|
1
|
Anand AC. Living-Donor Liver Transplantation-The Need for Greater Transparency. J Clin Exp Hepatol 2025; 15:102507. [PMID: 39989608 PMCID: PMC11846549 DOI: 10.1016/j.jceh.2025.102507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 01/14/2025] [Indexed: 02/25/2025] Open
Affiliation(s)
- Anil C. Anand
- Division of Digestive Sciences, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India
| |
Collapse
|
|
2
|
Ercan LD, Durmaz Ö, Kaymakoğlu S, Önal Z, Büyükbabani N, Güllüoğlu M, Alper A, İbiş C, Cantez S, Yavru HA, Oğuz FS, Özden İ. The Consequences of HLA Screening in the Prevention of Graft-Versus-Host Disease in Living Donor Liver Transplantation. Pediatr Transplant 2024; 28:e14846. [PMID: 39177044 DOI: 10.1111/petr.14846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/16/2024] [Accepted: 08/08/2024] [Indexed: 08/24/2024]
Abstract
AIMS To study the effects of routine HLA screening and the policy of avoiding donor-dominant one-way HLA match to prevent graft-versus-host disease (GVHD) after living donor liver transplantation (LDLT). PATIENTS AND METHODS The records of potential living liver donors and recipients who attended our center between 2007 and 2018 were reviewed retrospectively. RESULTS Of the 149 patients who underwent LDLT and survived longer than 3 months, two developed GVHD despite our strict policy. The first patient presented with grade II GVHD limited to the skin. She was treated successfully by briefly discontinuing immunosuppression and switching to everolimus. In the second case, the policy had been relaxed due to the availability of a single donor for ABO-incompatible transplantation without any intervention to decrease anti-A antibody levels (special case: A2 to O). Nevertheless, the patient presented with grade I GVHD limited to skin and was treated successfully by adding oral methylprednisolone to tacrolimus and mycophenolate mofetil. To the best of our information, this is the second reported case who recovered from GVHD after LDLT from a donor, homozygous at HLA A, B and DR and a recipient, heterozygous for all. Sixteen potential donors (1.2% of all candidates) of 14 recipients were disqualified solely on the basis of the HLA results; five of these patients died due to unavailability of another donor. CONCLUSION The results support the policy of avoiding HLA combinations that preclude immune recognition of graft lymphocytes as foreign to decrease the risk of GVHD after LDLT.
Collapse
Affiliation(s)
- Leman Damla Ercan
- Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Özlem Durmaz
- Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Sabahattin Kaymakoğlu
- Department of Internal Medicine (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Zerrin Önal
- Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Mine Güllüoğlu
- Department of Pathology, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Aydın Alper
- Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Cem İbiş
- Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Serdar Cantez
- Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Hacer Ayşen Yavru
- Department of Anesthesiology, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Fatma Savran Oğuz
- Department of Medical Biology, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - İlgin Özden
- Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
| |
Collapse
|
|
3
|
Ogasawara H, Tokodai K, Nakanishi W, Fujio A, Kashiwadate T, Shono Y, Ohta M, Ishikawa Y, Miyagi S, Fujishima F, Unno M, Kamei T. Living-Donor Liver Transplantation for Erythropoietic Protoporphyria: A Case Report and Literature Review. TOHOKU J EXP MED 2023; 261:117-122. [PMID: 37495523 DOI: 10.1620/tjem.2023.j061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Erythropoietic protoporphyria (EPP) is a very rare disease with an estimated prevalence of 1 in 200,000 individuals. Decreased ferrochelatase activity causes the accumulation of protoporphyrin in the body, and light exposure results in the generation of active oxygen, causing photosensitivity. Liver damage has the greatest influence on the prognosis, and liver transplantation is the only treatment option for patients with decompensated liver cirrhosis. We report a case of living-donor liver transplantation for decompensated liver cirrhosis associated with EPP. The patient was a 52-year-old male who led a normal life except for mild photosensitivity. When the patient was 37-year-old, hepatic dysfunction was noticed. At 48-year-old, high erythrocyte protoporphyrin levels, skin biopsy, and genetic tests resulted in a diagnosis of EPP. The patient underwent living- donor liver transplantation because of decompensated liver cirrhosis. In the operating room and intensive care unit, a special light-shielding film was applied to all light sources to block light with harmful wavelengths during treatment. Due to the need for special measures, a lecture on patients with EPP was given before surgery to deepen understanding among all medical professionals involved in the treatment. As a result, no adverse events occurred during the perioperative period, and the patient was discharged on the 46th post-operative day. Currently, the transplanted liver is functioning extremely well, and the patient is alive 3 years post-transplant. Herein, we describe a case of living donor liver transplantation for EPP with a brief literature review.
Collapse
Affiliation(s)
| | - Kazuaki Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Wataru Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Atsushi Fujio
- Department of Surgery, Tohoku University Graduate School of Medicine
| | | | - Yoshihiro Shono
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Mineto Ohta
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Yuki Ishikawa
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Shigehito Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine
| | | | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine
| |
Collapse
|
|
4
|
Swiss Academy of Medical Sciences. Medical-ethical guidelines: Living donation of solid organs. Swiss Med Wkly 2023; 153:40126. [PMID: 37774384 DOI: 10.57187/smw.2023.40126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
No abstract available.
Collapse
|
|
5
|
Kim SH, Park JH, An BH. Minimal Surgical Manpower for Living Donor Liver Transplantation. J Clin Med 2022; 11:jcm11154292. [PMID: 35893383 PMCID: PMC9331439 DOI: 10.3390/jcm11154292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform LDLT with minimal manpower and evaluate the outcomes in adult patients. Methods: The main surgical procedures of donor and recipient operations of LDLT were performed by a single specialist surgeon who led a team of minimal manpower that only included one fellow, one resident, one intern, and three nurses. He also provided postsurgical care and followed up all the patients as a primary care physician. The outcomes were analyzed from the standpoints of the feasibility and acceptability. Results: Between November 2018 and February 2020, a total of 47 patients underwent LDLT. Ten patients had ABO-incompatible donors. The median age of the overall recipients was 57 years old (36–71); 37 patients (78.7%) were male. The MELD score was 10 (6–40), and the main etiologies were hepatic malignancy (38 patients or 80.9%) and liver failure (9 patients or 19.1%). The median age of the overall donors was 34 years old (19–62); 22 patients (46.8%) were male. All the graft types were right liver except for one case of extended right liver with middle hepatic vein. All donors had an uneventful recovery with no complications. There was one intraoperative mortality due to cardiac arrest after reperfusion in one recipient. Hepatic artery thrombosis was developed in 5 (10.6%) recipients. An acute rejection episode occurred in one patient. The median follow-up period for all the patients was 32.9 months (range, 24.7–39.8). Biliary complications were developed in 11 (23.4%) recipients. In total, 7 (15%) patients died, including 1 intraoperative mortality, 5 from cancer recurrence, and 1 from intracranial hemorrhage. The 1-, 2-, and 3-year overall survival rates in the recipient group were 91.5%, 87.2%, and 85.1%, respectively. Conclusions: LDLT with minimal surgical manpower is feasible under the supervision of a single expert surgeon who has the capacity for all the main surgical procedures in both donor and recipient operations without compromising the outcomes in the present era of advanced surgical management.
Collapse
Affiliation(s)
- Seoung Hoon Kim
- Correspondence: or ; Tel.: +82-31-9201647; Fax: +82-31-9201138
| | | | | |
Collapse
|
|
6
|
Udayasankar M, Rammohan A, Sathya AC, Rajakumar A, Rela M. Thrombotic Thrombocytopenic Purpura After Live Liver Donation: Villain or Scapegoat? Cureus 2021; 13:e12890. [PMID: 33654582 PMCID: PMC7904498 DOI: 10.7759/cureus.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Living donor liver transplantation is a complex surgery, where the donor’s safety is of paramount importance. Despite all precautions, donor morbidity may be inevitable, and long-term follow-up data attest to this fact. However, being a “past donor” all ailments are intuitively attributed to the donation process, which may not always be the case. We present the case of a 47-year-old lady, who developed thrombotic thrombocytopenic purpura secondary to systemic lupus erythematosus 18 months following her liver donation, when she detected to be anti-nuclear antibody (ANA) positive. She developed neurological signs and was managed successfully with therapeutic plasma exchange and steroids. She was discharged home on immunosuppression and remains well on follow-up. We present the medical and social issues that were addressed in the case and highlight the need for a more stringent follow-up protocol in those who are ANA positive. This would also help detect morbidities that may be unrelated to the donation process.
Collapse
Affiliation(s)
- Madhumita Udayasankar
- The Institute of Liver Disease & Transplantation, Dr Rela Institute and Medical Centre, Chennai, IND
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr Rela Institute and Medical Centre, Chennai, IND
| | - A C Sathya
- The Institute of Liver Disease & Transplantation, Dr Rela Institute and Medical Centre, Chennai, IND
| | - Akila Rajakumar
- The Institute of Liver Disease & Transplantation, Dr Rela Institute and Medical Centre, Chennai, IND
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr Rela Institute and Medical Centre, Chennai, IND
| |
Collapse
|
|
7
|
Toniutto P, Bitetto D, Fornasiere E, Fumolo E. Challenges and future developments in liver transplantation. MINERVA GASTROENTERO 2018; 65:136-152. [PMID: 30303340 DOI: 10.23736/s1121-421x.18.02529-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Liver transplantation (LT) has become the treatment of choice for a wide range of liver diseases in both adult and pediatric patients. Until recently, the largest proportion of LT in adults, were performed in patients with hepatitis C (HCV) related cirrhosis. The recent availability of safe and effective direct antiviral agents to cure HCV infection in almost all patients whatever the HCV genotype and severity of liver disease, will reduce the need for LT in this category of recipients. Thus, it is presumed that in the next 1 to 2 decades HCV related liver disease will diminish substantially, whereas non-alcoholic steato-hepatitis (NASH) will correspondingly escalate as an indication for LT. The greatest challenges facing LT remain the limited supply of donor organs, and the need for chronic immunosuppression, which represent the true obstacles to the greater application and durable success of the LT procedure. This review aimed to highlight, in different sections, the main open issues and future developments in LT. These will be focused to explore current and future strategies to maximize the use of limited organs, to offer an update on potential new approaches to immunosuppression and to imagine new indications for LT when the number of patients awaiting transplants for HCV related liver disease is reduced.
Collapse
Affiliation(s)
- Pierluigi Toniutto
- Unit of Hepatology and Liver Transplantation, Department of Medical Area (DAME), University of Udine, Udine, Italy -
| | - Davide Bitetto
- Unit of Hepatology and Liver Transplantation, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Ezio Fornasiere
- Unit of Hepatology and Liver Transplantation, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Elisa Fumolo
- Unit of Hepatology and Liver Transplantation, Department of Medical Area (DAME), University of Udine, Udine, Italy
| |
Collapse
|
|
8
|
Abstract
Living donation has become a medically and ethically accepted practice in solid organ transplantation. Published proceedings from the international kidney transplant community and from the Ethics Committee of The Transplantation Society articulated the general principles and specific recommendations for living donation, which remain the backbone of Centers for Medicare and Medicaid Services and Organ Procurement and Transplantation Network requirements and policies. Meanwhile, there have been major advancements in another revolutionary field of transplant medicine: vascularized composite allotransplantation. Recent interventions have demonstrated potential for superior functional and aesthetic outcomes in a single operation when compared to staged conventional reconstructions. In view of these successes, the indications for vascularized composite allotransplantation are expected to broaden to include less extensive types of transplants, which would introduce the possibility of using living vascularized composite allotransplantation donors. In this article, the authors discuss the feasibility and ethics associated with living donation of vascularized composite allografts. The authors explore the current guidelines and policies set by the Organ Procurement and Transplantation Network regarding living organ donation. In addition, the authors provide several clinical scenarios in which living donation of vascularized composite allotransplantation could be used to augment the reconstructive ladder currently used by reconstructive surgeons to guide their reconstructive strategies.
Collapse
|
|
9
|
Ho CM, Huang YM, Hu RH, Wu YM, Ho MC, Lee PH. Revisiting donor risk over two decades of single-center experience: More attention on the impact of overweight. Asian J Surg 2018; 42:172-179. [PMID: 29454573 DOI: 10.1016/j.asjsur.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/14/2018] [Accepted: 01/29/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Morbidity rates after living donor hepatectomy vary greatly among centers. Donor morbidity in a tertiary center over the past two decades was revisited. METHODS Clinical data and grading of complications were reviewed by a nontransplant surgeon based on Clavien 5 tier grading. Risk factors were analyzed. RESULTS In total, 473 consecutive living liver donors from 1997 to 2016 were included for analysis; 305 were right liver donors and 168 left liver donors, and the corresponding morbidity rates were 27.2% and 9.5%. The majority (81/99, 81.2%) of complications were grade I and II. Donors with morbidity compared with those without were significantly younger, nonoverweight body figure (BMI < 25), more as the right liver donors, and longer length of hospital stay. Right liver donation had significantly higher morbidity rates than did left liver donation in earlier periods (before 2011), but not thereafter. Multivariate modeling revealed that right lobe donation and overweight (BMI ≥ 25 kg/m2) were significant factors associated with donor morbidity, with adjusted hazard ratios HR (95% confidence interval) of 3.401 (1.909-6.060) and 0.550 (0.304-0.996), respectively. Further, overweight was a paradoxical risk factor in right donor hepatectomy with HR 0.422 (0.209-0.851), but the effect was nonsignificant in left liver donors. Most complications in overweight donors were grade I and not specific to liver surgery. CONCLUSIONS The overall complication rate was 20.9%. Overweight might be protective against morbidity in right hepatectomy and warrants further deliberation.
Collapse
Affiliation(s)
- Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Min Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
|
10
|
Lee JG, Lee KW, Kwon CHD, Chu CW, Kim BW, Choi DL, You YK, Kim DS, Nah YW, Kang KJ, Choi IS, Yu HC, Hong G, Han HS, Hwang S, Kim MS. Donor safety in living donor liver transplantation: The Korean organ transplantation registry study. Liver Transpl 2017; 23:999-1006. [PMID: 28431203 DOI: 10.1002/lt.24778] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/04/2017] [Accepted: 03/31/2017] [Indexed: 02/05/2023]
Abstract
Major concerns about donor safety cause controversy and limit the use of living donor liver transplantation to overcome organ shortages. The Korean Organ Transplantation Registry established a nationwide organ transplantation registration system in 2014. We reviewed the prospectively collected data of all 832 living liver donors who underwent procedures between April 2014 and December 2015. We allocated the donors to a left lobe group (n = 59) and a right lobe group (n = 773) and analyzed the relations between graft types and remaining liver volumes and complications (graded using the Clavien 5-tier grading system). The median follow-up was 19 months (range, 10-31 months). During the study period, 553 men and 279 women donated livers, and there were no deaths after living liver donation. The overall, biliary, and major complication (grade ≥ III) rates were 9.3%, 1.7%, and 1.9%, respectively. The graft types and remaining liver volume were associated with significantly different overall, biliary, and major complication rates. Of the 16 patients with major complications, 9 (56.3%) involved biliary complications (2 biliary strictures [12.5%] and 7 bile leakages [43.8%]). Among the 832 donors, the mean aspartate transaminase, alanine aminotransferase, and total bilirubin levels were 23.9 ± 8.1 IU/L, 20.9 ± 11.3 IU/L, and 0.8 ± 0.4 mg/dL, respectively, 6 months after liver donation. In conclusion, biliary complications were the most common types of major morbidity in living liver donors. Donor hepatectomy can be performed successfully with minimal and easily controlled complications. Our study shows that prospective, nationwide cohort data provide an important means of investigating the safety in living liver donation. Liver Transplantation 23 999-1006 2017 AASLD.
Collapse
Affiliation(s)
- Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chong Woo Chu
- Department of Surgery, Pusan National University College of Medicine, Busan, South Korea
| | - Bong-Wan Kim
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Dong Lak Choi
- Department of Surgery, Catholic University of Daegu College of Medicine, Daegu, South Korea
| | - Young Kyoung You
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Sik Kim
- Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Yang Won Nah
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Koo Jeong Kang
- Department of Surgery, Keimyung University School of Medicine, Daegu, South Korea
| | - In Soek Choi
- Department of Surgery, Konyang University Hospital, Nonsan, South Korea
| | - Hee Chul Yu
- Department of Surgery, Chonbuk National University School of Medicine, Jeonju, South Korea
| | - Geun Hong
- Department of Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Shin Hwang
- Department of Surgery, College of Medicine University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
|
11
|
Successful extracorporeal resuscitation after perioperative anaphylactic shock during living donor liver transplantation. Asian J Surg 2017; 40:317-319. [DOI: 10.1016/j.asjsur.2014.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 10/01/2014] [Accepted: 10/06/2014] [Indexed: 11/24/2022] Open
|
|
12
|
Shen S, Zhang W, Jiang L, Yan L, Yang J. Comparison of Upper Midline Incision With and Without Laparoscopic Assistance for Living-Donor Right Hepatectomy. Transplant Proc 2017; 48:2726-2731. [PMID: 27788808 DOI: 10.1016/j.transproceed.2016.03.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/01/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since minimally invasive procedures for living-donor right hepatectomy (LDRH) became popular in recent years, several studies comparing the outcomes of donors undergoing an upper midline incision (UMI) under laparoscopic assistance for LDRH with those undergoing the traditional open LDRH have been published. However, there are very few comparative studies of outcomes for a UMI for LDRH with and without laparoscopic-assistance. We designed the present study to compare the benefits and shortcomings of a UMI for LDRH with and without laparoscopic assistance. METHODS Forty-eight patients in our center were included in the study: group hybrid (n = 28) versus group UMI (n = 20). Their surgical outcomes, postoperative course, and cosmetic outcomes were studied from medical records. RESULTS No differences existed between the 2 groups regarding their baseline characteristics except that group Hybrid had more donors with positive hepatitis B core antibody. No difference was observed in operative time, graft weight, warm ischemia time, blood loss, incision length, liver and coagulation function test results, postoperative complications, or cosmetic parameters. No deaths occurred in both groups. The length of postoperative hospital stay was similar for both groups, but the hospital cost was significantly lower for group UMI than for group hybrid (6,906.7 ± 777.4 USD vs 7,643.3 ± 918.6 USD; P = .005). CONCLUSIONS An UMI without laparoscopic assistance can be considered as the first-line incision of choice for LDRH.
Collapse
Affiliation(s)
- S Shen
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - W Zhang
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - L Jiang
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
| | - L Yan
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - J Yang
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| |
Collapse
|
|
13
|
Toniutto P, Zanetto A, Ferrarese A, Burra P. Current challenges and future directions for liver transplantation. Liver Int 2017; 37:317-327. [PMID: 27634369 DOI: 10.1111/liv.13255] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/08/2016] [Indexed: 12/14/2022]
Abstract
Liver transplantation is an effective and widely used therapy for several patients with acute and chronic liver diseases. The discrepancy between the number of patients on the waiting list and available donors remains the key issue and is responsible for the high rate of waiting list mortality. The recent news is that the majority of patients with hepatitis C virus related liver disease will be cured by new antivirals therefore we should expect soon a reduction in the need of liver transplantation for these recipients. This review aims to highlight, in two different sections, the main open issues of liver transplantation concerning the current and future strategies to the best use of limited number of organs. The first section cover the strategies to increase the donor pool, discussing the use of older donors, split grafts, living donation and donation after cardiac death and mechanical perfusion systems to improve the preservation of organs before liver transplantation. Challenges in immunosuppressive therapy and operational tolerance induction will be evaluated as potential tools to increase the survival in liver transplant recipients and to reducing the need of re-transplantation. The second section is devoted to the evaluation of possible new indications to liver transplantation, where the availability of organs by implementing the strategies mentioned in the first section and the reduction in the number of waiting transplants for HCV disease is realized. Among these new potential indications for transplantation, the expansion of the Milan criteria for hepatocellular cancer is certainly the most open to question.
Collapse
Affiliation(s)
- Pierluigi Toniutto
- Department of Clinical Sciences Experimental and Clinical, Medical Liver Transplant Section, University of Udine, Udine, Italy
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padova, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padova, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padova, Italy
| |
Collapse
|
|
14
|
Eguchi S, Soyama A, Nagai K, Miyazaki Y, Kurihara S, Hidaka M, Ono S, Adachi T, Natsuda K, Hara T, Fujita F, Kanetaka K, Takatsuki M. The donor advocacy team: a risk management program for living organ, tissue, and cell transplant donors. Surg Today 2017; 47:980-985. [PMID: 28205018 DOI: 10.1007/s00595-017-1468-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/20/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Although the incidence of living donor death is low in Japan, statistics show one living liver donor death in more than 7000 living liver transplants. Thus, medical transplant personnel must recognize that the death of a living organ or tissue transplant donor can occur and develop an appropriate risk management program. METHODS AND RESULTS We describe how Nagasaki University Hospital established and implemented a Donor Advocacy Team (DAT) program: a risk management program for initiation in the event of serious, persistent, or fatal impairment of an organ, tissue, or cell transplantation from a living donor. DISCUSSION The purposes of the DAT program are as follows: 1. To disclose official information without delay. 2. To provide physical and psychological care to the patient experiencing impairment and their family. 3. To provide psychological care to the medical staff in charge of the transplant. 4. To standardize the responses of the diagnosis and treatment department staff and other hospital staff. 5. To minimize the damage that the whole medical transplantation system may suffer and leverage the occurrence for improvement. To address (1) and (5), actions, such as reporting and responses to the government, mass media, transplant-related societies, and organ transplant networks, have been established to ensure implementation.
Collapse
Affiliation(s)
- Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Kazuhiro Nagai
- Department of Medical Safety, Nagasaki University Hospital, Nagasaki, Japan
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasushi Miyazaki
- Department of Medical Safety, Nagasaki University Hospital, Nagasaki, Japan
| | - Shintaro Kurihara
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Shinichiro Ono
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Koji Natsuda
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Takanobu Hara
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Fumihiko Fujita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Mistuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| |
Collapse
|
|
15
|
Russo FP, Ferrarese A, Zanetto A. Recent advances in understanding and managing liver transplantation. F1000Res 2016; 5:F1000 Faculty Rev-2895. [PMID: 28105300 PMCID: PMC5224676 DOI: 10.12688/f1000research.8768.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 12/13/2022] Open
Abstract
Liver transplantation (LT) has been established as the most effective treatment modality for end-stage liver disease over the last few decades. Currently, patient and graft survival after LT are excellent, with 1- and 5-year survival of 90% and 80%, respectively. However, the timing of referral to LT is crucial for improving survival benefit and outcome. The current shortage of donors and the increasing demand for LT currently lengthen the waiting time. Thus, waiting list mortality is about 10-15%, according to the geographical area. For this reason, over the last several years, alternatives to deceased donor LT and new options for prioritizing patients on the waiting list have been proposed.
Collapse
Affiliation(s)
- Francesco Paolo Russo
- Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Alberto Ferrarese
- Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Alberto Zanetto
- Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| |
Collapse
|
|
16
|
Al-Hamoudi W, Abaalkhail F, Bendahmash A, Allam N, Hegab B, Elsheikh Y, Al-bahili H, Almasri N, Al-sofayan M, Alabbad S, Al-Sebayel M, Broering D, Elsiesy H. The impact of metabolic syndrome and prevalent liver disease on living donor liver transplantation: a pressing need to expand the pool. Hepatol Int 2016; 10:347-354. [PMID: 26341515 DOI: 10.1007/s12072-015-9664-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Organ shortage has been the ongoing obstacle to expanding liver transplantation worldwide. Living donor liver transplantation (LDLT) is hoped to improve this shortage. The aim of the present study is to analyze the impact of metabolic syndrome and prevalent liver disease on living donations. METHODS From July 2007 to May 2012, 1065 potential living donors were evaluated according to a stepwise evaluation protocol. The age of the worked-up donors ranged from 18 to 45 years. RESULTS Only 190 (18%) were accepted for donation, and 875 (82%) were rejected. In total, 265 (24.9%) potential donors were excluded because of either diabetes or a body mass index >28. Some potential donors were excluded at initial screening because of incompatible blood groups (115; 10.8%), social reasons (40; 3.8%), or elevated liver enzymes (9; 1%). Eighty-five (8%) donors were excluded because of positive hepatitis serology. Steatosis resulted in the exclusion of 84 (8%) donors. In addition, 80 (7.5%) potential donors were rejected because of variations in biliary anatomy, and 20 (2%) were rejected because of aberrant vascular anatomy. Rejection due to biliary-related aberrancy decreased significantly in the second half of our program (11 vs. 4%, p = 0.001). In total, 110 (10.3%) potential donors were rejected because of insufficient remnant volume (<30%) as determined by CT volumetry, whereas 24 (2.2%) were rejected because of a graft-to-recipient body weight ratio less than 0.8%. CONCLUSION Metabolic syndrome and viral hepatitis negatively impacted our living donor pool. Expanding the donor pool requires the implementation of new strategies.
Collapse
Affiliation(s)
- Waleed Al-Hamoudi
- Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, P.O BOX 2454, Riyadh, 11451, Saudi Arabia.
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia.
| | - Faisal Abaalkhail
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Abdurahman Bendahmash
- Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, P.O BOX 2454, Riyadh, 11451, Saudi Arabia
| | - Naglaa Allam
- Hepatology Department, National Liver Institute, Menoufeya University, Menoufeya, Egypt.
| | - Bassem Hegab
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Yasser Elsheikh
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Hamad Al-bahili
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Nasser Almasri
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Mohammed Al-sofayan
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Saleh Alabbad
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Mohammed Al-Sebayel
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Dieter Broering
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia
| | - Hussien Elsiesy
- Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia.
| |
Collapse
|
|
17
|
O'Connor R, Parkosewich J, Curran J, Cartiera K, Knobf MT. Getting Used to Being a Patient: The Postoperative Experience of Living Liver Transplant Donors. Prog Transplant 2015; 25:153-9. [DOI: 10.7182/pit2015298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Context— Living donor liver transplant is a viable option for eligible persons in need of a liver transplant, but little is known about the hospitalization experience of patients undergoing hepatectomy for transplant donation. Objective— To explore the hospital experience of patients recovering from donor hepatectomy. Design— A qualitative interpretive descriptive design was used to understand the hospital experience of patients recovering from donor hepatectomy. Semistructured interviews, conducted before discharge, were audiotaped and transcribed verbatim. Coding was performed independently, then jointly by investigators to reach consensus on emerging themes. Setting— Major university hospital in the Northeastern United States. Sample— Adults (>18 years of age) whose primary language was English or Spanish and who could provide written informed consent. Results— The sample consisted of 15 participants who had a mean age of 34.6 years; half were women. Most were white and college educated. The relationship of the donors to recipients varied from immediate family to altruistic donors. “Getting used to being a patient” was the major theme that captured the patients' postoperative experience. Four subthemes explained the experience: regaining consciousness, all those tubes, expecting horrible pain, and feeling special and cared for. These were described in the context of an “amazing and impressive” transplant team. Conclusion— As healthy donors are getting used to being patients, these results provide clinicians with a deeper understanding of the transplant experience from the donor's perspective so that care can be tailored to meet their unique needs.
Collapse
Affiliation(s)
- Rick O'Connor
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| | - Janet Parkosewich
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| | - Jeffrey Curran
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| | - Katarzyna Cartiera
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| | - M. Tish Knobf
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| |
Collapse
|
|
18
|
Dutkowski P, Linecker M, DeOliveira ML, Müllhaupt B, Clavien PA. Challenges to liver transplantation and strategies to improve outcomes. Gastroenterology 2015; 148:307-23. [PMID: 25224524 DOI: 10.1053/j.gastro.2014.08.045] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/29/2014] [Accepted: 08/29/2014] [Indexed: 02/07/2023]
Abstract
Liver transplantation (LT) is a highly successful treatment for many patients with nonmalignant and malignant liver diseases. However, there is a worldwide shortage of available organs; many patients deteriorate or die while on waiting lists. We review the important clinical challenges to LT and the best use of the scarce organs. We focus on changes in indications for LT and discuss scoring systems to best match donors with recipients and optimize outcomes, particularly for the sickest patients. We also cover controversial guidelines for the use of LT in patients with hepatocellular carcinoma and cholangiocarcinoma. Strategies to increase the number of functional donor organs involve techniques to perfuse the organs before implantation. Partial LT (living donor and split liver transplantation) techniques might help to overcome organ shortages, and we discuss small-for-size syndrome. Many new developments could increase the success of this procedure, which is already one of the major achievements in medicine during the second part of the 20th century.
Collapse
Affiliation(s)
- Philipp Dutkowski
- Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Michael Linecker
- Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Michelle L DeOliveira
- Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Beat Müllhaupt
- Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
|
19
|
Liu X, Hakucho A, Liu J, Fujimiya T. Delayed ethanol elimination and enhanced susceptibility to ethanol-induced hepatosteatosis after liver resection. World J Gastroenterol 2014; 20:18249-18259. [PMID: 25561792 PMCID: PMC4277962 DOI: 10.3748/wjg.v20.i48.18249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/04/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate ethanol-induced hepatic steatosis after liver resection and the mechanisms behind it.
METHODS: First, the preliminary examination was performed on 6 sham-operated (Sham) and 30 partial hepatectomy (PH) male Wistar rats (8-wk-old) to evaluate the recovery of the liver weight and liver function after liver resection. PH rats were sacrificed at the indicated time points (4, 8, and 12 h; 1, 3, and 7 d) after PH. Second, the time point for the beginning of the chronic ethanol exposure (1 wk after sham- or PH-operation) was determined based on the results of the preliminary examination. Finally, pair-feeding was performed with a controlled diet or with a 5-g/dL ethanol liquid diet for 28 d in another 35 age-matched male Wistar rats with a one-week recovery after undergoing a sham- (n = 15) or PH-operation (n = 20) to evaluate the ethanol-induced liver injury after liver resection. Hepatic steatosis, liver function, fatty acid synthase (Fas) gene expression level, the expression of lipid metabolism-associated enzyme regulator genes [sterol regulatory element binding protein (Srebp)-1 and peroxisome proliferator-activated receptor (Ppar)-α], the mediators that alter lipid metabolism [plasminogen activator (Pai)-1 gene expression level and tumor necrosis factor (Tnf)-α production], and hepatic class-1 alcohol dehydrogenase (Adh1)-associated ethanol elimination were investigated in the 4 groups based on histological, immunohistochemical, biochemical, Western blotting, reverse transcriptase chain reaction, and blood ethanol concentration analyses. The relevant gene expression levels, liver weight, and liver function were assessed before and 1 wk after surgery to determine the subject’s recovery from the liver resection using the rats that had been subjected to the preliminary examination.
RESULTS: In the PH rats, ethanol induced marked hepatic steatosis with impaired liver functioning, as evidenced by the accumulation of fatty droplets within the hepatocytes, the higher increases in their hepatic triglyceride and blood alanine aminotransferase and blood aspartate aminotransferase levels after the 28-d pair-feeding period. The Sham-ethanol rats, not the PH-ethanol rats, demonstrated the up-regulation of Srebp-1 and the down-regulation of Ppar-α mRNA expression levels after the 28-d pair-feeding period. The 28-d ethanol administration induced the up-regulation of Pai-1 gene expression level and an overproduction of TNF-α in the Sham and the PH rats; however, the effect was more significant in the PH rats. The PH-ethanol rats (n = 4) showed higher residual blood ethanol concentrations than did the Sham-ethanol rats (n = 6) after a 5-h fast (0.66 ± 0.4 mg/mL vs 0.2 ± 0.1 mg/mL, P < 0.05); these effects manifested without up-regulation of Adh1 gene expression, which was present in the Sham-ethanol group after the 28-d pair-feeding period. One week after the liver resection, the liver weight, function, the gene expression levels of Fas, Srebp-1, Ppar-α, Pai-1 and Tnf-α recovered; however, the Adh1 gene expression did not recover in rats.
CONCLUSION: Desensitization to post-hepatectomy ethanol treatment and slow recovery from PH in Adh1 gene expression enhanced the susceptibility to ethanol-induced hepatic steatosis after PH in rats.
Collapse
|
|
20
|
Iwasaki J, Iida T, Mizumoto M, Uemura T, Yagi S, Hori T, Ogawa K, Fujimoto Y, Mori A, Kaido T, Uemoto S. Donor morbidity in right and left hemiliver living donor liver transplantation: the impact of graft selection and surgical innovation on donor safety. Transpl Int 2014; 27:1205-1213. [DOI: 10.1111/tri.12414] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/29/2013] [Accepted: 07/28/2014] [Indexed: 01/14/2023]
Affiliation(s)
- Junji Iwasaki
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Taku Iida
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Masaki Mizumoto
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tadahiro Uemura
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Shintaro Yagi
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tomohide Hori
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Kohei Ogawa
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Yasuhiro Fujimoto
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Akira Mori
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Toshimi Kaido
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Shinji Uemoto
- Division of Hepatobiliary Pancreatic and Transplant Surgery; Department of Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| |
Collapse
|
|
21
|
Small Upper Midline Incision for Living Donor Hemi-Liver Graft Procurement in Adults. J Am Coll Surg 2014; 219:e39-43. [DOI: 10.1016/j.jamcollsurg.2014.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/17/2014] [Accepted: 04/23/2014] [Indexed: 02/07/2023]
|
|
22
|
Panocchia N, Bossola M, Silvestri P, Midolo E, Teleman AA, Tazza L, Sacchini D, Minacori R, Di Pietro ML, Spagnolo AG. Ethical evaluation of risks related to living donor transplantation programs. Transplant Proc 2014; 45:2601-3. [PMID: 24034000 DOI: 10.1016/j.transproceed.2013.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The shortage of available cadaveric organs for transplantation and the growing demand has incresed live donation. To increase the number of transplantations from living donors, programs have been implemented to coordinate donations in direct or indirect form (cross-over, paired, and domino chain). Living donors with complex medical conditions are accepted by several transplantation programs. In this way, the number of transplants from living has exceeded that from cadaver donors in several European countries. No mortality has been reported in the case of lung, pancreas, or intestinal Living donations, but the perioperative complications range from 15% to 30% for pancreas and lung donors. In living kidney donors, the perioperative mortality is 3 per 10,000. Their frequency of end-stage renal disease does not exceed the United States rate for the general population. However, long-term follow-up studies of living donors for kidney transplantations have several limitations. The frequency of complications in live donor liver transplantation is 40%, of these, 48% are possibly life-threatening according to the Clavien classification. Residual disability, liver failure, or death has occurred in 1% of cases. The changes in live donor acceptance criteria raise ethical issues, in particular, the physician's role in evaluating and accepting the risks taken by the living donor. Some workers argue to set aside medical paternalism on behalf of the principle of donor autonomy. In this way the medical rule "primum non nocere" is overcome. Transplantation centers should reason beyond the shortage of organs and think in terms of the care for both donor and recipient.
Collapse
Affiliation(s)
- N Panocchia
- Hemodialysis Service, Department of Surgery, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
23
|
Molinari M, Matz J, DeCoutere S, El-Tawil K, Abu-Wasel B, Keough V. Live liver donors' risk thresholds: risking a life to save a life. HPB (Oxford) 2014; 16:560-74. [PMID: 24251593 PMCID: PMC4048078 DOI: 10.1111/hpb.12192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/19/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is still some controversy regarding the ethical issues involved in live donor liver transplantation (LDLT) and there is uncertainty on the range of perioperative morbidity and mortality risks that donors will consider acceptable. METHODS This study analysed donors' inclinations towards LDLT using decision analysis techniques based on the probability trade-off (PTO) method. Adult individuals with an emotional or biological relationship with a patient affected by end-stage liver disease were enrolled. Of 122 potential candidates, 100 were included in this study. RESULTS The vast majority of participants (93%) supported LDLT. The most important factor influencing participants' decisions was their wish to improve the recipient's chance of living a longer life. Participants chose to become donors if the recipient was required to wait longer than a mean ± standard deviation (SD) of 6 ± 5 months for a cadaveric graft, if the mean ± SD probability of survival was at least 46 ± 30% at 1 month and at least 36 ± 29% at 1 year, and if the recipient's life could be prolonged for a mean ± SD of at least 11 ± 22 months. CONCLUSIONS Potential donors were risk takers and were willing to donate when given the opportunity. They accepted significant risks, especially if they had a close emotional relationship with the recipient.
Collapse
Affiliation(s)
| | - Jacob Matz
- Department of Surgery, Dalhousie UniversityHalifax, NS, Canada
| | - Sarah DeCoutere
- Department of Infectious Disease, Dalhousie UniversityHalifax, NS, Canada
| | - Karim El-Tawil
- Department of Surgery, Dalhousie UniversityHalifax, NS, Canada
| | | | - Valerie Keough
- Department of Radiology, Dalhousie UniversityHalifax, NS, Canada
| |
Collapse
|
|
24
|
Fukuda A, Sakamoto S, Shigeta T, Uchida H, Hamano I, Sasaki K, Kanazawa H, Loh DL, Kakee N, Nakazawa A, Kasahara M. Clinical outcomes and evaluation of the quality of life of living donors for pediatric liver transplantation: a single-center analysis of 100 donors. Transplant Proc 2014; 46:1371-6. [PMID: 24836837 DOI: 10.1016/j.transproceed.2013.12.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/16/2013] [Indexed: 01/10/2023]
Abstract
There are few reports about the quality of life (QOL) and morbidities of pediatric living donor liver transplantation (LDLT) donors. We evaluated the potential morbidities and identified the predictive factors regarding the QOL of living donors after pediatric LDLT. This cross-sectional study was a single-center analysis of 100 donors for pediatric LDLT. The severity of morbidities was assessed with the Clavien classification, the QOL was investigated with the short form-36 (SF-36), and the decision-making process regarding donation was analyzed with questionnaires. The median follow-up period was 3.8 years (range, 2.2-6.0 years). A total of 13% of the donors developed postoperative complications of Clavien grades I (7%), II (3%), and IIIA (3%). There was no grade IV morbidity or mortality. Eighty-one donors responded to the questionnaire and SF-36. The analysis of the questionnaires revealed that the donors had difficulty in the decision-making process, and suggested that it may be necessary to administer multistep informed consent. We identified unique predictive risk factors for lower SF-36 scores in the donors, which were the time to donation (more than 4 weeks) and the predonation self-oriented perception. The donors who have risk factors require enhanced pre- and post-donation psychological care.
Collapse
Affiliation(s)
- A Fukuda
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
| | - S Sakamoto
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - T Shigeta
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - H Uchida
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - I Hamano
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - K Sasaki
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - H Kanazawa
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - D L Loh
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - N Kakee
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - A Nakazawa
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - M Kasahara
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
|
25
|
Kawaguchi Y, Sugawara Y, Yamashiki N, Kaneko J, Tamura S, Aoki T, Sakamoto Y, Hasegawa K, Nojiri K, Kokudo N. Role of 6-month abstinence rule in living donor liver transplantation for patients with alcoholic liver disease. Hepatol Res 2013; 43:1169-74. [PMID: 23387410 DOI: 10.1111/hepr.12065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 12/30/2012] [Accepted: 01/03/2013] [Indexed: 12/15/2022]
Abstract
AIM Although alcoholic liver disease (ALD) is an accepted indication for liver transplantation (LT), there are several controversial issues. The aim of this study is to examine the applicability of the 6-month abstinence rule prior to LT and to evaluate the results in living donor LT for patients with ALD. METHODS A retrospective study of 102 patients with ALD referred for LT was performed. Clinical data, including alcohol consumption history, were analyzed. A period of abstinence from drinking alcohol of at least 6 months was strictly required. RESULTS Among 102 patients, 21 abstained from drinking for at least 6 months. Of these, 13 patients (12%) underwent LT, five patients (5%) recovered without LT and three patients (3%) were listed for deceased donor LT. LT was not indicated for the remaining 81 patients (80%). Eight patients died within 6 months of referral to our program. The Child-Pugh score was higher in these eight patients than in the 21 who achieved 6-month abstinence, although the alcohol consumption history variables did not significantly differ between the two groups. The 5-year overall survival rates after LT in 13 patients with ALD (91%) were similar to those in 387 non-ALD patients (83%). The rate of alcohol consumption relapse after LT was 8% (n = 1/13). CONCLUSION Living donor LT for patients with ALD who complied with the 6-month abstinence rule provides sufficient survival benefit with good compliance, compensating for the potential risks to the donors.
Collapse
Affiliation(s)
- Yoshikuni Kawaguchi
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
26
|
Yamashita YI, Shirabe K, Tsuijita E, Takeishi K, Ikegami T, Yoshizumi T, Soejima Y, Ikeda T, Utsunomiya T, Maehara Y. Third or more repeat hepatectomy for recurrent hepatocellular carcinoma. Surgery 2013; 154:1038-45. [PMID: 23973109 DOI: 10.1016/j.surg.2013.04.046] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 04/19/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND We sought to evaluate the surgical results of third or more repeat hepatectomy for recurrent hepatocellular carcinoma (HCC). The role of repeat hepatectomy for recurrent HCC, especially in cases with third or more repeat hepatectomy, is controversial. METHODS We performed A retrospective, cohort study to analyze the surgical results of repeat hepatectomy performed at a single medical center from 1989 to 2011. A total of 1,000 hepatectomies for HCC were divided into 3 groups: A first hepatectomy group (n = 791), second hepatectomy group (n = 163), and third or more hepatectomy group (n = 46). Operative results and patient prognoses were compared among the 3 groups. RESULTS There were no differences in early surgical results such as mortality and morbidity among the 3 groups. The 5-year survival rates after the first, second, and third or more hepatectomy were 67%, 60%, and 43%, respectively (P = .1913). There was a significant difference in disease-free survival among the 3 groups, and the 5-year disease-free survival rates after first, second, and third or more hepatectomy were 37%, 29%, and 18%, respectively (P = .0169). CONCLUSION Third or more repeat hepatectomy for recurrent HCC was performed safely and associated with relatively long-term survival. Third or more repeat hepatectomy for recurrent HCC seems justified, but high rate of HCC recurrence remains a problem.
Collapse
Affiliation(s)
- Yo-ichi Yamashita
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
27
|
Duerinckx N, Timmerman L, Van Gogh J, van Busschbach J, Ismail SY, Massey EK, Dobbels F. Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review. Transpl Int 2013; 27:2-18. [DOI: 10.1111/tri.12154] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/18/2013] [Accepted: 06/28/2013] [Indexed: 01/10/2023]
Affiliation(s)
- Nathalie Duerinckx
- Health Services and Nursing Research; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
- Heart Transplant Program; University Hospitals of Leuven; Leuven Belgium
| | - Lotte Timmerman
- Internal Medicine, Nephrology & Transplantation; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Johan Van Gogh
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Jan van Busschbach
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Sohal Y. Ismail
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Emma K. Massey
- Internal Medicine, Nephrology & Transplantation; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Fabienne Dobbels
- Health Services and Nursing Research; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
| | | |
Collapse
|
|
28
|
Settmacher U, Bauschke A, Malessa C, Scheuerlein H, Zanow J, Rauchfuß F. [Liver transplantation with living donor : current aspects, perspectives and significance in Germany]. Chirurg 2013; 84:398-408. [PMID: 23595852 DOI: 10.1007/s00104-012-2414-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
More than 20 years ago living donor liver transplantation was introduced into clinical practice. Specifics of this method were developed initially for children and later on for adults particularly in regions where a liver transplantation program using deceased donors was not readily available. The most sensitive aspect of living donation, namely the danger to a healthy relative in order to perform the transplantation is immanent in the system and, thus, it is definitively a secondary option as compared to deceased organ donation. Following worldwide initial euphoria the numbers have markedly decreased in the western world since the start of the new millennium. In Asian countries in particular, much work has been done to optimize the procedure so that the donor safety and the outcome quality for the recipient have been impressively demonstrated in large patient populations. There is still a severe donor organ shortage and the option to allocate an optimal (partial) organ on an individual basis by living donation has given new impact to the discussion about a further rise in the profile of living donations here as well. The new version of the German transplantation legislation implemented in summer 2012 requires a number of conditions with respect to insurance for living donors. The current state and perspectives are presented here.
Collapse
Affiliation(s)
- U Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland.
| | | | | | | | | | | |
Collapse
|
|
29
|
Living Donor Liver Transplant is not a Transparent Activity in India. J Clin Exp Hepatol 2013; 3:66-9. [PMID: 25755473 PMCID: PMC3940284 DOI: 10.1016/j.jceh.2012.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 10/10/2012] [Indexed: 12/12/2022] Open
Abstract
Living donor liver transplant has gained rapid popularity in India as a life saving procedure for end stage liver disease. The undoubted benefit for the recipient is clouded by a few unfavorable outcomes in donors which have led to allegations of lack of transparency. These factors are easily remediable with an attitude of self audit and self disclosure by transplant centers, enabling a truly informed consenting procedure.
Collapse
|
|
30
|
Hu A, Liang W, Zheng Z, Guo Z, He X. Living donor vs. deceased donor liver transplantation for patients with hepatitis C virus-related diseases. J Hepatol 2012; 57:1228-43. [PMID: 22820490 DOI: 10.1016/j.jhep.2012.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/23/2012] [Accepted: 07/12/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Living donor liver transplantation (LDLT) provides a timely alternative to deceased donor liver transplantation (DDLT) for patients with hepatitis C virus-related (HCV-related) diseases in the circumstances of severe organ dearth. However, the patient and graft outcomes, and recurrence of HCV after LDLT remain controversial. Here we sought to compare the post-transplant outcomes after LDLT and DDLT. METHODS A systematic review and meta-analysis were performed. PubMed/MEDLINE, EMBASE, and the Cochrane database were searched for eligible literatures. The major end points were patient survival, graft survival, recurrence rate, and acute rejection. The pooled odds ratio (OR) was calculated using random-effects model to synthesize the results. Heterogeneity and publication bias were quantitatively evaluated. RESULTS Fourteen studies with a total of 2024 participants were included in this analysis. We found comparable patient survival between groups (1-year: OR, 0.78, 95% CI, 0.48-1.26, p=0.31; 2-year: OR, 0.71, 95% CI, 0.41-1.23, p=0.23; 3-year: OR, 0.79, 95% CI, 0.5-1.12, p=0.18; 4-year: OR, 0.92, 95% CI, 0.43-1.95, p=0.83; 5-year: OR, 1.06, 95% CI, 0.53-2.14, p=0.86, respectively). Although 1- and 3-year graft survivals were inferior in LDLT, 2-, 4- and 5-year graft survivals were similar. HCV recurrence rates and acute rejection rates were equivalent. CONCLUSIONS LDLT was equivalent to DDLT in terms of patient survival, long-term graft survival, HCV recurrence, and acute rejection rates, with potentially lower short-term patient and graft survival.
Collapse
Affiliation(s)
- Anbin Hu
- Department of General Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | | | | | | | | |
Collapse
|
|
31
|
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
|
|
32
|
Nagai S, Brown L, Yoshida A, Kim D, Kazimi M, Abouljoud MS. Mini-incision right hepatic lobectomy with or without laparoscopic assistance for living donor hepatectomy. Liver Transpl 2012; 18:1188-97. [PMID: 22685084 DOI: 10.1002/lt.23488] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Minimally invasive procedures are considered to be safe and effective approaches to the management of surgical liver disease. However, this indication remains controversial for living donor hepatectomy. Between 2000 and 2011, living donor right hepatectomy (LDRH) was performed 58 times. Standard right hepatectomy was performed in 30 patients via a subcostal incision with a midline extension. Minimally invasive procedures began to be used for LDRH in 2008. A hybrid technique (hand-assisted laparoscopic liver mobilization and minilaparotomy for parenchymal dissection) was developed and used in 19 patients. In 2010, an upper midline incision (10 cm) without laparoscopic assistance for LDRH was innovated, and this technique was used in 9 patients. The perioperative factors were compared, and the indications for minimally invasive LDRH were investigated. The operative blood loss was significantly less for the patients undergoing a minimally invasive procedure versus the patients undergoing the standard procedure (212 versus 316 mL, P = 0.001), and the operative times were comparable. The length of the hospital stay was significantly shorter for the minimally invasive technique group (5.9 versus 7.8 days, P < 0.001). The complication rates were 23% and 25% for the standard technique and minimally invasive technique groups, respectively (P = 0.88). Patients undergoing minilaparotomy LDRH had a body mass index (24.0 kg/m(2)) similar to that of the hybrid technique patients (25.8 kg/m(2), P = 0.36), but the graft size was smaller (780 versus 948 mL, P = 0.22). In conclusion, minimally invasive LDRH can be performed without safety being impaired. LDRH with a 10-cm upper midline incision and without laparoscopic assistance may be appropriate for donors with a smaller body mass. Laparoscopic assistance can be added as needed for larger donors. This type of LDRH with a 10-cm incision is innovative and is recommended for experienced centers.
Collapse
Affiliation(s)
- Shunji Nagai
- Division of Transplant and Hepatobiliary Surgery, Henry Ford Transplant Institute, Henry Ford Hospital, Detroit, MI 48202, USA
| | | | | | | | | | | |
Collapse
|
|
33
|
Quintini C, Hashimoto K, Uso TD, Miller C. Is there an advantage of living over deceased donation in liver transplantation? Transpl Int 2012; 26:11-9. [PMID: 22937787 DOI: 10.1111/j.1432-2277.2012.01550.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Living donor liver transplantation (LDLT) is a well-established strategy to decrease the mortality in the waiting list and recent studies have demonstrated its value even in patients with low MELD score. However, LDLT is still under a high level of scrutiny because of its technical complexity and ethical challenges as demonstrated by a decline in the number of procedures performed in the last decade in Western Countries. Many aspects make LDLT different from deceased donor liver transplantation, including timing of transplantation, procedure-related complications as well as immunological factors that may affect graft outcomes. Our review suggests that in selected cases, LDLT offers significant advantages over deceased donor liver transplantation and should be used more liberally.
Collapse
|
|
34
|
Ohno Y, Mita A, Ikegami T, Masuda Y, Urata K, Nakazawa Y, Kobayashi A, Terada M, Ikeda S, Miyagawa S. Temporary auxiliary partial orthotopic liver transplantation using a small graft for familial amyloid polyneuropathy. Am J Transplant 2012; 12:2211-9. [PMID: 22500969 DOI: 10.1111/j.1600-6143.2012.04061.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor shortage is a major issue in liver transplantation. We have successfully performed temporary auxiliary partial orthotopic liver transplantation (APOLT) using a small volume graft procured from a living donor for recipients with familial amyloid polyneuropathy (FAP). The aim of this study was to evaluate this procedure by comparing it with standard living donor liver transplantation (LDLT). We compared 13 recipients undergoing this procedure with 23 recipients undergoing a standard LDLT for the treatment of FAP. The estimated donor graft volume and the graft volume/recipient's standard liver volume ratio were significantly smaller in the temporary APOLT group than in the standard LDLT group. Postoperative complications were comparable, although the hospital stay was longer in the temporary APOLT group. All the patients safely underwent a remnant native liver resection about 2 months after their first operation in the temporary APOLT group. No symptoms related to FAP developed before the remnant liver resection, and no significant differences in graft and patient survival were observed between the two groups. We successfully performed temporary APOLT using a small volume liver graft without postoperative liver failure for FAP. Temporary APOLT for FAP might be a useful alternative procedure for expanding the donor pool for LDLT.
Collapse
Affiliation(s)
- Y Ohno
- Department of Surgery, Division of Transplantation, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
35
|
Ringe KI, Ringe BP, von Falck C, Shin HO, Becker T, Pfister ED, Wacker F, Ringe B. Evaluation of living liver donors using contrast enhanced multidetector CT - The radiologists impact on donor selection. BMC Med Imaging 2012; 12:21. [PMID: 22828359 PMCID: PMC3427040 DOI: 10.1186/1471-2342-12-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/24/2012] [Indexed: 01/10/2023] Open
Abstract
Background Living donor liver transplantation (LDLT) is a valuable and legitimate treatment for patients with end-stage liver disease. Computed tomography (CT) has proven to be an important tool in the process of donor evaluation. The purpose of this study was to evaluate the significance of CT in the donor selection process. Methods Between May 1999 and October 2010 170 candidate donors underwent biphasic CT. We retrospectively reviewed the results of the CT and liver volumetry, and assessed reasons for rejection. Results 89 candidates underwent partial liver resection (52.4%). Based on the results of liver CT and volumetry 22 candidates were excluded as donors (31% of the cases). Reasons included fatty liver (n = 9), vascular anatomical variants (n = 4), incidental finding of hemangioma and focal nodular hyperplasia (n = 1) and small (n = 5) or large for size (n = 5) graft volume. Conclusion CT based imaging of the liver in combination with dedicated software plays a key role in the process of evaluation of candidates for LDLT. It may account for up to 1/3 of the contraindications for LDLT.
Collapse
Affiliation(s)
- Kristina Imeen Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str, 1, 30625, Hannover, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
|
36
|
Soejima Y, Shirabe K, Taketomi A, Yoshizumi T, Uchiyama H, Ikegami T, Ninomiya M, Harada N, Ijichi H, Maehara Y. Left lobe living donor liver transplantation in adults. Am J Transplant 2012; 12:1877-85. [PMID: 22429497 DOI: 10.1111/j.1600-6143.2012.04022.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Adult left lobe (LL) living donor liver transplantation (LDLT) has not generally been recognized as a feasible procedure because of the problem of graft size. The objectives of this study were to assess the feasibility and short- and long-term results of adult LL LDLT in comparison with right lobe (RL) LDLT. Data on 200 consecutive LL LDLTs, including five retransplants, were retrospectively compared with those of 112 RL LDLTs, in terms of survival, complications and donor morbidity. The mean graft weight to standard volume ratio of LL grafts was 38.7% whereas that of RL grafts was 47.6% (p < 0.0001). The 1-, 5- and 10-year patient survival rates of LL LDLT were 85.6%, 77.9% and 69.5%, respectively, which were comparable to those of RL LDLT (89.8%, 71.3% and 70.7%, respectively). The incidence of small-for-size syndrome was higher in LL LDLT (19.5%) than in RL LDLT (7.1%) (p < 0.01). The overall donor morbidity rates were comparable between LL (36.0%) and RL (34.8%), whereas postoperative liver function tests and hospital stay were significantly better (p < 0.0001) in LL donors. In conclusion, adult LL LDLT has comparable outcomes to that of RL LDLT. LL LDLT is viable and is the first choice in adult LDLT.
Collapse
Affiliation(s)
- Y Soejima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
37
|
Nicoluzzi JEL, Silveira F, Silveira FP, Macri MM, Monteiro M, Woitovicz V, Stalchimidt F. Primeiro transplante duplo de fígado esquerdo intervivos adultos do Brasil. Rev Col Bras Cir 2012; 39:226-9. [DOI: 10.1590/s0100-69912012000300012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 09/09/2011] [Indexed: 01/10/2023] Open
Abstract
O transplante hepático inter vivos adulto expandiu as possibilidades terapêuticas para pacientes com insuficiência hepática terminal. A necessidade de um volume hepático adequado que será retirado do doador e necessário ao receptor limita sua utilização em alguns casos. Apresentamos um caso em que se utilizou dois lobos esquerdos de dois doadores vivos no intuito de prover parênquima hepático suficiente ao receptor.
Collapse
|
|
38
|
Ishizaki Y, Kawasaki S, Sugo H, Yoshimoto J, Fujiwara N, Imamura H. Left lobe adult-to-adult living donor liver transplantation: Should portal inflow modulation be added? Liver Transpl 2012; 18:305-14. [PMID: 21932379 DOI: 10.1002/lt.22440] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Recently, the successful application of portal inflow modulation has led to renewed interest in the use of left lobe grafts in adult-to-adult living donor liver transplantation (LDLT). However, data on the hepatic hemodynamics supporting portal inflow modulation are limited, and the optimal portal circulation for a liver graft is still unclear. We analyzed 42 consecutive adult-to-adult left lobe LDLT cases without splenectomy or a portocaval shunt. The mean actual graft volume (GV)/recipient standard liver volume (SLV) ratio was 39.8% ± 5.7% (median = 38.9%, range = 26.1%-54.0%). The actual GV/SLV ratio was less than 40% in 24 of the 42 cases, and the actual graft-to-recipient weight ratio was less than 0.8% in 17 of the 42 recipients. The mean portal vein pressure (PVP) was 23.9 ± 7.6 mm Hg (median = 23.5 mm Hg, range = 9-38 mm Hg) before transplantation and 21.5 ± 3.6 mm Hg (median = 22 mm Hg, range = 14-27 mm Hg) after graft implantation. The mean portal pressure gradient (PVP - central venous pressure) was 14.5 ± 6.8 mm Hg (median = 13.5 mm Hg, range = 3-26 mm Hg) before transplantation and 12.4 ± 4.4 mm Hg (median = 13 mm Hg, range = 1-21 mm Hg) after graft implantation. The mean posttransplant portal vein flow was 301 ± 167 mL/minute/100 g of liver in the 38 recipients for whom it was measured. None of the recipients developed small-for-size syndrome, and all were discharged from the hospital despite portal hyperperfusion. The overall 1-, 3-, and 5-year patient and graft survival rates were 100%, 97%, and 91%, respectively. In conclusion, LDLT with a left liver graft without splenectomy or a portocaval shunt yields good long-term results for adult patients with a minimal donor burden.
Collapse
Affiliation(s)
- Yoichi Ishizaki
- Department of Hepatobiliary Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
|
39
|
Zheng S. Liver Transplantation for Hepatocellular Carcinoma. PRIMARY LIVER CANCER 2012:433-456. [DOI: 10.1007/978-3-642-28702-2_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
|
|
40
|
Ignacio Herrero J. III Reunión de consenso de la Sociedad Española de Trasplante Hepático (SETH). Hepatitis C, trasplante hepático de donante vivo, calidad de los injertos hepáticos y calidad de los programas de trasplante hepático. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:641-59. [DOI: 10.1016/j.gastrohep.2011.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 05/31/2011] [Indexed: 02/06/2023]
|
|
41
|
Pomfret EA, Lodge JPA, Villamil FG, Siegler M. Should we use living donor grafts for patients with hepatocellular carcinoma? Ethical considerations. Liver Transpl 2011; 17 Suppl 2:S128-32. [PMID: 21656657 DOI: 10.1002/lt.22356] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Elizabeth A Pomfret
- Department of Transplantation and Hepatobiliary Diseases, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
| | | | | | | |
Collapse
|
|
42
|
III Reunión de consenso de la Sociedad Española de Trasplante Hepático (SETH). Hepatitis C, trasplante hepático de donante vivo, calidad de los injertos hepáticos y calidad de los programas de trasplante hepático. Cir Esp 2011; 89:487-504. [DOI: 10.1016/j.ciresp.2011.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/02/2011] [Indexed: 12/17/2022]
|
|
43
|
Wertheim JA, Petrowsky H, Saab S, Kupiec-Weglinski JW, Busuttil RW. Major challenges limiting liver transplantation in the United States. Am J Transplant 2011; 11:1773-84. [PMID: 21672146 PMCID: PMC3166424 DOI: 10.1111/j.1600-6143.2011.03587.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Liver transplantation is the gold standard of care in patients with end-stage liver disease and those with tumors of hepatic origin in the setting of liver dysfunction. From 1988 to 2009, liver transplantation in the United States grew 3.7-fold from 1713 to 6320 transplants annually. The expansion of liver transplantation is chiefly driven by scientific breakthroughs that have extended patient and graft survival well beyond those expected 50 years ago. The success of liver transplantation is now its primary obstacle, as the pool of donor livers fails to keep pace with the growing number of patients added to the national liver transplant waiting list. This review focuses on three major challenges facing liver transplantation in the United States and discusses new areas of investigation that address each issue: (1) the need for an expanded number of useable donor organs, (2) the need for improved therapies to treat recurrent hepatitis C after transplantation and (3) the need for improved detection, risk stratification based upon tumor biology and molecular inhibitors to combat hepatocellular carcinoma.
Collapse
Affiliation(s)
- Jason A. Wertheim
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Los Angeles, CA,Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Henrik Petrowsky
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Los Angeles, CA,Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sammy Saab
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Los Angeles, CA,Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jerzy W. Kupiec-Weglinski
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Los Angeles, CA,Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ronald W. Busuttil
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Los Angeles, CA,Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
|
44
|
The impact of anatomical variations of the donorʼs liver on the procedure of living-related liver transplantation. EGYPTIAN LIVER JOURNAL 2011. [DOI: 10.1097/01.elx.0000397033.63789.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
|
45
|
Factors associated with changes in coagulation profiles after living donor hepatectomy. Transplant Proc 2011; 42:2430-5. [PMID: 20832521 DOI: 10.1016/j.transproceed.2010.04.069] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 03/03/2010] [Accepted: 04/01/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hepatic resection may be associated with postoperative coagulopathy. However, there is limited information about the predictors affecting coagulopathy after donor hepatectomy. We evaluated the contributors of maximal changes in prothrombin time (PT), activated thromboplastin time (aPTT), and platelet count in the development of postoperative coagulopathy. METHODS We retrospectively analyzed 864 living donors, all of whom received general anesthesia using desflurane, isoflurane, or sevoflurane. A coagulation derangement was defined as one or more of the following events postoperatively: peak PT >1.5 international normalized ratio (INR; highest quartile of PT), peak aPTT >46 seconds (highest quartile of aPTT), or nadir platelet count <100 × 10(9)/L. Factors were evaluated by univariate and multivariate logistic regression analysis to identify predictors of coagulopathy. RESULTS Mean postoperative peak PT, peak aPTT, and nadir platelet count were 1.4 ± 0.2 INR, 43.8 ± 23.7 seconds, and 155.9 ± 37.3 × 10(9)/L, respectively, with 39.4% of donors being at the risk for coagulation derangement. Multivariate logistic regression analysis revealed that predictors of such derangement included anesthesia duration, remnant liver volume, and body mass index (BMI). However, coagulation derangement was not independently associated with age, gender, volatile anesthetics, central venous pressure, fatty change in the liver, estimated blood loss, or intraoperative hypotensive episodes. CONCLUSION We found that long anesthesia duration, low BMI, and small remnant liver volume were predictors of coagulation derangement. These results provide a better understanding of risk factors affecting changes in coagulation profiles after living donor hepatectomy.
Collapse
|
|
46
|
Abstract
A perception that living donor liver transplantation can be accomplished with an acceptable donor complication rate and recipient survival rate has led to the acceptance of living donor liver transplantation as a viable alternative to decreased deceased donor transplantation. Careful candidate evaluation and selection has been crucial to the success of this procedure. Advancements in the understanding of the lobar nature of the liver and of liver regeneration have advanced the surgical technique. Initial attempts at adult-to-adult donation utilized the left hepatic lobe, but now have evolved into use of the right hepatic lobe. Size matching is very important to successful graft function in the recipient. There is great concern regarding morbidity and mortality in donors. Biliary complications and infections continue to be among the most highly reported complications, although rates vary among centers and countries. Reports of single center complications have ranged from 9% to 67%. A survey of centers in the United States in 2003 reported complications of 10%. A series from our institution reported complications arising in 13 (33%) of 39 patients. A review focused on documenting donor deaths found 33 living liver donor deaths worldwide. The much publicized immediate postoperative mishap of 2002 that resulted in a donor’s death resulted in a drop in the utilization of living donor liver transplantation in the United States, from which this procedure has never fully recovered. The future development and expansion of living donor liver transplantation depends on open communication regarding donor complications and deaths. Close immediate postoperative monitoring and meticulous management will remain an essential aspect in limiting donor complications and deaths.
Collapse
Affiliation(s)
- Bhargavi Gali
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Charles B. Rosen
- Department of Surgery, Transplant Center, Mayo Clinic, Rochester, MN, USA
| | - David J. Plevak
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
|
47
|
Abstract
Donor safety is of paramount importance in living donor transplantation. Yet, living donor deaths occur. We believe that problems exist in our system of live donor transplantation that can be summarized in a series of simple statements: (1) Donor mortality can never be completely eliminated; (2) Live donor risk has not been mitigated so that it is as low as possible; (3) After a donor death, systematic reviews are not routinely performed to identify correctable causes; (4) The lessons learned from any donor death are not adequately communicated to other programs and (5) The administrative mechanisms and resources are not universally available at all transplant centers to implement lessons learned. To rectify these problems, we propose the following: (1) A national living donor death task force be established with the purpose of performing systematic reviews of any donor death. (2) Findings of these reviews be disseminated to all institutions performing live donor transplants on a secure, password-protected website. (3) A no-fault donor death indemnity fund be established to provide a financial imperative for institutions to cooperate with this external peer-review. These measures will serve the best interests of the involved institutions, the transplant community, and most importantly, the patients and their families.
Collapse
Affiliation(s)
- L E Ratner
- Department of Surgery, Columbia University, New York, NY, USA.
| | | |
Collapse
|
|
48
|
Kaido T, Uemoto S. Does living donation have advantages over deceased donation in liver transplantation? J Gastroenterol Hepatol 2010; 25:1598-603. [PMID: 20880167 DOI: 10.1111/j.1440-1746.2010.06418.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Liver transplantation (LT) is the best treatment option for patients with end-stage liver disease. Living donor LT (LDLT) has developed as an alternative to deceased donor LT (DDLT) in order to overcome the critical shortage of deceased organ donations, particularly in Asia. LDLT offers several advantages over DDLT. The major advantage of LDLT is the reduction in waiting time mortality. Especially among patients with hepatocellular carcinoma (HCC), LDLT can shorten the waiting time and lower the dropout rate. The Hong Kong group reported that median waiting time was significantly shorter for LDLT than for DDLT. Intention-to-treat survival rates of HCC patients with voluntary live donors were significantly higher than those of patients without voluntary live donors. In contrast, a multicenter adult-to-adult LDLT retrospective cohort study reported that LDLT recipients displayed a significantly higher rate of HCC recurrence than DDLT recipients, although LDLT recipients had shorter waiting times than DDLT recipients. The advantage of LDLT involves the more liberal criteria for HCC compared with those for DDLT. Various preoperative interventions including nutritional treatment can also be planned for both the donor and recipient in LDLT. Conversely, LDLT has marked unfavorable characteristics in terms of donor risks. Donor morbidity is not infrequent and the donor mortality rate is estimated at around 0.1-0.3%. In conclusion, living donation is not necessarily advantageous over deceased donation in LT. Taking the advantages and disadvantages of each option into consideration, LDLT and DDLT should both be used to facilitate effective LT for patients requiring transplant.
Collapse
Affiliation(s)
- Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.
| | | |
Collapse
|
|
49
|
[Living donation liver transplantation in children]. Chirurg 2010; 81:813-9. [PMID: 20694715 DOI: 10.1007/s00104-009-1875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Liver transplantation is the first-line therapy for children with acute and chronic hepatic failure, metabolic liver diseases and liver tumors. As most of the children with end-stage liver disease are very small in stature the resources of compatible organs of deceased donors are limited. Living liver donation was able to nearly eliminate waiting list mortality with excellent patient and graft survival. As 80% of the pediatric recipients have a body weight <25 kg donation of the left lateral lobe (segments II+III) is sufficient in most of the cases. According to a standardization of the surgical procedures as well as the preoperative, intraoperative and postoperative management donation of the left lateral lobe advanced to a procedure with very low donor morbidity and mortality rates. The complexity of hepatic disease patterns in pediatric patients which often affect other organ systems demand a close cooperation with an experienced pediatric team. Pediatric living donor liver transplantation requires high expertise in liver surgery and split liver transplantation and should therefore only be performed in transplant centers meeting these high qualifications.
Collapse
|
|
50
|
White SA, Manas DM, Farid SG, Prasad KR. Optimal treatment for hepatocellular carcinoma in the cirrhotic liver. Ann R Coll Surg Engl 2009; 91:545-50. [PMID: 19833013 DOI: 10.1308/003588409x464649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- S A White
- Department of Hepatobiliary and Liver Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK.
| | | | | | | |
Collapse
|