed: 11/26/2022]
|
|
19
|
Obed A, Schnitzbauer AA, Tsui TY, Gosh HA, Jarrad A, Bashir A, Schlitt HJ. Living donor liver resection: A low-tech but highly efficient technique. The Regensburg experience. Langenbecks Arch Surg 2008; 393:413-21. [DOI: 10.1007/s00423-007-0261-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 11/07/2007] [Indexed: 01/29/2023]
|
|
20
|
Li F, Yan L, Li B, Zeng Y, Wen T, Xu M, Wang W, Chen Z, Yang J, Liu B, Jiang X. Complications in the Right Lobe Adult Living Donor: Single-Center Experience in China. Transplant Proc 2007; 39:2977-80. [DOI: 10.1016/j.transproceed.2007.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 09/13/2007] [Indexed: 01/28/2023]
|
|
21
|
Yamamoto K, Takada Y, Fujimoto Y, Haga H, Oike F, Kobayashi N, Tanaka K. Nonalcoholic steatohepatitis in donors for living donor liver transplantation. Transplantation 2007; 83:257-62. [PMID: 17297396 DOI: 10.1097/01.tp.0000250671.06456.3f] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2003, we encountered the first donor death for living donor liver transplantation in Japan, which was related to nonalcoholic steatohepatitis (NASH). The aim of this study was to retrospectively investigate the prevalence of NASH among a living donor liver transplantation donor population and to analyze the postoperative course for both donors and recipients of NASH grafts to minimize risk for donors. METHODS The study population comprised 263 donors who donated the right lobe of the liver between February 1998 and April 2003. Their zero-hour biopsy specimens were screened retrospectively. Regarding severe steatosis or NASH, long-term follow-up results for laboratory data from donors were investigated along with changes in graft histologic findings in recipients. RESULTS NASH was diagnosed histopathologically in three cases (1.1%). Pathologic examination showed that a donor who died in 2003 had the most severe NASH among the three cases. The remaining two NASH donors had uneventful postoperative courses without complications. All grafts showed improvement with respect to the steatosis and histologic findings of NASH. CONCLUSIONS Donor safety is a top priority in living donor liver transplantation. To exclude patients with NASH from potential donor lists, careful evaluation, including selective preoperative liver biopsy, should be carried out.
Collapse
Affiliation(s)
- Koji Yamamoto
- Department of Transplantation and Immunology, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | | |
Collapse
|
|
22
|
Giannelli G, Antonaci S. New frontiers in biomarkers for hepatocellular carcinoma. Dig Liver Dis 2006; 38:854-9. [PMID: 16782417 DOI: 10.1016/j.dld.2006.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 04/30/2006] [Accepted: 05/10/2006] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma represents the fifth most frequent cancer in the world; it commonly occurs on cirrhotic liver. Prognosis and survival are still poor, mainly because of diagnosis at a late stage and/or recurrence of the disease. For this reason, surveillance strategies are widely used to screen for early occurrence of cancer in populations at risk. Alpha-foetoprotein is so far the only serological marker available, but its diagnostic accuracy is unsatisfactory because of low sensitivity despite reliable specificity. For this reason, new biomarkers for the diagnosis of hepatocellular carcinoma are in strong demand by clinicians. In this review, we will focus on new biomarkers currently under investigation, but also on still newer, very promising biomarkers that seem to significantly improve diagnosis.
Collapse
Affiliation(s)
- G Giannelli
- Department of Internal Medicine, Immunology, and Infectious Diseases, Section of Internal Medicine, University of Bari Medical School, Bari, Italy.
| | | |
Collapse
|
|
23
|
Yilmaz F, Aydin U, Nart D, Zeytunlu M, Karasu Z, Kaya T, Ozer I, Yuce G, Aydogdu S, Kilic M. The incidence and management of acute and chronic rejection after living donor liver transplantation. Transplant Proc 2006; 38:1435-1437. [PMID: 16797325 DOI: 10.1016/j.transproceed.2006.02.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Indexed: 10/24/2022]
Abstract
Living donor liver transplantation (LDLT) is a good alternative to cadaveric liver transplantation for end-stage liver disease. Herein we report the outcome of 132 LDLTs performed between 1999 and 2005, with special emphasis on the incidence and management of acute and chronic rejection. Among the LDLT population a first acute rejection episode (ARE) was clinically suspected in 24% and proven by liver biopsy in 11%. According to the Banff classification, 50% of AREs were grade 1, and 50%, grade 2. There was no grade 3 AREs. The first ARE occurred between 7 days and 23 months posttransplantation (mean 97 days, median 70 days). Ninety-seven percent (31/32) of the AREs occurred within the first year after transplantation and 3% (1/32) in the second year. Among the patients with ARE, 23% developed a second ARE between 4 and 11 months. A third ARE was detected in 8% of patients after month 18. All AREs responded to adjustment of immunosuppressive doses or steroid boluses. Chronic rejection (CR) was detected in 2%. In conclusion, the incidences of ARE and CR are consistent with the previously reported data. Acute and chronic rejections seem to be mild and easily manageable clinical conditions. Our results also showed a significant difference between clinically suspected and biopsy-proven ARE emphasizing the importance of indicated liver biopsies in the management of the LDLT population.
Collapse
Affiliation(s)
- F Yilmaz
- Ege Universitesi Tip Fakultesi, Izmir, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
24
|
Akamatsu N, Sugawara Y, Tamura S, Imamura H, Kokudo N, Makuuchi M. Regeneration and function of hemiliver graft: right versus left. Surgery 2006; 139:765-772. [PMID: 16782431 DOI: 10.1016/j.surg.2005.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 12/08/2005] [Accepted: 12/16/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND A right liver graft used almost routinely for adult living donor liver transplantation (LDLT), is associated with a higher incidence of morbidity and mortality in the donor. We compared volume regeneration and graft function between left and right liver grafts to examine the feasibility of using left liver grafts. METHODS The left liver was considered acceptable as a graft when it was estimated to be over 40% of the recipient standard liver volume. Otherwise, right liver harvesting was used, provided the estimated right liver volume was less than 70% of the donor's standard liver volume. Graft volume on computed tomography and the results of liver function tests 1, 3, and 12 months after LDLT were compared between recipients with left (n = 76) and right (n = 83) grafts. Possible factors influencing graft regeneration were evaluated by multivariate analysis. RESULTS A higher regeneration rate in the left liver graft group resulted in the same ratio of graft to standard liver volume as in the right liver graft group (88% vs 87%) 1 year after LDLT. Liver function tests and 5-year survival rates were comparable between the 2 groups. An episode of acute rejection was a predictive factor for impaired graft regeneration 1 month after LDLT. The initial ratio of graft volume to standard liver volume was an independent factor for regeneration 1 year after LDLT. CONCLUSIONS A properly evaluated left liver graft can be used as safely as a right liver graft in adult-to-adult LDLT. The findings of the present study justify LDLT with a left liver graft under specific selection criteria and may be preferred to a right liver graft.
Collapse
Affiliation(s)
- Nobuhisa Akamatsu
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
|
25
|
Sozen H, Karakayali H, Moray G, Dalgic A, Emiroglu R, Haberal M. Analysis of postsurgical complications in 75 living liver transplantation donors. J Gastrointest Surg 2006; 10:646-51. [PMID: 16713538 DOI: 10.1007/bf03239970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Accepted: 01/05/2006] [Indexed: 02/07/2023]
Abstract
Seventy-five living donor liver hepatectomies were performed at our transplantation center between April 1990 and December 2004. We collected the data from patient charts, files, and the Baskent University Liver Registry. There were 39 male and 36 female donors (mean age, 35.1 +/- 9.3 years). We have performed 29 (38.6%) left hepatic lobectomies, 18 (24%) left lateral segmentectomies, 26 (34.6%) right lobectomies, and two (2.6%) donors had simultaneous living donor nephrectomy plus left lobe hepatectomy. The mean remnant liver volume was 598 +/- 168 cm(3) (range, 410-915 cm(3)). The mean percentage of remnant liver for the donor was 55.2%. Mean postoperative hospital stay was 10 +/- 4.4 days. After surgery, there was no mortality or reoperation. We saw 15 (20%) postsurgical complications in 14 donors. Intra-abdominal collection was seen in five (6.6%) patients. Biliary leak was seen in four patients. Portal vein thrombosis was seen in one patient, and a pulmonary embolus developed in one liver donor. Patient safety must be the primary focus in living-donor liver transplantation. These donors face significant risks, including substantial morbidity and death. More experience, improved surgical techniques, and meticulous donor evaluation will help minimize morbidity and mortality for both living liver donors and recipients.
Collapse
Affiliation(s)
- Hakan Sozen
- Baskent University Faculty of Medicine, Department of General Surgery, Division of Transplantation, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
|
26
|
Jochum C, Beste M, Penndorf V, Farahani MS, Testa G, Nadalin S, Malago M, Broelsch CE, Gerken G. Quantitative liver function tests in donors and recipients of living donor liver transplantation. Liver Transpl 2006; 12:544-9. [PMID: 16482561 DOI: 10.1002/lt.20627] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The unique ability of the liver to regenerate quickly after resection makes living donor liver transplantation (LDLT) possible. This technique uses the unique ability of the liver to regenerate to full size after partial resection. However, the quality and course of this regeneration process in humans are still widely unexplored. In the present study we investigated the quantitative liver function tests galactose elimination capacity (GEC), indocyanine green half-life (ICG), and lidocaine half-life as markers for the quality of the liver regeneration in the first 3 months after LDLT. In this study, 22 consecutive living liver donors and their corresponding recipients were analyzed at baseline and at 10 and 90 days after LDLT. Six recipients lost their grafts during the study period. We compared donors and recipients at the different time points. After LDLT, GEC decreased (-42.6%) and ICG increased (+50.6%) significantly in donors. ICG and GEC remained significantly altered over 3 months in donors with an improvement between days 10 and 90 (GEC, +59.3%; ICG, -9.1%). ICG and GEC improved significantly in recipients between days 10 and 90 (ICG, -63.7%; GEC, +16.3%). The lidocaine half-life showed no significant changes. The donors had better test results and recovered faster than the recipients. In conclusion, after LDLT the parameters for liver capacity and flow remain altered in donors and recipients despite rapid volume growth.
Collapse
Affiliation(s)
- Christoph Jochum
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
27
|
Sebagh M, Yilmaz F, Karam V, Falissard B, Ichaï P, Roche B, Castaing D, Guettier C, Samuel D, Azoulay D. Cadaveric full-size liver transplantation and the graft alternatives in adults: a comparative study from a single centre. J Hepatol 2006; 44:118-25. [PMID: 16226825 DOI: 10.1016/j.jhep.2005.07.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 06/01/2005] [Accepted: 07/02/2005] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS This study aims to compare the results of living donor (LDLT), cadaveric split (SLT) and domino (DO) liver transplantation which are currently available alternatives to the conventional cadaveric full-size liver transplantation (CAD). METHODS Immunologic, vascular and biliary complications (BC) were evaluated in 38 LDLT, 20 SLT, 17 DO and 38 CAD recipients. RESULTS The incidence of acute rejection (AR) was similar between groups, and between blood-related and blood-unrelated patients. AR was more severe in the SLT group according to the Banff scores (P=0.03, P<0.001, P<0.001). The evolution of AR was similar between the groups, in terms of development of chronic rejection. No venous complications occurred in the overall population. The rate of arterial thrombosis (10.5, 10, 0 and 3%, respectively) was statistically similar between groups. The rate of BC (26, 40, 12, and 8%, respectively) was higher in the partial grafts than in the whole grafts (P=0.006), but was not significantly different within each group. There was an association between the severity of preservation injury and occurrence of AR (P=0.01) and arterial thrombosis (P=0.016), but not BC. One- and 2-year graft and patient survival rates were similar between groups. CONCLUSIONS None of the graft types seemed to confer immunological advantage. BC remained problematic in the partial grafts, independently from ischemia time.
Collapse
Affiliation(s)
- Mylène Sebagh
- Service d'Anatomie Pathologique, Hôpital Paul Brousse, 14 Avenue Paul Vaillant Couturier, 94 804 Villejuif Cedex, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
28
|
Lee MW, Lee JM, Lee JY, Kim SH, Park EA, Han JK, Kim YJ, Shin KS, Suh KS, Choi BI. Preoperative evaluation of the hepatic vascular anatomy in living liver donors: Comparison of CT angiography and MR angiography. J Magn Reson Imaging 2006; 24:1081-7. [PMID: 17024662 DOI: 10.1002/jmri.20726] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To compare the diagnostic performance of CT angiography (CTA) and MR angiography (MRA) for preoperative hepatic vascular evaluation in living liver donors. MATERIALS AND METHODS Twenty-eight living donor candidates underwent preoperative CTA and MRA. Two blinded radiologists evaluated the anatomic types of the hepatic artery (HA) and portal vein (PV), and the number of aberrant hepatic veins (HVs) on both CTA and MRA, independently. Four grades of confidence levels were used to indicate the clarity of depiction of the HA and PV. Surgical findings were used as a standard of reference. RESULTS For determining the anatomic types of the HA and PV, and the number of aberrant HVs, CTA and MRA did not significantly differ in terms of accuracy ([89%, 96%, and 68% on CTA] vs. [86%, 93%, and 68% on MRA] for reader 1, P>0.05; and [93%, 100%, and 86% on CTA] vs. [89%, 93%, and 79% on MRA] for reader 2, P>0.05). Confidence for the depiction of major branches of HA and PV did not differ between CTA and MRA, except for a better depiction of the left HA (LHA) on CTA (P<0.05) CONCLUSION In living donor candidates, both CTA and MRA can provide a complete evaluation of the hepatic vascular anatomy.
Collapse
Affiliation(s)
- Min Woo Lee
- Department of Radiology, Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
29
|
Lebertransplantation. PICHLMAYRS CHIRURGISCHE THERAPIE 2006. [PMCID: PMC7136971 DOI: 10.1007/3-540-29184-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
|
|
30
|
Nadalin S, Bockhorn M, Malagó M, Valentin-Gamazo C, Frilling A, Broelsch C. Living donor liver transplantation. HPB (Oxford) 2006; 8:10-21. [PMID: 18333233 PMCID: PMC2131378 DOI: 10.1080/13651820500465626] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The introduction of living donor liver transplantation (LDLT) has been one of the most remarkable steps in the field of liver transplantation (LT). First introduced for children in 1989, its adoption for adults has followed only 10 years later. As the demand for LT continues to increase, LDLT provides life-saving therapy for many patients who would otherwise die awaiting a cadaveric organ. In recent years, LDLT has been shown to be a clinically safe addition to deceased donor liver transplantation (DDLT) and has been able to significantly extend the scarce donor pool. As long as the donor shortage continues to increase, LDLT will play an important role in the future of LT.
Collapse
Affiliation(s)
- S. Nadalin
- Department of General-, Visceral- and Transplantation Surgery, University HospitalEssenGermany
| | - M. Bockhorn
- Department of General-, Visceral- and Transplantation Surgery, University HospitalEssenGermany
| | - M. Malagó
- Department of General-, Visceral- and Transplantation Surgery, University HospitalEssenGermany
| | - C. Valentin-Gamazo
- Department of General-, Visceral- and Transplantation Surgery, University HospitalEssenGermany
| | - A. Frilling
- Department of General-, Visceral- and Transplantation Surgery, University HospitalEssenGermany
| | - C.E. Broelsch
- Department of General-, Visceral- and Transplantation Surgery, University HospitalEssenGermany
| |
Collapse
|
|
31
|
Vilatoba M, Eckstein C, Bilbao G, Frennete L, Eckhoff DE, Contreras JL. 17beta-estradiol differentially activates mitogen-activated protein-kinases and improves survival following reperfusion injury of reduced-size liver in mice. Transplant Proc 2005; 37:399-403. [PMID: 15808658 DOI: 10.1016/j.transproceed.2004.12.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ischemia-reperfusion injury (I/R-I), which is unavoidable in liver transplantation, impairs liver regeneration and predisposes to liver failure. The three major mitogen-activated protein-kinases (MAPKs): ERK, p38, and JNK, are critical in the transmission of signals triggered by proinflammatory cytokines, by stress, and by growth factors. JNK and p38alpha activation have been associated with apoptosis; p38beta with cell survival; and ERK with proliferation. Previous studies have demonstrated gender dimorphism in hepatocellular dysfunction after experimental trauma and hemorrhage. Female mice are protected to a much greater extent from I/R-I than male mice. We assessed the effects of 17beta-estradiol (17beta-E) on liver function, host survival, and cellular activation of MAPK in a murine model of I/R-I in reduced-size livers. C57BL/6 mice were subjected to 45 minutes of warm ischemia (70% of the liver mass). After reperfusion, the nonischemic lobes were excised. Vehicle, 17beta-E or the estrogen receptor antagonist ICI-182780, was delivered 1 hour before the injury. We evaluated AST and apoptosis as well as activation of JNK, p38, and ERK. Female mice showed a lower level of hepatocellular injury (AST = 445 +/- 82 IU/L) after I/R-I compared with male mice (AST = 1400 +/- 210). 17beta-E decreased the liver injury in male mice (AST = 522 +/- 77), an effect that was partially reversed by ICI-182,780 (910 +/- 92). A higher rate of apoptosis was observed in male animals given saline (enrichment factor = 7.22 +/- 0.8) versus those treated with 17beta-E (5.85 +/- 0.3, P < .05). A significant increase in liver regeneration, as assessed by the percentage of liver weight/body weight was demonstrated in females (184% +/- 24%) and male mice given 17beta-E (168% +/- 22%) compared with male mice given vehicle (9% +/- 4%). 17beta-E significantly down-regulated JNK and p38alpha activities, whereas I/R-I promoted p38beta and ERK activation. These results suggest that the cytoprotective effects of 17beta-E on I/R-I to reduced-size livers are associated with selective modulation of MAPK kinases.
Collapse
Affiliation(s)
- M Vilatoba
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | | | | |
Collapse
|
|
32
|
Schemmer P, Mehrabi A, Friess H, Sauer P, Schmidt J, Büchler MW, Kraus TW. Living related liver transplantation: the ultimate technique to expand the donor pool? Transplantation 2005; 80:S138-S141. [PMID: 16286892 DOI: 10.1097/01.tp.0000187132.49178.ec] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Today, living donor liver transplantation (LDLT) is well established in many centers as a therapeutic method for end-stage liver disease. LDLT is an option for selected cases and is still under development. From the beginning of LDLT until now, many innovations have been presented and as a consequence both the surgical and medical complications in both donors and recipients reduced greatly. As a benefit, this procedure enriches the donor organ pool and reduces the imbalance between the scarcity of organ resource and organ demand; however, LDLT will not solve the problem of organ shortage. Because the modality of LDLT is still associated with morbidity and mortality of the donors, recipient's graft-size match problems and substantial surgical complications, ethical issues of live organ donation must be discussed. Nevertheless, estimates of patient survival and complications in both donors and recipients should incorporate waiting time mortality. With this background, the extended indications for LDLT compared with cadaveric liver transplantation would have to be discussed in many cases. In this brief review, we focus on potential complications for both donors and recipients after adult-to-adult LDLT, discuss ethical problems and controversies with special interest on the perspective and potentials of this surgical method.
Collapse
Affiliation(s)
- Peter Schemmer
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
| | | | | | | | | | | | | |
Collapse
|
|
33
|
Abstract
Complications involving the biliary tract after orthotopic liver transplantation (OLT) have been a common problem since the early beginning of this technique. Biliary complications have been reported to occur at a relatively constant rate of approximately 10-15% of all deceased donor full size OLTs. There is a wide range of potential biliary complications which can occur after OLT. Their incidence varies according to the type of graft, type of donor, and the type of biliary anastomosis performed. The spectrum of biliary complications has changed over the past decade because of the establishment of split liver, reduced-size, and living donor liver transplantation. Apart from technical developments, novel diagnostic methods have been introduced and evaluated in OLT, the most prominent being magnetic resonance imaging (MRI). Treatment modalities have also changed over the past years towards a primarily nonoperative, endoscopy-based strategy, leaving the surgical intervention for lesions which otherwise are not curable. The management of biliary complications after OLT requires a multidisciplinary approach. Conservative, interventional, and endoscopic treatment options have to be weighed up against surgical re-intervention. In the following the spectrum of specific bile duct complications after OLT and their treatment options will be reviewed.
Collapse
Affiliation(s)
- Andreas Pascher
- Department of General, Visceral, and Transplantation Surgery, Universitätsmedizin Berlin, Berlin, Germany.
| | | |
Collapse
|
|
34
|
Abstract
Hepatocellular carcinoma is one of the most common malignancies worldwide. The general management of hepatocellular carcinoma begins with an accurate diagnosis. With advances in imaging studies, noninvasive diagnosis has become an accepted standard of care for hepatocellular carcinoma, though pathologic examination is still required in selected cases. Following diagnosis, accurate staging is the next most important step in selecting the most appropriate treatment modality. Patients with localised tumor and compensated liver disease should be considered for partial hepatectomy, and patients with poor hepatic function but early tumor stage are candidates for liver transplantation. Patients who do not qualify for either of these curative treatments may be evaluated for palliative therapy, of which transarterial chemoembolisation is most widely used. This review will discuss the role of biopsy, the pros and cons of noninvasive and pathologic tissue diagnosis as well as the general approach to choose the most appropriate treatment for patients with hepatocellular carcinoma.
Collapse
Affiliation(s)
- Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, 750 Welch Road, Suite 210, Palo Alto, CA 94304-1509, USA
| | | |
Collapse
|
|
35
|
Maluf DG, Stravitz RT, Cotterell AH, Posner MP, Nakatsuka M, Sterling RK, Luketic VA, Shiffman ML, Ham JM, Marcos A, Behnke MK, Fisher RA. Adult living donor versus deceased donor liver transplantation: a 6-year single center experience. Am J Transplant 2005; 5:149-56. [PMID: 15636624 DOI: 10.1111/j.1600-6143.2004.00654.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
No long-term (>3 years) prospective comparison of adult-to-adult living donor liver transplantation (A2ALLTx) to adult deceased donor liver transplantation (ADDLTx) has been reported. This is a prospective, IRB approved, 6-year comparison of A2ALLTx to ADDLTx. Data include: age, gender, ethnicity, primary liver disease, waiting time, pretransplant CTP/MELD score, cold ischemia time (CIT), perioperative mortality, acute and chronic rejection, graft and patient survival, charges and post-transplant complications. In 6 years, 202 ADDLTx (74.5%) and 69 A2ALLTx (25.5%) were performed at VCUHS. Hepatitis C virus (HCV) was the most common reason for transplantation in both groups (48.1% vs. 42%). Data regarding overall patient and graft survival, monetary charges and retransplantation rates were similar. Comparison of patient/graft survivals, retransplantation rates in patients with and without HCV were not statistically different. A2ALLTx patients had less acute rejection (11.5% vs. 23.9%) and more biliary complications (26.1% vs. 11.4%). Overall, A2ALLTx is as durable a liver replacement technique as the ADDLTx. Patients with A2ALLTx were younger, had lower MELD scores, less acute rejection and similar histological HCV recurrence. Biliary complications were more common in A2ALLTx but were not associated with increased graft loss compared to ADDLTx.
Collapse
Affiliation(s)
- Daniel G Maluf
- Division of Transplantation, Department of Surgery, Virginia Commonwealth University Health System, Richmon, VA, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
36
|
Shimada M, Fujii M, Morine Y, Imura S, Ikemoto T, Ishibashi H. Living-donor liver transplantation: present status and future perspective. THE JOURNAL OF MEDICAL INVESTIGATION 2005; 52:22-32. [PMID: 15751270 DOI: 10.2152/jmi.52.22] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
About 15 years have passed since the first liver transplant from a living donor (living donor liver transplantation: LDLT), and the status of the procedure has since been established as a standard cure for end-stage liver disease in Japan where liver transplantation (LTx) from deceased donors has not yet been accepted. However, the following problems are surfacing with the increase in the number of LDLTs between adults: graft size mismatching, an ABO blood-type incompatible transplantation, the expansion of LDLT indication to hepatocellular carcinoma (HCC), the relapse of hepatitis C after LDLT, marginal donors, and the freedom from immunosuppressive treatment. In this article we outline the present conditions of these problems and the future view of the LDLT.
Collapse
Affiliation(s)
- Mitsuo Shimada
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | | | | | | | | | | |
Collapse
|
|
37
|
|
|
38
|
Kishi Y, Sugawara Y, Akamatsu N, Kaneko J, Matsui Y, Kokudo N, Makuuchi M. Sharing the middle hepatic vein between donor and recipient: left liver graft procurement preserving a large segment VIII branch in donor. Liver Transpl 2004; 10:1208-1212. [PMID: 15350016 DOI: 10.1002/lt.20226] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are few reported techniques to minimize the congestion in the donor after left liver graft procuring. If a large tributary of the middle hepatic vein (MHV) draining segment VIII (V8) converges into the root of the MHV in a donor of left liver, this branch should be preserved on the donor side. The volume of congested area when the V8 was ligated was predicted preoperatively by computed tomography (CT) and examined intraoperatively by the clamp test. Postoperative regeneration of the donor liver was evaluated by CT volumetry. This technique was used in 3 cases. The regeneration rate after 3 months of the right paramedian sector was 27, 38, and 8%, and that of the right lateral sector was 31, 63, and 39% in each donor, respectively. No severe complications occurred in the donors. In conclusion, V8 preservation in donors who underwent left liver resection led to satisfactory regeneration both of the right paramedian and lateral sectors and can minimize congestion in remnant liver.
Collapse
Affiliation(s)
- Yoji Kishi
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
|
39
|
Ravaioli M, Ercolani G, Cescon M, Vetrone G, Voci C, Grigioni WF, D'Errico A, Ballardini G, Cavallari A, Grazi GL. Liver transplantation for hepatocellular carcinoma: further considerations on selection criteria. Liver Transpl 2004; 10:1195-202. [PMID: 15350014 DOI: 10.1002/lt.20239] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The selection criteria in liver transplantation for HCC are a matter of debate. We reviewed our series, comparing two periods: before and after 1996, when we started to apply the Milan criteria. The study population was composed of patients with a preoperative diagnosis of HCC, confirmed by the pathological report and with a survival of >1 year. Preoperative staging as revealed by radiological imagining was distinguished from postoperative data, including the variable of tumor volume. After 1996 tumor recurrences significantly decreased (6 out of 15 cases, 40% vs. 3 out of 48, 6.3%, P < .005) and 5-year patient survival improved (42% vs. 83%, P < .005). Not meeting the Milan criteria was significantly related to higher recurrence rate (37.5% vs. 12.7%, P < .05) and to lower 5-year patient survival (38% vs. 78%, P < .005%) in the preoperative analysis, but not in the postoperative one. The alfa-fetoprotein level of more than 30 ng/dL and the preoperative tumor volume of more than 28 cm3 predicted HCC recurrences in the univariate and mutivariate analysis (P < .005 and P < .05, respectively). The ROC curve showed a linear correlation between preoperative tumor volume and HCC recurrence. Milan criteria significantly reduced tumor recurrences after liver transplantation, improving long-term survival. In conclusion, the efficacy of tumor selection criteria must be analyzed with the use of preoperative data, to avoid bias of the postoperative evaluation. Tumor volume and alfa-fetoprotein level may improve the selection of patients.
Collapse
Affiliation(s)
- Matteo Ravaioli
- Department of Surgery and Transplantation, Surgical Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
40
|
Di Benedetto F, Lauro A, Masetti M, Cautero N, Quintini C, Dazzi A, Ramacciato G, Risaliti A, Miller CM, Pinna AD. Use of a branch patch with the cystic artery in living-related liver transplantation. Clin Transplant 2004; 18:480-3. [PMID: 15233829 DOI: 10.1111/j.1399-0012.2004.00195.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Technical aspects in living-related liver transplantation are still under debate: the main pitfall is the arterial reconstruction due to the small diameter and the discrepancy between stumps, with a subsequent increased risk of arterial thrombosis. The gold standard is the microsurgical technique, that reports the lowest risk of thrombosis, but it is a time consuming procedure requiring a long training. Our method of choice reconstructing hepatic artery in right lobe is the use of the cystic artery as a branch patch with the recipient hepatic artery by loop magnification, saving time and with a low incidence of hepatic artery thrombosis.
Collapse
Affiliation(s)
- Fabrizio Di Benedetto
- Liver and Multivisceral Transplantation Center, University of Modena, Modena, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
41
|
Abt PL, Mange KC, Olthoff KM, Markmann JF, Reddy KR, Shaked A. Allograft survival following adult-to-adult living donor liver transplantation. Am J Transplant 2004; 4:1302-7. [PMID: 15268732 DOI: 10.1111/j.1600-6143.2004.00522.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adult-to-adult living donor liver transplantation (AALDLT) is emerging as a method to treat patients with end-stage liver disease. The aims of this study were to identify donor and recipient characteristics of AALDLT, to determine variables that affect allograft survival, and to examine outcomes compared with those achieved following cadaveric transplantation. Cox proportional hazards models were fit to examine characteristics associated with the survival of AALDLT. Survival of AALDLT was then compared with cadaveric allografts in multivariable Cox models. Older donor age (>44 years), female-to-male donor to recipient relationship, recipient race, and the recipient medical condition before transplant were factors related to allograft failure among 731 AALDLT. Despite favorable donor and recipient characteristics, the rate of allograft failure, specifically the need for retransplantation, was increased among AALDLT (hazard ratio 1.66, 95% C.I. = 1.30-2.11) compared with cadaveric recipients. In conclusion, among AALDLT recipients, selecting younger donors, placing the allografts in recipients who have not had a prior transplant and are not in the ICU, may enhance allograft survival. Analysis of this early experience with AALDLT suggests that allograft failure may be higher than among recipients of a cadaveric liver.
Collapse
Affiliation(s)
- Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | |
Collapse
|
|
42
|
Niemann CU, Hirose R, Stock P, Roberts JP, Mandell S, Spencer Yost C. Intraoperative fluid management of living donor versus cadaveric liver transplant recipients. Transplant Proc 2004; 36:1466-8. [PMID: 15251359 DOI: 10.1016/j.transproceed.2004.04.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Living donor liver transplantation has increasingly become an alternative to cadaveric donor liver transplants for select adult patients. Because these cases can be performed electively, living donor recipients may have better compensated liver disease at the time of surgery than cadaver donor recipients. However, it is unknown if this difference would have a significant effect on their intraoperative course. Therefore, we compared the intraoperative fluid management of patients receiving liver grafts from either living or cadaveric donors (n = 25, each group). Patient groups did not differ in demographics or baseline laboratory values. The duration of anesthesia and anhepatic phases were significantly longer in living donor cases (651 +/- 80 minutes vs 409 +/- 20 and 55 +/- 14 vs 45 +/- 6, P < .05). Adjusted for anesthesia time and patient weight, fluid administration (crystalloid and albumin) was not different between the two groups. Intraoperative transfusion requirements were also not significantly different in recipients from living donors versus cadaveric donors with regard to red blood cells, fresh frozen plasma, platelets, and cryoprecipitate. However, arterial oxygenation was better preserved in recipients from living donors. The PaO2/FiO2 (P/F) ratio at the end of the procedure was significantly better in patients receiving livers from living rather than from cadaveric donors (P/F ratio 335 +/- 114 mm Hg vs 271 +/- 174, P < .05). Our results indicate that while intraoperative fluid and transfusion requirements are similar, the impact of transplantation on pulmonary gas exchange is more pronounced in patients receiving organs from cadaveric donors. This difference may arise from longer cold ischemia times present in the cadaveric donor group.
Collapse
Affiliation(s)
- C U Niemann
- Anesthesia and Perioperative Care, University of California San Francisco, 94143, USA
| | | | | | | | | | | |
Collapse
|
|
43
|
Varotti G, Gondolesi GE, Goldman J, Wayne M, Florman SS, Schwartz ME, Miller CM, Sukru E. Anatomic variations in right liver living donors. J Am Coll Surg 2004; 198:577-82. [PMID: 15051012 DOI: 10.1016/j.jamcollsurg.2003.11.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Revised: 10/27/2003] [Accepted: 11/24/2003] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anatomic knowledge is crucial in right liver living donor transplantation. STUDY DESIGN We reviewed radiologic and surgical findings in right liver donors. Arterial and portal anatomy was assessed in 96 donors, biliary anatomy in 77, and hepatic venous anatomy in 65. RESULTS Portal vein (PV): 86.4% had classic anatomy; 6.3% had a trifurcated PV; 7.3% had a right anterior PV taken off the left PV. Hepatic artery (HA): 70.8% had classic anatomy; 12.5% had a left HA arising from the left gastric artery; 13.5% had a right HA arising from the superior mesenteric artery; 2.1% had a double replaced left HA and right HA; and in 1.0% the common HA arose from the superior mesenteric artery. Biliary tree: 55.8% had normal anatomy; 14.3% had a trifurcated biliary anatomy; in 5.2% the right anterior bile duct and in 15.6% the right posterior bile duct opened into the left bile duct; in 2.6% the right anterior and in 6.5% the right posterior ducts opened into the common bile duct. Hepatic veins: S5 and S8 accessory hepatic veins had incidences of 43% and 49%, respectively. The incidence of S6 or S7 short hepatic vein was 38%. CONCLUSIONS Anatomic variations are common but do not contraindicate donation; surgeons should be prepared to recognize and manage them.
Collapse
Affiliation(s)
- Giovanni Varotti
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029, USA
| | | | | | | | | | | | | | | |
Collapse
|
|
44
|
N/A. N/A. Shijie Huaren Xiaohua Zazhi 2004; 12:434-438. [DOI: 10.11569/wcjd.v12.i2.434] [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] [Indexed: 02/27/2023] Open
|
|
45
|
Tan HP, Madeb R, Kovach SJ, Orloff M, Mieles L, Johnson LA, Bozorgzadeh A, Marcos A. Hypophosphatemia after 95 right-lobe living-donor hepatectomies for liver transplantation is not a significant source of morbidity. Transplantation 2003; 76:1085-8. [PMID: 14557757 DOI: 10.1097/01.tp.0000085652.47821.8a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypophosphatemia appears to be a universal event after right hepatic lobectomy for live-donor adult liver transplantation according to one report. Because hypophosphatemia appears to contribute to increased postoperative complications, routine hyperalimentation with supratherapeutic levels of phosphorus was advocated. METHODS From July 2000 to May 2002, we performed 95 right-lobe living-donor hepatectomies for 95 adult liver-transplant recipients, the largest single institutional experience. We reviewed our data that were collected prospectively. RESULTS We did not find profound hypophosphatemia (<1.0 mg/dL) to be prevalent in our donors. At least six (6.3%) donors did not have postoperative hypophosphatemia. In addition, there appears to be no increased morbidity related to hypophosphatemia when aggressively corrected with intravenous or oral phosphates in our group of donors that underwent right-lobe hepatectomies. CONCLUSIONS We, therefore, cannot endorse the routine administration of hyperalimentation with supratherapeutic phosphorus because of its potential morbidity.
Collapse
Affiliation(s)
- Henkie P Tan
- Thomas E. Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
| | | | | | | | | | | | | | | |
Collapse
|
|
46
|
Abstract
1. Hepatitis C virus (HCV) is the most common indication for living donor liver transplantation (LDLT). 2. Preliminary evidence suggests that HCV may occur earlier and may be more severe in LDLT recipients. However, current data is inconclusive relative to the impact of recurrent HCV on patient and graft survival in LDLT recipients. 3. Potential mechanisms for differences in severity of HCV in LDLT recipients are discussed. 4. LDLT remains a viable treatment option for selected patients with HCV.
Collapse
Affiliation(s)
- Michael A Zimmerman
- Division of Gastroenterology/Hepatology, University of Colorado Health Sciences Center, Denver, CO 80202, USA
| | | |
Collapse
|
|
47
|
Affiliation(s)
- Gregory T Everson
- Division of Gastroenterology/Hepatology, University of Colorado Health Sciences Center, Denver, CO 80202, USA.
| | | |
Collapse
|
|
48
|
Affiliation(s)
- Jacques Belghiti
- Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Hospital Beaujon, 92118 Clichy-University Paris 7, France
| |
Collapse
|
|
49
|
Affiliation(s)
- Elizabeth A Pomfret
- Live Donor Liver Transplantation, Department of Liver Transplantation and Hepatobiliary Surgery, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
| |
Collapse
|
|
50
|
Abstract
Patients who need a new liver usually face a long wait. Some die before a suitable donor is found. Living liver donation is offered routinely in some countries. Should the United Kingdom follow suit?
Collapse
|