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1
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Chau SS, Beutler BD, Grant EG, Tchelepi H. Ultrasound innovations in abdominal radiology: multiparametic imaging in liver transplantation. Abdom Radiol (NY) 2025; 50:679-692. [PMID: 39167237 PMCID: PMC11794643 DOI: 10.1007/s00261-024-04518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Ultrasound plays a central role in liver transplant evaluation. Acute, subacute, and chronic complications can be readily identified using grayscale and color Doppler ultrasound. Contrast-enhanced ultrasound adds a new dimension to liver transplant evaluation, depicting vascular and parenchymal processes with exquisite detail. In addition, emerging evidence suggests that contrast-enhanced ultrasound may allow for localization of biliary leak in select patients. We aimed to assess the use of multiparametric ultrasound-including grayscale, color and spectral Doppler, and contrast-enhanced ultrasound-in the setting of liver transplantation. METHODS A literature review was performed using the MEDLINE bibliographic database through the National Library of Medicine. The following terms were searched and relevant citations assessed: "abdominal ultrasound," "contrast-enhanced ultrasound," "liver transplant," and "ultrasound." RESULTS Grayscale and color Doppler ultrasound represent the mainstay imaging modalities for postoperative liver transplant evaluation. The addition of contrast enhancement plays a complementary role and can provide valuable information related to the allograft vasculature, parenchyma, and biliary tree. The appropriate implementation of grayscale, color Doppler, and contrast-enhanced ultrasound can optimize sensitivity, specificity, and accuracy for the detection of liver transplantation complications, including hepatic artery stenosis, biliary leakage, and infection. CONCLUSION Multimodal sonographic evaluation is essential to identify postoperative complications in liver transplant recipients. Contrast-enhanced ultrasound may be of value in challenging cases, providing excellent anatomic delineation and reducing the risk of false-positive and false-negative diagnoses. A broad familiarity with appropriate applications of both nonenhanced and contrast-enhanced ultrasound may help radiologists optimize allograft assessment and improve patient outcomes.
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Affiliation(s)
- Samantha S Chau
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Bryce D Beutler
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
| | - Edward G Grant
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Hisham Tchelepi
- Department of Radiology, Los Angeles General Medical Center, Los Angeles, CA, USA
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Srivastava S, Garg I. Thrombotic complications post liver transplantation: Etiology and management. World J Crit Care Med 2024; 13:96074. [PMID: 39655303 PMCID: PMC11577539 DOI: 10.5492/wjccm.v13.i4.96074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 10/01/2024] [Accepted: 10/24/2024] [Indexed: 10/31/2024] Open
Abstract
Liver transplantation (LT) is the life saving therapeutic option for patients with acute and chronic end stage liver disease. This is a routine procedure with excellent outcomes in terms of patient survival and quality of life post LT. Orthotopic LT (OLT) patients require a critical care as they are prone to variety of post-operative vascular, cardiovascular, biliary, pulmonary and abdominal complications. Thrombotic complications (both arterial and venous) are not uncommon post liver transplant surgery. Such vascular problems lead to increased morbidity and mortality in both donor and graft recipient. Although thromboprophylaxis is recommended in general surgery patients, no such standards exist for liver transplant patients. Drastic advancements of surgical and anesthetic procedures have improvised survival rates of patients post OLT. Despite these, haemostatic imbalance leading to thrombotic events post OLT cause significant graft loss and morbidity and even lead to patient's death. Thus it is extremely important to understand pathophysiology of thrombosis in LT patients and shorten the timing of its diagnosis to avoid morbidity and mortality in both donor and graft recipient. Present review summarizes the current knowledge of vascular complications associated with LT to highlight their impact on short and long-term morbidity and mortality post LT. Also, present report discusses the lacunae existing in the literature regarding the risk factors leading to arterial and venous thrombosis in LT patients.
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Affiliation(s)
- Swati Srivastava
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development organization, Delhi 110054, India
| | - Iti Garg
- Defence Institute of Physiology and Allied Sciences, Defence Research and Development organization, Delhi 110054, India
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3
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Silva MS, Waisberg DR, Caldas TG, Martino RB, Rocha-Santos V, Pinheiro RS, Ducatti L, Arantes RM, Alvarez J, Marin-Castro P, Vieira IF, Almeida JD, Carneiro-D'Albuquerque LA, Andraus W. Life-Threatening Ruptured Hepatic Artery Pseudoaneurysm Post-Liver Transplant: A Case Report. Transplant Proc 2024; 56:1092-1095. [PMID: 38744591 DOI: 10.1016/j.transproceed.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/01/2024] [Accepted: 04/21/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Hepatic artery pseudoaneurysm after liver transplantation is a rare condition that can lead to spontaneous bleeding, depending on its extent and location. Treatment involves endovascular and surgical approaches in addition to liver retransplantation in cases of graft failure. CASE REPORT A 42-year-old female underwent deceased donor liver transplantation due to cryptogenic cirrhosis and schistosomiasis with an uneventful postoperative course. However, 18 days after the operation, she presented to the emergency department with abdominal pain, hypotension, and lipothymia. A computed tomography scan revealed a hepatic artery anastomotic pseudoaneurysm, and due to hemodynamic instability, emergency laparotomy was indicated. During the operation, the pseudoaneurysm was found to be ruptured, and the recipient's hepatic artery was ligated due to life-threatening bleeding. She later developed ischemic cholangiopathy and biliary complications, eventually undergoing retransplantation 7 months after the emergency operation. The patient remains well 11 months after the retransplantation. CONCLUSION We report a rare case of life-threatening rupture of hepatic artery pseudoaneurysm, which required emergency ligation of the recipient's hepatic artery and subsequent liver retransplantation due to biliary complications.
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Affiliation(s)
- Maciana Santos Silva
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Daniel Reis Waisberg
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil.
| | - Tarsila Gomes Caldas
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Rodrigo Bronze Martino
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Vinicius Rocha-Santos
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Rafael Soares Pinheiro
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Liliana Ducatti
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Rubens Macedo Arantes
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Jhosimar Alvarez
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Pedro Marin-Castro
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Igor Ferreira Vieira
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Juliani Dourado Almeida
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Luiz Augusto Carneiro-D'Albuquerque
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil; Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Wellington Andraus
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil; Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
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4
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Ninh KV, Do DH, Nguyen TD, Tran PH, Hoang T, Le DT, Nguyen NQ. Outcomes of liver transplantation for hepatocellular carcinoma: Experiences from a Vietnamese center. Ann Hepatobiliary Pancreat Surg 2024; 28:34-41. [PMID: 38193614 PMCID: PMC10896682 DOI: 10.14701/ahbps.23-072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 01/10/2024] Open
Abstract
Backgrounds/Aims Liver transplantation (LT) provides a favorable outcome for patients with hepatocellular carcinoma (HCC) and was launched in Vietnam in 2004. In this study, we evaluated the short-term and long-term outcomes of LT and its risk factors. Methods This retrospective study analyzed HCC patients who underwent LT at Viet Duc University hospital, Vietnam, from 01/2012-03/2022. The following data were gathered: demographics, virus infection, tumor characteristics, alpha-fetoprotein (AFP) level, Child-Pugh and MELD scores, selection criteria, type of LT, complications, 30-day mortality, and disease-free and overall survival (DFS and OS). Results Fifty four patients were included, the mean age was 55.39 ± 8.46 years. Nearly 90% had hepatitis B virus-related HCC. The median (interquartile range) AFP level was 16.2 (88.7) ng/mL. The average MELD score was 10.57 ± 5.95; the rate of Child-Pugh A and B were 70.4% and 18.5%, respectively. Nearly 40% of the patients were within Milan criteria, brain-dead donor was 83.3%. Hepatic and portal vein thrombosis occurred in 0% and 1.9%, respectively; hepatic artery thrombosis 1.9%, biliary leakage 5.6%, and postoperative hemorrhage 3.7%. Ninety-day mortality was 5.6%. Five-year DFS and OS were 79.3% and 81.4%, respectively. MELD score and Child-Pugh score were predictive factors for DFS and OS (p < 0.05). In multivariate analysis, Child-Pugh score was the only significant factor (p < 0.05). Conclusions In Vietnam, LT is an effective therapy for HCC with an acceptable complication rate, mortality rate, and good survival outcomes, and should be further encouraged.
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Affiliation(s)
- Khai Viet Ninh
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Dang Hai Do
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Trung Duc Nguyen
- Department of General Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Phuong Ha Tran
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Tuan Hoang
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Dung Thanh Le
- Medical Imaging & Nuclear Medicine Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Nghia Quang Nguyen
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
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Elkomos B, Alkomos P, Junaid Saleem R, Ebeidallah G, Hanna J, Abdelaal A. A Systematic Review and Meta-Analysis: Do We Still Need Microscope Surgery in Hepatic Artery Anastomosis to Decrease the Incidence of Complications in Living Donor Liver Transplantation? Cureus 2023; 15:e48112. [PMID: 37920422 PMCID: PMC10619707 DOI: 10.7759/cureus.48112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/04/2023] Open
Abstract
Hepatic artery thrombosis (HAT) is the most serious vascular complication after liver transplantation (LT). Moreover, in comparison to deceased donor liver transplantation (DDLT), hepatic artery (HA) anastomosis is more challenging in living donor liver transplantation (LDLT) with a lot of controversial topics about the use of microscopic surgery. We aimed to compare the use of microscopic and loupe surgery in HA anastomosis in adult and pediatric LDLT to decrease the incidence of vascular complications. We searched PubMed, Scopes, Web of Science, and Cochrane Library for eligible studies from inception to April 2023 and a systematic review and a meta-analysis were done. According to our eligibility criteria, 10 studies with a total of 1939 patients were included. In comparison to microscopic surgery, loupe anastomosis has a similar incidence of HAT (thrombosis, risk ratio (RR) = 0.96, 95% CI = 0.26-3.48, P = 0.95). In addition to that, no significant difference was detected between the two types in terms of stenosis, decreased blood flow and hospital stay (decreased blood flow, RR = 0.68, 95% CI = 0.01-86.65, P = 0.88), (stenosis, RR = 1.81, 95% CI = 0.19-17.21, P = 0.60), (hospital stay, mean deviation (MD) = 1.16, 95% CI = -3.79-6.11, P = 0.65). However, the anastomotic time was longer in the case of microscopic surgery (anastomotic time, MD = 24.09, 95% CI = 7.79-40.39, P = 0.004). With an equal incidence of complications and longer anastomotic time, there is no added benefit of the routine use of microscopic surgery in HA anastomosis in LDLT.
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Affiliation(s)
| | | | | | - Guirgis Ebeidallah
- Acute and Emergency Medicine, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Joseph Hanna
- General Surgery, Manchester Foundation Trust, Manchester, GBR
| | - Amr Abdelaal
- General Surgery, Ain Shams University, Cairo, EGY
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6
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Sica GS, Sensi B, Siragusa L, Blasi F, Crispino B, Pirozzi B, Angelico R, Biancone L, Khan J. Surgical management of colon cancer in ulcerative colitis patients with orthotopic liver transplant for primary sclerosing cholangitis. A systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106922. [PMID: 37210276 DOI: 10.1016/j.ejso.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Colon cancer in ulcerative colitis patients with liver transplant (UCCOLT) due to primary sclerosing cholangitis carries significant treatment challenges. Aim of this literature search is to review management strategies and provide a framework to facilitate the decisional process in this clinical setting. METHODS PRISMA-compliant systematic search was followed by critical expert commentary of the results and development of a surgical management algorithm. Endpoints included surgical management, operative strategies, functional and survival outcomes. Technical and strategics aspects with particular regard to the choice of reconstruction were evaluated to tentatively develop an integrated algorithm. RESULTS Ten studies reporting treatment of 20 UCCOLT patients were identified after screening. Nine patients underwent proctocolectomy and end-ileostomy (PC) and eleven had restorative ileal pouch-anal anastomosis (IPAA). Reported results for perioperative outcomes, oncological outcomes, and graft loss were comparable for both procedures. There were no reports of subtotal colectomies and ileo-rectal anastomosis (IRA). CONCLUSIONS Literature in the field is scarce and decision-making is particularly complex. PC and IPAA have been reported with good results. Nevertheless, IRA may also be considered in UCCOLT patients in selected cases, reducing the risks of sepsis, OLT and pouch failure; furthermore, in young patients, it has the advantage of preserving fertility or sexual function. The proposed treatment algorithm may represent a valuable support in guiding surgical strategy.
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Affiliation(s)
- G S Sica
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy.
| | - B Sensi
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - L Siragusa
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - F Blasi
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - B Crispino
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - B Pirozzi
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - R Angelico
- Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy
| | - L Biancone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - J Khan
- Portsmouth Hospitals, NHS Trust, Portsmouth, UK
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7
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Semash KO, Dzhanbekov TA, Akbarov MM. Vascular complications after liver transplantation: contemporary approaches to detection and treatment. A literature review. RUSSIAN JOURNAL OF TRANSPLANTOLOGY AND ARTIFICIAL ORGANS 2023; 25:46-72. [DOI: 10.15825/1995-1191-2023-4-46-72] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Vascular complications (VCs) after liver transplantation (LT) are rare but are one of the most dreaded conditions that can potentially lead to graft loss and recipient death. This paper has analyzed the international experience in the early diagnosis of various VCs that can develop following LT, as well as the optimal timing and methods of treatment of these complications.
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Affiliation(s)
- K. O. Semash
- Republican Specialized Scientific and Practical Medical Center for Surgery; Tashkent Medical Academy
| | - T. A. Dzhanbekov
- Republican Specialized Scientific and Practical Medical Center for Surgery; Tashkent Medical Academy
| | - M. M. Akbarov
- Republican Specialized Scientific and Practical Medical Center for Surgery; Tashkent Medical Academy
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8
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Kubihal V, Sasturkar S, Mukund A. Imaging and Intervention in the Management of Vascular Complications Following Liver Transplantation. J Clin Exp Hepatol 2023; 13:854-868. [PMID: 37693256 PMCID: PMC10483010 DOI: 10.1016/j.jceh.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/27/2023] [Indexed: 09/12/2023] Open
Abstract
Liver transplantation is the treatment of choice in majority of the patients with end stage liver disease. Vascular complication following liver transplantation is seen in around 7-13% of the patients and is associated with graft dysfunction and high morbidity and mortality. Early diagnosis and prompt treatment are crucial in management of these patients. Advances in interventional radiology have significantly improved the management of vascular complications using minimally invasive percutaneous approach. Endovascular management is preferred in patients with late hepatic artery thrombosis, or stenosis, whereas retransplantation, surgical revision, or endovascular management can be considered in patients with early hepatic artery thrombosis or stenosis. Hepatic artery pseudoaneurysm, arterioportal fistula, and splenic artery steal syndrome are often treated by endovascular means. Endovascular management is also preferred in patients with symptomatic portal vein stenosis, early portal vein thrombosis, and symptomatic late portal vein thrombosis, whereas surgical revision or retransplantation is preferred in patients with perioperative portal vein thrombosis occurring within 3 days of transplantation. Venoplasty with or without stent placement can be considered in patients with hepatic venous outflow tract or inferior vena cava obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) may be required in transplant recipients who develop cirrhosis, often, secondary to disease recurrence, or chronic rejection. Indications for TIPS remain same in the transplant patients; however, major difference is altered vascular anatomy, for which adjunct techniques may be required to create TIPS.
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Affiliation(s)
- Vijay Kubihal
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Shridhar Sasturkar
- Department of Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
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Özkan Kuşcu Ö, Kuş M, İncekaş C, Özmete Ö, Ergenoğlu P, Yıldırım S, Torgay A, Haberal M. Relationship Between Perioperative Factors and Splenic Artery Steal Syndrome After Orthotopic Liver Transplant: A Retrospective Clinical Study. EXP CLIN TRANSPLANT 2023; 21:743-748. [PMID: 37885290 DOI: 10.6002/ect.2023.0160] [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: 10/28/2023]
Abstract
OBJECTIVES After orthotopic liver transplant, ischemia of biliary tract and graft loss may occur due to impaired hepatic arterial blood flow. This situation with hypersplenism and impaired hepatic arterial blood flowis defined as splenic artery steal syndrome.The aim of this study was to investigate the relationship between perioperative factors and splenic artery steal syndrome in orthotopic liver transplant patients. MATERIALS AND METHODS Forty-five patients who underwent orthotopic liver transplant between 2014 and 2022 were included in the study. The data for the patients were obtained from the hospital database, including the intraoperative anesthesiology and postoperative intensive care records. RESULTS Eleven patients were diagnosed with splenic artery steal syndrome. Patients with splenic artery steal syndrome had higher need for intraoperative vasopressor agents (P = .016) and exhibited lower intraoperative urine output (P = .031). In the postoperative intensive care follow-up, patients with splenic artery steal syndrome had higher levels of C-reactive protein during the first 48 hours (P = .030). CONCLUSIONS Intraoperative administration of vasopressor drugs, low urine output, and early postoperative high C-reactive protein levels were associated with the development of splenic artery steal syndrome in patients undergoing orthotopic liver transplant. Future studies should focus on investigation of biomarkers associated systemic hypoperfusion that may contribute to the development of splenic artery steal syndrome.
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Affiliation(s)
- Özlem Özkan Kuşcu
- From the Department of Anesthesiology and Reanimation, Baskent University Faculty of Medicine, Adana, Turkey
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10
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Buros C, Dave AA, Furlan A. Immediate and Late Complications After Liver Transplantation. Radiol Clin North Am 2023; 61:785-795. [PMID: 37495287 DOI: 10.1016/j.rcl.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Other than rejection, hepatic artery and portal vein thrombosis are the most common complications in the immediate postoperative period with hepatic arterial thrombosis more common and more devastating. Hepatic artery stenosis is more common 1 month after transplantation, whereas portal and hepatic vein stenosis is more often seen as a late complication. Ultrasound is the first-line imaging examination to diagnose vascular complications with contrast-enhanced CT useful if ultrasound findings are equivocal. MR cholangiography is often most helpful in diagnosing bile leaks, biliary strictures, and biliary stones.
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Affiliation(s)
- Christopher Buros
- Department of Radiology, University of Pittsburgh Medical Center, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Atman Ashwin Dave
- Department of Radiology, University of Pittsburgh Medical Center, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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11
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Selim M, Hohenwalter EJ, Rilling WS, Hong JC. Risk of Hepatic Artery Complications After Liver Transplantation in Patients Who Received Pretransplant Transarterial Chemoembolization Therapy: A Single-Center Experience. Transplant Proc 2023; 55:1631-1637. [PMID: 37391331 DOI: 10.1016/j.transproceed.2023.03.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/02/2023] [Accepted: 03/30/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Pretransplant transarterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC) has been associated with an increased risk of hepatic artery thrombosis (HAT) after liver transplantation (LT). Innovative surgical LT and interventional vascular radiology TACE techniques may mitigate the risk of HAT. We sought to investigate the incidence of HAT after LT in patients who received pre-transplant TACE at our center. METHODS We performed a single-center retrospective review of all LT patients, >18 years of age, from October 1, 2012, to May 31, 2018. Outcomes were compared between patients who received pre-LT TACE and those who did not. Median follow-up was 26 months. RESULTS Among the 162 LT recipients, 110 (67%) patients did not receive pre-LT TACE (Group I), while 52 (32%) received pre-LT TACE (Group II). The <30-day incidence rates of post-LT HAT were as follows: Group I = 1.8% and Group II = 1.9% (P = .9). Most hepatic arterial complications occurred >30 days after LT. Based on competing risks regression analysis, TACE was not associated with an increased risk of HAT. Patient or graft survivals were comparable between the 2 groups (P = .1 and .2, respectively). CONCLUSIONS Our study shows a similar incidence of hepatic artery complications post-LT in patients who received TACE before LT compared with those who did not. In addition, we suggest that the surgical technique of early vascular control of the common hepatic artery during LT, in combination with a super-selective vascular intervention radiology approach, has clinical utility in reducing the risk of HAT in patients requiring pre-transplant TACE.
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Affiliation(s)
- Motaz Selim
- Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eric J Hohenwalter
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William S Rilling
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Johnny C Hong
- Division of Transplantation, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
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12
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Nejatollahi SMR, Nazari M, Mostafavi K, Ghorbani F. Reoperation etiologies in the initial hospital stay after liver transplantation: a single-center study from Iran. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:103-108. [PMID: 37435148 PMCID: PMC10332282 DOI: 10.4285/kjt.23.0026] [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] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Background Liver transplantation (LT) is widely recognized as a life-saving therapy for patients with end-stage liver disease. However, due to certain posttransplant complications, reoperations or endovascular interventions may be necessary to improve patient outcomes. This study was conducted to examine reasons for reoperation during the initial hospital stay following LT and to identify its predictive factors. Methods We evaluated the incidence and etiology of reoperation in 133 patients who underwent LT from brain-dead donors over a 9-year period based on our experiences. Results A total of 52 reoperations were performed for 29 patients, with 17 patients requiring one reoperation, seven requiring two, three requiring three, one requiring four, and one requiring eight. Four patients underwent liver retransplantation. The most common cause of reoperation was intra-abdominal bleeding. Hypofibrinogenemia was identified as the sole predisposing factor for bleeding. Frequencies of comorbidities such as diabetes mellitus and hypertension did not differ significantly between groups. Among patients who underwent reoperation due to bleeding, the mean plasma fibrinogen level was 180.33±68.21 mg/dL, while among reoperated patients without bleeding, it was 240.62±105.14 mg/dL (P=0.045; standard mean difference, 0.61; 95% confidence interval, 0.19-1.03). The initial hospital stay was significantly longer for the reoperated group (47.5±15.5 days) than for the non-reoperated group (22.5±5.5 days). Conclusions Meticulous pretransplant assessment and postoperative care are essential for the early identification of predisposing factors and posttransplant complications. In order to enhance graft and patient outcomes, any complications should be addressed without hesitation, and appropriate intervention or surgery should not be delayed.
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Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Nazari
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keihan Mostafavi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Astarcıoglu I, Egeli T, Gulcu A, Ozbilgin M, Agalar C, Cesmeli EB, Kaya E, Karademir S, Unek T. Vascular Complications After Liver Transplantation. EXP CLIN TRANSPLANT 2023; 21:504-511. [PMID: 30880648 DOI: 10.6002/ect.2018.0240] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Vascular complications after liver transplant can be lethal. High levels of suspicion and aggressive use of diagnostic tools may help with early diagnosis and treatment. Here, we share our experiences regarding this topic. MATERIALS AND METHODS Adult and pediatric patients who had liver transplant between February 1997 and June 2018 in our clinic were included in the study. Patients were grouped according to age (pediatric patients were those under 18 years old), male versus female, indication for transplant, type of liver transplant, type of vascular complication, treatment, and survival aftertreatment.We analyzed the statistical incidence of vascular complications according to age, male versus female, and type of liver transplant. RESULTS Our analyses included 607 liver transplant procedures, including 7 retransplants, with 349 (57.4%) from living donors and 258 (42.6%) from deceased donors. Of total patients, 539 were adults (89.8%) and 61 were children (10.2%). Vascular complications occurred in 25 patients (4.1%), with hepatic artery complications seen in 13 patients (2.1%) (10 adults [1.8%] and 3 children [4.9%]), portal vein complications seen in 9 patients (1.5%) (6 adults [1.1%] and 3 children [4.9%]), and hepatic vein complications seen in 3 patients (0.5%) (2 adults [0.36%] and 1 child [1.6%]). Rate of vascular complications was statistically higher in pediatric patients (11.4% vs 3.3%; P = .007) and higher but not statistically in recipients of livers from living donors (5.2% vs 2.7%; P = .19). Twelve patients (48.8%) were treated with endovascular approach, and 11 (0.44%)required surgicaltreatment. Two patients underwent immediate retransplant due to hepatic artery thrombosis. CONCLUSIONS Because vascular complications are the most severe complications afterlivertransplant,there must be close follow-up of vascular anastomoses, particularly early postoperatively, with radiologic methods. In cases of vascular complications, emergent treatment, including endovascular interventions, surgery, and retransplant, must be performed.
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Affiliation(s)
- Ibrahim Astarcıoglu
- From the Department of General Surgery, Hepatopancreaticobiliary Surgery and Liver Transplantation Unit, Dokuz Eylul University Faculty of Medicine, Narlıdere, Izmir, Turkey
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14
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Gheorghe G, Diaconu CC, Bungau S, Bacalbasa N, Motas N, Ionescu VA. Biliary and Vascular Complications after Liver Transplantation-From Diagnosis to Treatment. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:850. [PMID: 37241082 PMCID: PMC10221850 DOI: 10.3390/medicina59050850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
The last decades have brought impressive advances in liver transplantation. As a result, there was a notable rise in the number of liver transplants globally. Advances in surgical techniques, immunosuppressive therapies and radiologically guided treatments have led to an improvement in the prognosis of these patients. However, the risk of complications remains significant, and the management of liver transplant patients requires multidisciplinary teams. The most frequent and severe complications are biliary and vascular complications. Compared to vascular complications, biliary complications have higher incidence rates but a better prognosis. The early diagnosis and selection of the optimal treatment are crucial to avoid the loss of the graft and even the death of the patient. The development of minimally invasive techniques prevents surgical reinterventions with their associated risks. Liver retransplantation remains the last therapeutic solution for graft dysfunction, one of the main problems, in this case, being the low number of donors.
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Affiliation(s)
- Gina Gheorghe
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania; (G.G.); (N.B.); (V.-A.I.)
- Gastroenterology Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania; (G.G.); (N.B.); (V.-A.I.)
- Internal Medicine Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Nicolae Bacalbasa
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania; (G.G.); (N.B.); (V.-A.I.)
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania
| | - Natalia Motas
- Institute of Oncology “Profesor Doctor Alexandru Trestioreanu” Bucharest, 022328 Bucharest, Romania;
- Department of Thoracic Surgery, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
| | - Vlad-Alexandru Ionescu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania; (G.G.); (N.B.); (V.-A.I.)
- Gastroenterology Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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15
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Firat A, Abbasoglu TT, Karcaaltincaba M, Balaban YH. Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview. World J Radiol 2023; 15:1-9. [PMID: 36721671 PMCID: PMC9884335 DOI: 10.4329/wjr.v15.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/02/2022] [Accepted: 12/27/2022] [Indexed: 01/17/2023] Open
Abstract
The liver has a complex vascular anatomy with a unique dual blood supply. Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma. In most vascular disorders, the effects on the liver are generally subclinical because of its abundant blood supply. However, early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality. Because imaging findings of vascular disease are not always readily apparent, diagnosis can be difficult. Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning. In this review article, we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.
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Affiliation(s)
- Aysegul Firat
- Department of Anatomy, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | | | | | - Yasemin H Balaban
- Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
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16
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Novruzbekov MS, Lutsyk KN, Olisov OD, Magomedov KM, Kazymov BI, Alekberov KF, Akhmedov AR, Yaremin BI. [Indocyanine green in liver transplantation]. Khirurgiia (Mosk) 2023:63-72. [PMID: 37682549 DOI: 10.17116/hirurgia202309263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The purpose of this study was to evaluate the first own experience of using indocyanine green (ICG) in liver transplantation compared to literature data and to determine its potential for clinical practice. Liver transplantation is an effective option for patients with end-stage disease, but this procedure is associated with many problems such as graft rejection, graft dysfunction, surgical risk and postoperative management. Modern methods for assessing graft function have their limitations, so a more efficient method is needed. According to this review, ICG fluorescence is valuable for effective intraoperative blood flow control, assessment of graft function, intraoperative and postoperative monitoring of clinical status. ICG fluorescence can also predict clinical status of patients at all stages of liver transplantation. Routine ICG fluorescence method is advisable in liver transplantation to improve outcomes and optimize treatment process.
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Affiliation(s)
- M S Novruzbekov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K N Lutsyk
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - O D Olisov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K M Magomedov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - B I Kazymov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - K F Alekberov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A R Akhmedov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - B I Yaremin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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17
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Pollok JM, Tinguely P, Berenguer M, Niemann CU, Raptis DA, Spiro M, Dominguez B, Muller E, Rando K, Enoch MA, Tamir N, Healy P, Manser T, Briggs T, Chaudhary A, Humar A, Jafarian A, Soin AS, Eghtesad B, Miller C, Cherqui D, Samuel D, Broering D, Pomfret E, Villamil F, Durand F, Berlakovich G, McCaughan G, Auzinger G, Testa G, Klintmalm G, Belghiti J, Findlay J, Lai J, Fung J, Klinck J, Roberts J, Liu L, Cattral M, Ghobrial M, Selzner M, Ramsay M, Rela M, Ascher N, Man NK, Selzner N, Burra P, Friend P, Busuttil R, Hwang S, McCluskey S, Mas V, Vohra V, Vij V, Merritt W, Tokat Y, Kang Y, Chan A, Mazzola A, Hessheimer A, Rammohan A, Hogan B, Vinaixa C, Nasralla D, Victor D, De Martin E, Alconchel F, Roll G, Kabacam G, Sapisochin G, Campos-Varela I, Liu J, Patel MS, Izzy M, Kalisvaart M, Adams M, Goldaracena N, Tinguely P, Hernandez-Alejandro R, Chadha R, Shaker TM, Klair TS, Pan T, Tanaka T, Yoon U, Kirchner V, Hannon V, Cheah YL, Frola C, Morkane C, Milliken D, Lurje G, Potts J, Fernandez T, Badenoch A, Mukhtar A, Zanetto A, Montano-Loza A, Chieh AKW, Shetty A, et alPollok JM, Tinguely P, Berenguer M, Niemann CU, Raptis DA, Spiro M, Dominguez B, Muller E, Rando K, Enoch MA, Tamir N, Healy P, Manser T, Briggs T, Chaudhary A, Humar A, Jafarian A, Soin AS, Eghtesad B, Miller C, Cherqui D, Samuel D, Broering D, Pomfret E, Villamil F, Durand F, Berlakovich G, McCaughan G, Auzinger G, Testa G, Klintmalm G, Belghiti J, Findlay J, Lai J, Fung J, Klinck J, Roberts J, Liu L, Cattral M, Ghobrial M, Selzner M, Ramsay M, Rela M, Ascher N, Man NK, Selzner N, Burra P, Friend P, Busuttil R, Hwang S, McCluskey S, Mas V, Vohra V, Vij V, Merritt W, Tokat Y, Kang Y, Chan A, Mazzola A, Hessheimer A, Rammohan A, Hogan B, Vinaixa C, Nasralla D, Victor D, De Martin E, Alconchel F, Roll G, Kabacam G, Sapisochin G, Campos-Varela I, Liu J, Patel MS, Izzy M, Kalisvaart M, Adams M, Goldaracena N, Tinguely P, Hernandez-Alejandro R, Chadha R, Shaker TM, Klair TS, Pan T, Tanaka T, Yoon U, Kirchner V, Hannon V, Cheah YL, Frola C, Morkane C, Milliken D, Lurje G, Potts J, Fernandez T, Badenoch A, Mukhtar A, Zanetto A, Montano-Loza A, Chieh AKW, Shetty A, DeWolf A, Olmos A, Mrzljak A, Blasi A, Berzigotti A, Malik A, Rajakumar A, Davidson B, O'Farrell B, Kotton C, Imber C, Kwon CHD, Wray C, Ahn CS, Morkane C, Krenn C, Quintini C, Maluf D, Mina DS, Sellers D, Balci D, Patel D, Rudow DL, Monbaliu D, Bezinover D, Krzanicki D, Milliken D, Kim DS, Brombosz E, Blumberg E, Weiss E, Wey E, Kaldas F, Saliba F, Pittau G, Wagener G, Song GW, Biancofiore G, Testa G, Crespo G, Rodríguez G, Palli GM, McKenna G, Petrowsky H, Egawa H, Montasser I, Pirenne J, Eason J, Guarrera J, Pomposelli J, Lerut J, Emond J, Boehly J, Towey J, Hillingsø JG, de Jonge J, Potts J, Caicedo J, Heimbach J, Emamaullee JA, Bartoszko J, Ma KW, Kronish K, Forkin KT, Chok KSH, Olthoff K, Reyntjens K, Lee KW, Suh KS, Denehy L, van der Laan LJ, McCormack L, Gorvin L, Ruffolo L, Bhat M, Ramírez MAM, Londoño MC, Gitman M, Levstik M, Selzner M, de Santibañes M, Lindsay M, Parotto M, Armstrong M, Kasahara M, Schofield N, Rizkalla N, Akamatsu N, Scatton O, Keskin O, Imventarza O, Andacoglu O, Muiesan P, Giorgio P, Northup P, Matins P, Abt P, Newsome PN, Dutkowski P, Bhangui P, Bhangui P, Tandon P, Brustia R, Planinsic R, Brown R, Porte R, Barth R, Ciria R, Florman S, Dharancy S, Pai SL, Yagi S, Nadalin S, Chinnakotla S, Forbes SJ, Rahman S, Hong SK, Liying S, Orloff S, Rubman S, Eguchi S, Ikegami T, Reichman T, Settmacher U, Aluvihare V, Xia V, Yoon YI, Soejima Y, Genyk Y, Jalal A, Borakati A, Gustar A, Mohamed A, Ramirez A, Rothnie A, Scott A, Sharma A, Munro A, Mahay A, Liew B, Hidalgo C, Crouch C, Yan CT, Tschuor C, Shaw C, Schizas D, Fritche D, Huda FF, Wells G, Farrer G, Kwok HT, Kostakis I, Mestre-Costa J, Fan KH, Fan KS, Fraser K, Jeilani L, Pang L, Lenti L, Kathirvel M, Zachiotis M, Vailas M, Milan MM, Elnagar M, Alradhawi M, Dimitrokallis N, Machairas N, Morare N, Yeung O, Khanal P, Satish P, Ghani SA, Makhdoom S, Arulrajan S, Bogan S, Pericleous S, Blakemore T, Otti V, Lam W, Jackson W, Abdi Z. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference. Lancet Gastroenterol Hepatol 2023; 8:81-94. [PMID: 36495912 DOI: 10.1016/s2468-1253(22)00268-0] [Show More Authors] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/12/2022]
Abstract
There is much controversy regarding enhanced recovery for recipients of liver transplants from deceased and living donors. The objectives of this Review were to summarise current knowledge on individual enhanced recovery elements on short-term outcomes, identify key components for comprehensive pathways, and create internationally accepted guidelines on enhanced recovery for liver-transplant recipients. The ERAS4OLT.org collaborative partnered by the International Liver Transplantation Society performed systematic literature reviews on the effect of 32 relevant enhanced perioperative recovery elements on short-term outcomes, and global specialists prepared expert statements on deceased and living donor liver transplantation. The Grading Recommendations, Assessment, Development and Evaluations approach was used for rating of quality of evidence and grading of recommendations. A virtual international consensus conference was held in January, 2022, in which results were presented, voted on by the audience, and discussed by an independent international jury of eight members, applying the Danish model of consensus. 273 liver transplantation specialists from 30 countries prepared expert statements on elements of enhanced recovery for liver transplantation based on the systematic literature reviews. The consensus conference yielded 80 final recommendations, covering aspects of enhanced recovery for preoperative assessment and optimisation, intraoperative surgical and anaesthetic conduct, and postoperative management for the recipients of liver transplants from both deceased and living donors, and for the living donor. The recommendations represent a comprehensive overview of the relevant elements and areas of enhanced recovery for liver transplantation. These internationally established guidelines could direct the development of enhanced recovery programmes worldwide, allowing adjustments according to local resources and practices.
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Affiliation(s)
- Joerg M Pollok
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Pascale Tinguely
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, NHS Foundation Trust, London, UK
| | - Marina Berenguer
- Liver Unit, CIBERehd, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe-Universidad de Valencia, Valencia, Spain
| | - Claus U Niemann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA; Department of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, CA, USA
| | - Dimitri A Raptis
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Michael Spiro
- Department of Anaesthesia and Intensive Care Medicine, Royal Free Hospital, NHS Foundation Trust, London, UK; The Royal Free Perioperative Research Group, Royal Free Hospital, NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
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Han JW, Choi JY, Lee SK, Sung PS, Jang JW, Yoon SK, Choi YH, Lee IS, Oh JS, Chun HJ, Choi HJ, You YK. Long-term Clinical Outcomes and Predictive Factors for Living-donor Liver Transplant Recipients With Biliary Strictures. Transplantation 2022; 106:1990-1999. [PMID: 35771085 DOI: 10.1097/tp.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Biliary strictures frequently occur in living-donor liver transplant (LDLT) recipients. However, long-term clinical outcomes and their associated factors are unclear. METHODS We analyzed an historical cohort of 228 recipients who underwent LDLT with post-liver transplantation biliary strictures. Endoscopic retrograde cholangiography or percutaneous transhepatic biliary drainage were performed to treat biliary strictures. Patients that experienced persistent jaundice over 3 mo after the initial treatment were defined as a remission-failure group. RESULTS Median observation period was 8.5 y after the diagnosis of biliary stricture. The 15-y graft survival (GS) rate was 70.6%, and 15-y rate of developing portal hypertension (PH) was 26.1%. Remission failure occurred in 25.0% of study participants. In the multivariate analysis, biopsy-proven acute rejection, and portal vein/hepatic artery abnormalities were risk factors for remission failure. Development of PH, retransplantation, and death were significantly more frequent in the remission-failure group. Remission failure and PH were associated with poor GS. In multivariate analyses, hepatic artery abnormality and biloma were common significant factors that were associated with a poor GS and development of PH. CONCLUSIONS The insufficient blood supply reflected by hepatic artery abnormality and biloma might be the most important factor that can predict poor long-term survival in LDLT patients with biliary strictures. Future large-scale prospective studies are needed to validate our observations.
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Affiliation(s)
- Ji Won Han
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Young Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon Kyu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Pil Soo Sung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Won Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Kew Yoon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Seok Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Suk Oh
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Jong Chun
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Kyoung You
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Pillai AA, Kriss M, Al‐Adra DP, Chadha RM, Cushing MM, Farsad K, Fortune BE, Hess AS, Lewandowski R, Nadim MK, Nydam T, Sharma P, Karvellas CJ, Intagliata N. Coagulopathy and hemostasis management in patients undergoing liver transplantation: Defining a dynamic spectrum across phases of care. Liver Transpl 2022; 28:1651-1663. [PMID: 35253365 PMCID: PMC9790275 DOI: 10.1002/lt.26451] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/10/2023]
Abstract
Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies and society guidance address this emerging paradigm and offer recommendations to assist with hemostatic management in patients with liver disease. However, patients undergoing LT are unique and diverse, often with unstable disease that requires specialized approaches. Our aim is to provide a focused review of hemostatic management of the LT patient, distinguish unique aspects of the three main phases of care (before LT, perioperative, and after LT), and identify knowledge gaps and critical areas of future research.
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Affiliation(s)
- Anjana A. Pillai
- Department of MedicineUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Michael Kriss
- Department of Internal MedicineUniversity of ColoradoAuroraColoradoUSA
| | - David P. Al‐Adra
- Department of SurgerySchool of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Ryan M. Chadha
- Department of Anesthesiology and Perioperative MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Melissa M. Cushing
- Department of Pathology and Laboratory MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Khashayar Farsad
- Department of Interventional RadiologyOregon Health & Science UniversityPortlandOregonUSA
| | | | - Aaron S. Hess
- Department of AnesthesiologyUniversity of WisconsinMadisonWisconsinUSA,Department of Pathology & Laboratory MedicineUniversity of WisconsinMadisonWisconsinUSA
| | | | - Mitra K. Nadim
- Department of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Trevor Nydam
- Department of SurgeryUniversity of ColoradoAuroraColoradoUSA
| | - Pratima Sharma
- Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
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20
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Naidu SG, Alzubaidi SJ, Patel IJ, Iwuchukwu C, Zurcher KS, Malik DG, Knuttinen MG, Kriegshauser JS, Wallace AL, Katariya NN, Mathur AK, Oklu R. Interventional Radiology Management of Adult Liver Transplant Complications. Radiographics 2022; 42:1705-1723. [DOI: 10.1148/rg.220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sailendra G. Naidu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Sadeer J. Alzubaidi
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Indravadan J. Patel
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Chris Iwuchukwu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Kenneth S. Zurcher
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Dania G. Malik
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Martha-Gracia Knuttinen
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - J. Scott Kriegshauser
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Alex L. Wallace
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Nitin N. Katariya
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Amit K. Mathur
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Rahmi Oklu
- From the Division of Interventional Radiology (S.G.N., S.J.A., I.J.P., C.I., M.G.K., J.S.K., A.L.W., R.O.), Department of Radiology (K.S.Z., D.G.M.), and Division of Transplant Surgery (N.N.K., A.K.M.), Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054
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21
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Gonzalez A, Cooper E, Herren J, Lipnik AJ, Xie KL. Diagnostic and Interventional Radiology in the Management of Post-Liver Transplant Vascular Complications. Semin Intervent Radiol 2022; 39:537-544. [PMID: 36561931 PMCID: PMC9767772 DOI: 10.1055/s-0042-1758113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ana Gonzalez
- University of Illinois College of Medicine, Chicago, Illinois
| | - Eric Cooper
- University of Illinois College of Medicine, Chicago, Illinois
| | - Josi Herren
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Andrew J. Lipnik
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Karen L. Xie
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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22
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Kirchner VA, O'Farrell B, Imber C, McCormack L, Northup PG, Song GW, Spiro M, Raptis DA, Durand F. What is the optimal management of thromboprophylaxis after liver transplantation regarding prevention of bleeding, hepatic artery, or portal vein thrombosis? A systematic review of the literature and expert panel recommendations. Clin Transplant 2022; 36:e14629. [PMID: 35240723 PMCID: PMC10078564 DOI: 10.1111/ctr.14629] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/13/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND A key tenet of clinical management of patients post liver transplantation (LT) is the prevention of thrombotic and bleeding complications. This systematic review investigated the optimal management of thromboprophylaxis after LT regarding portal vein thrombosis (PVT) or hepatic artery thrombosis (HAT) and prevention of bleeding. METHODS Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Seven databases were used to conduct extensive literature searches focusing on the use of anticoagulation in LT and its impact on the following outcomes: PVT, HAT, and bleeding (CRD42021244288). RESULTS Of the 2478 articles/abstracts screened, 16 studies were included in the final review. All articles were critically appraised by a panel of independent reviewers. There was wide variation regarding the anticoagulation protocols used. Thromboprophylaxis with therapeutic doses of heparin/Vitamin K antagonist combination did not decrease the risk of de novo or the recurrence of PVT but was associated with an increased risk of bleeding in some studies. Only the use of aspirin resulted in a small but significant decrease in the incidence of HAT post-LT, yet it did not increase the risk of bleeding. CONCLUSIONS Based on existing data and expert opinion, thromboprophylaxis at therapeutic or prophylactic dose is not recommended for prevention of de novo PVT following LT in patients not at high risk. Aspirin should be considered as the standard of care following LT to prevent HAT. Thromboprophylaxis should be strongly considered in recipients at risk of HAT and PVT following LT.
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Affiliation(s)
- Varvara A Kirchner
- Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, USA.,Department of Surgery, Division of Abdominal Transplantation, Stanford University, Stanford, USA
| | | | - Charles Imber
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Lucas McCormack
- Liver Surgery and Transplantation Unit, Department of Surgery, Hospital Aleman, Buenos Aires, Argentina
| | - Patrick G Northup
- Division of Gastroenterology, Department of Medicine, University of Virginia Health System, Charlottesville, USA
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Michael Spiro
- Department of Anesthesia and Intensive Care Medicine, Royal Free Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Dimitri A Raptis
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - François Durand
- Hepatology and Liver Intensive Care, Hospital Beaujon, Clichy, France.,University of Paris, Paris, France.,INSER M U1149, Paris, France
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- Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, USA
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23
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Hu LS, Zhao Z, Li T, Li QS, Lu Y, Wang B. The Management of Portal Vein Thrombosis after Adult Liver Transplantation: A Case Series and Review of the Literature. J Clin Med 2022; 11:jcm11164909. [PMID: 36013148 PMCID: PMC9410203 DOI: 10.3390/jcm11164909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Portal vein thrombosis (PVT) after adult liver transplantation (LT) is a rare but serious complication with no consensus on the ideal treatment. We report a case series and a comprehensive review of the literature on PVT after LT to discuss the therapeutic options. Methods: The clinical data of 360 adult patients (≥18 years of age) who underwent LT from January 2017 to January 2020 were reviewed, and a comprehensive search of PubMed and Web of Science was conducted. Patients diagnosed with PVT after LT were identified, and relevant risk factors and therapies were analyzed. Results: Among the 360 patients, 7 (1.94%) developed PVT after LT. Onset of PVT within one week after LT was found in six patients (85.71%). Four of the seven patients with PVT received systemic anticoagulation (low molecular weight heparin and warfarin) therapy. Minimally invasive interventional therapies combined with systemic anticoagulation (heparin and warfarin) were applied for three patients, two of whom died because of severe abdominal hemorrhage and liver failure. Of the 33 cases reported in the literature, minimally invasive interventional therapy combined with systematic anticoagulation or sclerotherapy were the most-used methods (20/33). Systemic anticoagulation was administered to four patients, and surgical operation (thrombectomy; portosystemic shunt and retransplantation) was performed for nine patients. Among these 33 patients, 4 eventually died. Conclusions: Interventional therapy combined with systemic anticoagulation is a good choice for the management of PVT after LT, and in our experience, systemic anticoagulation alone can also have a positive effect for early PVT patients.
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24
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Karakaya E, Akdur A, Ayvazoğlu Soy EH, Boyvat F, Moray G, Haberal M. Vascular Complications in Pediatric Liver Transplants and Their Management. EXP CLIN TRANSPLANT 2022; 20:72-75. [PMID: 35570605 DOI: 10.6002/ect.pediatricsymp2022.o23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The blood supply of the liver occurs through the hepatic artery and portal vein. Outflow of blood circulation in the liver is via the hepatic veins. Any disruption in this blood circulation results in deterioration of liver functions. In this study, we evaluated early vascular complications in pediatric liver transplant recipients seen at our center. MATERIALS AND METHODS From November 1988 to December 2021, our team has performed 701 liver transplant procedures, which have included 334 pediatric liver transplants. Among these pediatric liver transplant recipients (mean age of 7.34 y), 176 were male patients. Nineteen patients (5.7%) were recipients of deceased donors. Reason for liver failure was mainly biliary atresia (n = 169). Mean weight of recipients was 23.3 kg. Most graft types were left lateral grafts (n = 204). RESULTS Three patients had hepatic vein complications. All 3 patients were successfully treated with interventional radiological methods by placing a stent in the anastomosis region. Portal vein complications occurred in 3 patients. One patient had hemostasis performed surgically. The second patient had surgically revision of the anastomosis because of thrombus formation. Because of stenosis of more than 50% in the portal vein anastomosis, the third patient required stent placement in the anastomosis region. Hepatic artery complications occurred in 54 patients: 31 patients had hepatic artery thrombosis, 13 patients had hepatic artery stenosis, 7 patients had bleeding from hepatic artery anastomosis, 2 patients had hepatic artery dissection, and 1 patient had pseudoaneurysm in the hepatic artery. Forty-three of these patients were successfully treated with interventional radiological methods and 11 required surgical treatment. CONCLUSIONS Vascular complications after liver transplant can cause deterioration in hepatic functions and acute liver failure. Vascular complications can be successfully treated in experienced organ transplant centers.
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Affiliation(s)
- Emre Karakaya
- From the Department of General Surgery, Division of Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey
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25
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Yamamoto H, Sambommatsu Y, Ishii M, Shimata K, Isono K, Honda M, Sugawara Y, Inomata Y, Hibi T. Surgical Outcomes of Domino Liver Transplantation Using Grafts From Living Donors With Familial Amyloid Polyneuropathy. Liver Transpl 2022; 28:603-614. [PMID: 34989109 DOI: 10.1002/lt.26401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/29/2021] [Accepted: 12/19/2021] [Indexed: 01/13/2023]
Abstract
Domino liver transplantation (DLT) using grafts from donors with familial amyloid polyneuropathy is an acceptable procedure for expanding the donor pool. The vascular and biliary reconstructions in living donor DLT (LDDLT) are technically demanding, and data on the short-term and long-term surgical outcomes of domino donors and recipients in LDDLT are limited. In this study, we identified 25 domino recipients from our liver transplantation program (1999-2018), analyzed the vascular and biliary reconstructions performed, and evaluated the surgical outcomes, including graft survival. Piggyback technique was adopted in all 25 domino donors. The only surgical complication in domino donors was hepatic vein (HV) stenosis with an incidence rate of 4%. In 22 domino recipients, right HV and middle/left HV were reconstructed separately. A total of 10 recipients had 2 arteries anastomosed, and 18 underwent duct-to-duct biliary anastomosis. HV stenosis and biliary stricture had incidence rates of 8% and 24%, respectively, in the recipients, but none of them developed hepatic artery thrombosis. The 1-year and 5-year graft survival rates were 100% each in the domino donors, and 84.0% and 67.3% in the domino recipients, respectively. In conclusion, LDDLT has acceptable outcomes without increasing the operative risk in donors despite the demanding surgical technique involved.
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Affiliation(s)
- Hidekazu Yamamoto
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yuzuru Sambommatsu
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masatsugu Ishii
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masaki Honda
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | | | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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26
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Kim JS, Kim DW, Kim KW, Song GW, Lee SG. Improving the Specificity of CT Angiography for the Diagnosis of Hepatic Artery Occlusion after Liver Transplantation in Suspected Patients with Doppler Ultrasound Abnormalities. Korean J Radiol 2022; 23:52-59. [PMID: 34983093 PMCID: PMC8743154 DOI: 10.3348/kjr.2021.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/22/2021] [Accepted: 08/07/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate whether the diagnostic performance of CT angiography (CTA) could be improved by modifying the conventional criterion (anastomosis site abnormality) to diagnose hepatic artery occlusion (HAO) after liver transplantation (LT) in suspected patients with Doppler ultrasound (US) abnormalities. MATERIALS AND METHODS One hundred thirty-four adult LT recipients (88 males and 46 females; mean age, 52.7 years) with suspected HAO on Doppler US (40 HAO and 94 non-HAO according to the reference standards) were included. We evaluated 1) abnormalities in the HA anastomosis, categorized as a cutoff, ≥ 50% stenosis at the anastomotic site, or diffuse stenosis at both graft and recipient sides around the anastomosis, and 2) abnormalities in the distal run-off, including invisibility or irregular, faint, and discontinuous enhancement. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the conventional (considering anastomosis site abnormalities alone) and modified CTA criteria (abnormalities in both the anastomosis site and distal run-off) for the diagnosis of HAO were calculated and compared using the McNemar test. RESULTS By using the conventional criterion to diagnose HAO, the sensitivity, specificity, PPV, NPV, and accuracy were 100% (40/40), 74.5% (70/94), 62.5% (40/64), 100% (70/70), and 82.1% (110/134), respectively. The modified criterion for diagnosing HAO showed significantly increased specificity (93.6%, 88/94) and accuracy (93.3%, 125/134) compared to that with the conventional criterion (p = 0.001 and 0.002, respectively), although the sensitivity (92.5%, 37/40) decreased slightly without statistical significance (p = 0.250). CONCLUSION The modified criterion considering abnormalities in both the anastomosis site and distal run-off improved the diagnostic performance of CTA for HAO in suspected patients with Doppler US abnormalities, particularly by increasing the specificity.
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Affiliation(s)
- Jin Sil Kim
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Gi Won Song
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Gyu Lee
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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27
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Ren J, Yuan C, Zhang T. Indocyanine green fluorescence imaging: A novel technique in liver transplantation. LIVER RESEARCH 2021; 5:204-208. [PMID: 39959607 PMCID: PMC11791790 DOI: 10.1016/j.livres.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/22/2021] [Accepted: 11/03/2021] [Indexed: 02/16/2023]
Abstract
Indocyanine green (ICG) is a fluorescent dye that is widely used in hepatobiliary surgery for fluorescence contrast. ICG is selectively absorbed by the liver after intravenous injection and then secreted into the bile. ICG's unique catabolism and fluorescence characteristics allow for multiple applications in liver transplantation. We have divided the applications of ICG fluorescence imaging in liver transplantation into: (i) cholangiography, (ii) evaluation of liver transplantation vessels, (iii) liver mapping, and (iv) evaluation of donor liver quality. In this review, we summarize the current status of applications of ICG fluorescence imaging in liver transplantation.
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Affiliation(s)
- Junkai Ren
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chao Yuan
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tong Zhang
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Liver Transplantation Center of Sun Yat-sen University, Guangzhou, China
- Organ Transplantation Institute of Guangdong Province, Guangzhou, China
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28
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Kykalos S, Karatza E, Kotsifa E, Pappas P, Sotiropoulos GC. Portal Vein Stent Placement in Anastomotic Stenosis After Deceased Donor Liver Transplantation: A Case Report. Transplant Proc 2021; 53:2779-2781. [PMID: 34593252 DOI: 10.1016/j.transproceed.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
Vascular complications (VCs) after liver transplantation (LT) frequently result in graft and patient loss. The smaller vessels and the insufficient length for reconstruction in living donor LT and pediatric transplantation predispose patients to a higher incidence of VCs. Herein we present a case of portal vein stenosis (PVS) in an adult deceased donor LT recipient with portal vein thrombosis requiring extended thrombectomy at the time of LT. He presented with ascites 4 months after LT, was diagnosed with PVS, and was successfully treated with percutaneous transhepatic venoplasty and placement of a portal stent. This case highlights the importance of Doppler ultrasound as a screening modality for detection of VCs after LT and the pivotal role of endovascular repair as a first-line treatment for PVS.
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Affiliation(s)
- Stylianos Kykalos
- Second Propedeutic Department of Surgery, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Elli Karatza
- Second Propedeutic Department of Surgery, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
| | - Eugenia Kotsifa
- Second Propedeutic Department of Surgery, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Paris Pappas
- Department of Radiology, Division of Interventional Radiology, Laiko General Hospital, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Propedeutic Department of Surgery, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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29
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Sambommatsu Y, Shimata K, Ibuki S, Narita Y, Isono K, Honda M, Irie T, Kadohisa M, Kawabata S, Yamamoto H, Sugawara Y, Ikeda O, Inomata Y, Hibi T. Portal Vein Complications After Adult Living Donor Liver Transplantation: Time of Onset and Deformity Patterns Affect Long-Term Outcomes. Liver Transpl 2021; 27:854-865. [PMID: 33346927 DOI: 10.1002/lt.25977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/08/2020] [Accepted: 11/29/2020] [Indexed: 01/10/2023]
Abstract
Portal vein complications (PVCs) after adult living donor liver transplantation (LDLT) are potentially lethal. We categorized PVCs by the time of onset (early versus late, <1 month versus ≥1 month, respectively) and deformity patterns (portal vein stenosis [PVS], portal vein thrombosis [PVT], and portal vein occlusion [PVO]) to establish optimal treatment strategies. Overall, 35/322 (10.9%) recipients developed PVCs between 2000 and 2019. Pretransplant PVT (odds ratio [OR], 15.20; 95% confidence interval [CI], 3.70-62.40; P < 0.001) was the only independent risk factor for PVS. In contrast, male sex (OR, 5.57; 95% CI, 1.71-18.20; P = 0.004), pretransplant PVT (OR, 4.79; 95% CI, 1.64-14.00; P = 0.004), and splenectomy (OR, 3.24; 95% CI, 1.23-8.57; P = 0.018) were independent risk factors for PVT. PVS was successfully treated with interventional radiology regardless of its time of onset. On the other hand, late PVT and PVO had significantly lower treatment success rates (2/15, 13%) compared with those that occurred in the early period (10/11, 91%) despite aggressive intervention (P < 0.001). Deformity patterns had a significant impact on the 5-year cumulative incidence of graft loss as a result of PVC (PVO + Yerdel grades 2-4 PVT group [n = 16], 41% versus PVS + Yerdel grade 1 PVT group [n = 19], 0%; P = 0.02). In conclusion, late grades 2 to 4 PVT and PVO are refractory to treatment and associated with poor prognoses, whereas PVS has a good prognosis regardless of time of onset. A tailored approach according to the time of onset and deformity patterns of PVC is essential.
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Affiliation(s)
- Yuzuru Sambommatsu
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Sho Ibuki
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yasuko Narita
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masaki Honda
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Tomoaki Irie
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masashi Kadohisa
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Seiichi Kawabata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Hidekazu Yamamoto
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Osamu Ikeda
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | | | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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Kumaran V, Kapoor S, Sable S, Nath B, Varma V. The "W" Technique: A Safe and Reproducible Technique for Hepatic Artery Reconstruction in Living Donor Liver Transplantation. Ann Transplant 2021; 26:e926979. [PMID: 33510125 PMCID: PMC7852041 DOI: 10.12659/aot.926979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Reconstruction of the hepatic arterial inflow can be technically demanding in living donor liver transplantation, and thrombosis can result in graft loss and mortality. We describe the safe and reproducible "W" technique to reconstruct the hepatic artery and outcomes before and after adoption of the technique in a consecutive series of liver transplants at 2 high-volume living donor liver transplant centers. MATERIAL AND METHODS Prospectively collected data were analyzed to compare the outcomes before and after introduction of a standardized "W" technique for reconstruction of the hepatic artery in 2 high-volume living donor liver transplant programs. RESULTS In a consecutive series of 675 liver transplants, of which 27 were deceased donor transplants and 648 were living donor transplants, 443 transplants were performed with a standard interrupted reconstruction of the hepatic artery under loupes. These transplants were performed by a single surgeon, with an incidence of hepatic artery thrombosis of 2%. After introduction of the "W" technique, despite the arterial reconstruction being done by several surgeons in the early part of their learning curve, the incidence of hepatic artery thrombosis decreased to 0.86% in the next 232 transplants. CONCLUSIONS The "W" technique is a simple, easy to learn and teach technique for reconstruction of the hepatic artery without the use of the operating microscope in living donor liver transplantation.
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Affiliation(s)
- Vinay Kumaran
- Department of Surgery (Transplant), Hume Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - Sorabh Kapoor
- Department of Surgical Gastroenterology and Liver Transplant, Zydus Hospital, Ahmedabad, India
| | - Shailesh Sable
- Department of Liver Transplant and Hepatobiliary Surgery, Sahyadri Hospital, Pune, India
| | - Barun Nath
- Department of Liver Transplant and Hepatobiliary Surgery, Apollo Gleneagles Hospital, Kolkata, India
| | - Vibha Varma
- Department of Liver Transplant and Hepatobiliary Surgery, Max Hospitals, New Delhi, India
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Tokunaga K, Furuta A, Isoda H, Uemoto S, Togashi K. Feasibility and mid- to long-term results of endovascular treatment for portal vein thrombosis after living-donor liver transplantation. Diagn Interv Radiol 2020; 27:65-71. [PMID: 33252338 DOI: 10.5152/dir.2020.19469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE We aimed to evaluate mid- to long-term results of endovascular treatment for portal vein thrombosis (PVT) after living-donor liver transplantation (LDLT). METHODS Thirty cases (14 males, 16 females; age range, 0.67-65 years) who underwent endovascular treatment including thrombolysis, angioplasty, stent placement, and/or collateral embolization for PVT after LDLT from 2001 to 2017 were retrospectively reviewed. Clinical and procedural data were collected and analyzed regarding the patency of the PVT site at the last follow-up date (PVT-free persistency) using Log-rank test. Results were considered statistically significant at P < 0.05. RESULTS Median follow-up was 120 months. The technical success rate was 80% (n=24). Patency rates at 1 week and 1, 3, 6, 12, 36, and 60 months were 73%, 59%, 55%, 51%, 51%, 51%, and 51% for primary patency and 80%, 70%, 66%, 66%, 66%, 61%, and 61% for assisted patency after secondary endovascular treatment. PVT-free persistency rates regarding the subgroups were as follows: children under 12 years vs. adults, 50% vs. 68% (P = 0.42); acute vs. nonacute, 76% vs. 46% (P = 0.10); localized vs. extensive, 90% vs. 50% (P = 0.035); transileocolic approach vs. percutaneous-transhepatic approach, 71% vs. 54% (P = 0.39); and thrombolysis-based treatment vs. non-thrombolysis-based treatment, 71% vs. 44% (P = 0.12), respectively. Among technically successful cases, PVT-free persistency rate was 94% for those with hepatopetal flow in the peripheral portal vein vs. 17% for those without hepatopetal flow (P < 0.001). The only major complication occurring was pleural hemorrhage (n=1). Minor complications (i.e., fever) occurred in 18 patients (60%). CONCLUSION In conclusion, mid- to long-term portal patency following endovascular treatment was approximately 50%-60% in PVT patients after LDLT. PVT site patency over three months after the first endovascular treatment, localized PVT, and hepatopetal flow in the peripheral portal vein were identified as key prognostic factors for mid- to long-term portal patency.
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Affiliation(s)
- Koji Tokunaga
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
| | - Akihiro Furuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Transplantation, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
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Shimata K, Sugawara Y, Irie T, Sambommatsu Y, Kadohisa M, Ibuki S, Kawabata S, Isono K, Honda M, Yamamoto H, Hibi T. Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports. BMC Gastroenterol 2020; 20:378. [PMID: 33183260 PMCID: PMC7664099 DOI: 10.1186/s12876-020-01528-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background Hepatic artery dissection after liver transplantation is an uncommon morbidity. The onset mechanism and management for this disorder remain unclear. The present report describes the cases of two patients with hepatic artery dissection after living-donor liver transplantation (LDLT) with simultaneous splenectomy and provides new insight into the onset mechanism of this disorder. Case presentation: Case 1 A 51-year-old man with liver cirrhosis caused by hepatitis B virus underwent LDLT with a right lobe graft and splenectomy simultaneously. The recipient’s right hepatic artery had partial dissection at the anastomosis site; therefore, his left hepatic artery was anastomosed. Contrast-enhanced computed tomography (CT) on postoperative day (POD) 27 showed dissection from his celiac artery to his left hepatic artery with bleeding in the false lumen. There was a risk of rupture of the false lumen; therefore, emergency interventional radiology and coil embolization of the false lumen were performed. The patient was doing well at 6 months after LDLT. Case 2 A 58-year-old woman with liver cirrhosis caused by primary biliary cholangitis underwent LDLT with a left lobe graft and splenectomy simultaneously. Her hepatic artery had a dissection that extended from her left hepatic artery to the proper hepatic artery. The gastroduodenal artery was anastomosed. Contrast-enhanced CT on POD 8 revealed dissection from the celiac artery to the common hepatic artery as well as a pseudoaneurysm at the celiac artery. We managed the patient with conservative treatment and performed daily follow-ups with Doppler ultrasonography examination and serial contrast-enhanced CT. At the time of writing this report, the patient was doing well at 34 months after LDLT. Conclusions Patients who have an intimal dissection at the anastomosis site and/or simultaneous splenectomy are at a higher risk of hepatic artery dissection. Most patients with asymptomatic hepatic artery dissections can be treated conservatively. Blood flow in the intrahepatic artery should be checked frequently using Doppler ultrasonography or contrast-enhanced CT soon after diagnosis.
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Affiliation(s)
- Keita Shimata
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Yasuhiko Sugawara
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tomoaki Irie
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuzuru Sambommatsu
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masashi Kadohisa
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Sho Ibuki
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Seiichi Kawabata
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kaori Isono
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hidekazu Yamamoto
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Taizo Hibi
- Department of Transplantation and Pediatric Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Chen L, Shi X, Lv G, Sun X, Sun C, Cai Y, Niu J, Jin J, Liu N, Li W. The long-term outcomes of deceased-donor liver transplantation for primary biliary cirrhosis: a two-center study in China. PeerJ 2020; 8:e9563. [PMID: 32879788 PMCID: PMC7443077 DOI: 10.7717/peerj.9563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background & Aims Factors that influence the outcomes after deceased-donor liver transplantation (DDLT) for primary biliary cirrhosis (PBC) are not well known. We aimed to clarify these effects on the outcomes after DDLT. Methods We retrospectively analyzed patients with PBC who underwent DDLT from March 2006 to July 2018 at the organ transplantation center of the First Hospital of Jilin University and the First Central Hospital of Tianjin. Changes in liver function were assessed posttransplantation. Recurrence, survival rate, and complications were recorded at follow-up. The effect of liver transplantation on survival and recurrence was evaluated using univariate and/or multivariate Cox regression analyses. Results In total, 69 patients with PBC undergoing DDLT were included in this study. At 4 weeks posttransplant, all liver function tests were normal. During a median follow-up time of 32 months, 5-year overall survival and recurrence rates were estimated as 95.1% and 21.8%, respectively. A recipient aspartate aminotransferase-to-platelet ratio index (APRI) greater than 2 was negatively associated with survival (P = 0.0018). Multivariate regression analysis demonstrated that age younger than 48 years was an independent risk factor for recurrent PBC in recipients undergoing liver transplantation (hazard ratio 0.028, 95% confidence interval 0.01-0.71, P = 0.03). Posttransplant infections (62%) and biliary tract complications (26%) were the most common complications. Conclusion Liver transplantation is an effective treatment for patients with PBC. Liver function normalizes by 4 weeks posttransplant. Although posttransplant survival rate is high, recurrence is possible. To some extent, survival rate and recurrence rate can be predicted by APRI and age, respectively.
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Affiliation(s)
- Lin Chen
- Department of Hepatology, First Hospital, Jilin University, Changchun, China
| | - Xiaodong Shi
- Department of Rheumatology, First Hospital, Jilin University, Changchun, China
| | - Guoyue Lv
- Department of Hepatobiliary Pancreatic Surgery, First Hospital, Jilin University, Changchun, China
| | - Xiaodong Sun
- Department of Hepatobiliary Pancreatic Surgery, First Hospital, Jilin University, Changchun, China
| | - Chao Sun
- Department of Transplant Center, First Central Hospital, Tianjin, Tianjin, China
| | - Yanjun Cai
- Department of Hepatology, First Hospital, Jilin University, Changchun, China
| | - Junqi Niu
- Department of Hepatology, First Hospital, Jilin University, Changchun, China
| | - Jinglan Jin
- Department of Hepatology, First Hospital, Jilin University, Changchun, China
| | - Ning Liu
- Department of Cardiology, First Hospital, Jilin University, Changchun, China
| | - Wanyu Li
- Department of Hepatology, First Hospital, Jilin University, Changchun, China
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Tang W, Qiu JG, Cai Y, Cheng L, Du CY. Increased Surgical Complications but Improved Overall Survival with Adult Living Donor Compared to Deceased Donor Liver Transplantation: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1320830. [PMID: 32908865 PMCID: PMC7468609 DOI: 10.1155/2020/1320830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/19/2020] [Accepted: 08/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) provides an alternative to deceased donor liver transplantation (DDLT) for patients with end-stage liver disease in the circumstance of scarcity of deceased grafts. However, the outcomes of LDLT remain controversial. METHOD A systematic review and meta-analysis were performed to compare the outcomes of LDLT with DDLT. Twelve outcomes were assessed. RESULTS Thirty-nine studies involving 38563 patients were included. LDLT was comparable in red blood cell transfusion, perioperative mortality, length of hospital stay, retransplantation rate, hepatitis C virus recurrence rate, and hepatocellular carcinoma recurrence rate with DDLT. Cold ischemia time was shorter and duration of recipient operation was longer in LDLT. Postoperative intra-abdominal bleeding rate occurred less frequently in LDLT recipients (odds ratio (OR) = 0.64, 95%confidence interval (CI) = 0.46 - 0.88, P = 0.006), but this did not decrease the perioperative mortality. LDLT was associated with significantly higher biliary (OR = 2.23, 95%CI = 1.59 - 3.13, P < 0.00001) and vascular (OR = 2.00, 95%CI = 1.31 - 3.07, P = 0.001) complication rates and better overall survival (OS) (1 year: OR = 1.32, 95%CI = 1.01 - 1.72, P = 0.04; 3 years: OR = 1.39, 95%CI = 1.14 - 1.69, P = 0.0010; and 5 years: OR = 1.33, 95%CI = 1.04 - 1.70, P = 0.02). According to subgroup analysis, biliary complication rate and OS improved dramatically as experience increased, while vascular complication rate could not be improved because it was mainly caused by the difference of the donor type itself. CONCLUSIONS LDLT remains a valuable option for patients in need of liver transplantation for it provides an excellent alternative to DDLT without compromising recipient outcomes. Further refinement in biliary and vascular reconstruction techniques and the accumulation of liver transplantation centers' experience are the key factors in expanding the application of LDLT.
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Affiliation(s)
- Wei Tang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jian-Guo Qiu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yang Cai
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Luo Cheng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Cheng-You Du
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Zhong J, Smith C, Walker P, Sheridan M, Guthrie A, Albazaz R. Imaging post liver transplantation part I: vascular complications. Clin Radiol 2020; 75:845-853. [PMID: 32709390 DOI: 10.1016/j.crad.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
Liver transplantation continues to rise in frequency, with over 1,000 procedures performed in the UK in 2018. Complications are increasingly uncommon but when they occur, early recognition and intervention is vital to save grafts. Imaging after the perioperative period is often performed at patients' local hospitals meaning that all radiologists and sonographers need to have an understanding of how to assess a transplant liver. Part I of this series will focus on vascular complications, including the normal postoperative vascular anatomy following liver transplantation, normal post-transplantation vascular imaging findings and abnormal findings that may prompt further investigation. Vascular complications following liver transplantation will be illustrated using a collection of cases.
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Affiliation(s)
- J Zhong
- Department of Clinical and Interventional Radiology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - C Smith
- Department of Clinical and Interventional Radiology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - P Walker
- Department of Clinical and Interventional Radiology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - M Sheridan
- Department of Clinical and Interventional Radiology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - A Guthrie
- Department of Clinical and Interventional Radiology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - R Albazaz
- Department of Clinical and Interventional Radiology, St James's University Hospital, Leeds, LS9 7TF, UK.
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Zanetto A, Senzolo M, Blasi A. Perioperative management of antithrombotic treatment. Best Pract Res Clin Anaesthesiol 2020; 34:35-50. [PMID: 32334786 DOI: 10.1016/j.bpa.2020.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/13/2019] [Accepted: 01/06/2020] [Indexed: 01/10/2023]
Abstract
End-stage liver disease is characterized by multiple and complex alterations of hemostasis that are associated with an increased risk of both bleeding and thrombosis. Liver transplantation further challenges the feeble hemostatic balance of patients with decompensated cirrhosis, and the management of antithrombotic treatment during and after transplant surgery, which is particularly difficult. Bleeding was traditionally considered the major concern during and early after surgery, but it is increasingly recognized that transplant recipients may also develop thrombotic complications. Pathophysiology of hemostatic complications during and after transplantation is multifactorial and includes pre-, intra-, and postoperative risk factors. Risk stratification is important, as it helps the identification of high-risk recipients in whom antithrombotic prophylaxis should be considered. In recipients who develop thrombosis during or after surgery, prompt treatment is indicated to prevent graft failure, retransplantation, and death.
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Affiliation(s)
- Alberto Zanetto
- Gastroenterology, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Marco Senzolo
- Gastroenterology, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Annabel Blasi
- Anesthesia Department, Hospital Clinic de Barcelona, Barcelona, Spain.
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Kim KS, Kim JM, Lee JS, Choi GS, Cho JW, Lee SK. Stent insertion and balloon angioplasty for portal vein stenosis after liver transplantation: long-term follow-up results. ACTA ACUST UNITED AC 2020; 25:231-237. [PMID: 31063137 DOI: 10.5152/dir.2019.18155] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE It is not easy to determine whether balloon angioplasty or stenting should be performed in patients with portal vein stenosis after liver transplantation. We aimed to propose appropriate indication by evaluating long-term outcomes of balloon angioplasty and stent insertion in adult liver transplant patients. METHODS We retrospectively reviewed 31 patients with portal vein stenosis among 1369 patients who underwent adult liver transplantation from January 2001 to December 2015. When stenosis was confirmed by venography, angioplasty was performed first. When there was no flow improvement or pressure gradient was not decreased after angioplasty, stent insertion was performed. We also performed primary stent insertion without angioplasty for diffuse stenosis, kinking, external compression, and near occlusion of portal vein in venography. We assessed patency in patients who underwent percutaneous transluminal angioplasty and stent insertion through regular outpatient follow-up and evaluated technical and clinical success and long-term results. RESULTS Technical success was 85% and 100% in balloon angioplasty and stent insertion, respectively. Clinical success was achieved in 78% of balloon angioplasties and in 100% of stent insertions. At 1, 5, and 10 years after balloon angioplasty, patency rates were 87%, 82%, and 68% respectively, and the rates of stent patency were all 100%. Portal vein size measured during the operation of patients with and without recurrence were 19±4.2 mm and 19±3.0 mm (P = 0.956), respectively. The balloon size of patients with and without recurrence were 11±1.95 mm and 14±1.66 mm, respectively (P = 0.013), when balloon angioplasty was performed after stenosis diagnosis. CONCLUSION Stent insertion can be considered when fibrotic changes are expected due to repeated inflammation and when the balloon size to be used is small. Balloon angioplasty seems less risky for anastomotic ruptures in portal vein stenosis in the early post liver transplantation period.
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Affiliation(s)
- Kyeong Sik Kim
- Department of Surgery-Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Man Kim
- Department of Surgery-Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Soo Lee
- Department of Surgery-Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Sung Choi
- Department of Surgery-Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Won Cho
- Department of Surgery-Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suk-Koo Lee
- Department of Surgery-Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Delgado-Moraleda JJ, Ballester-Vallés C, Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation. Insights Imaging 2019; 10:78. [PMID: 31414188 PMCID: PMC6694376 DOI: 10.1186/s13244-019-0759-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
Clinical manifestations of liver transplantation complications can be subtle and non-specific. Medical imaging, mainly Doppler ultrasound, plays an important role to detect and grade these. Colour Doppler ultrasound exams are routinely performed at 24–48 h, on the 7th day, the first and third month after transplantation. MDCT and MR images are acquired based on the Doppler ultrasound (DUS) findings, even in the absence of abnormal liver function. As vascular complications appear early after surgery, DUS should be performed by experience personnel. Diagnostic angiography is seldom performed. This pictorial review illustrates the key imaging findings of vascular complications in patients with liver transplantation: hepatic artery complications (such as thrombosis, stenosis of the anastomosis and pseudoaneurysms), portal vein abnormalities (such as occlusion and stenosis) and hepatic veins and/or inferior vena cava flow changes (Budd-Chiari syndrome).
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Affiliation(s)
- Juan-José Delgado-Moraleda
- Medical Imaging Department and Biomedical Imaging Research Group (GIBI230), La Fe Polytechnics and University Hospital and Health Research Institute, Valencia, Spain.
| | - Carmen Ballester-Vallés
- Medical Imaging Department and Biomedical Imaging Research Group (GIBI230), La Fe Polytechnics and University Hospital and Health Research Institute, Valencia, Spain
| | - Luis Marti-Bonmati
- Medical Imaging Department and Biomedical Imaging Research Group (GIBI230), La Fe Polytechnics and University Hospital and Health Research Institute, Valencia, Spain
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Miranda LE, Leitão L, Jucá N, Lacerda CM. Dissection of the Hepatic Artery: A Rare Cause of Late Ischemia After Liver Transplant. EXP CLIN TRANSPLANT 2019; 18:641-644. [PMID: 31250739 DOI: 10.6002/ect.2019.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hepatic artery dissection is an infrequent vascular complication that can arise after orthotopic liver transplant. Most patients with this complication are diagnosed during the intraoperative period or the first days after liver transplant, with an association shown with living-donor liver transplant. In this study, we discuss a rare case of an extrahepatic artery dissection that was successfully managed through surgical excision and arterial revascularization that was diagnosed 4 years after orthotopic liver transplant. Furthermore, we hypothesize on the potential causes of its occurrence.
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Affiliation(s)
- Luiz Eduardo Miranda
- From the Division of General Surgery and Liver Transplantation, Hospital Oswaldo Cruz, Pernambuco University, Recife, Pernambuco, Brazil
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Chen S, Wang X, Zhang B, Liu B, Pan H. Meta-analysis of the diagnostic value of contrast-enhanced ultrasound for the detection of vascular complications after liver transplantation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:388-396. [PMID: 30569729 DOI: 10.17235/reed.2018.5818/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND contrast-enhanced ultrasound (CEUS) is increasingly used to identify vascular complications in patients after liver transplantation. The present study aimed to evaluate the diagnostic accuracy of CEUS using all available data. MATERIALS AND METHODS relevant studies published before February 2018 were retrieved from PubMed, EMBASE, ScienceDirect and Web of Science. Pooled sensitivity and specificity, diagnostic odds ratio (DOR) and summary receiver operating characteristic curve (SROC) were calculated to estimate the diagnostic performance of CEUS for vascular complications. Sensitivity analysis was performed that stratified studies according to age, study design and sample size in order to determine the influence of these factors on the overall effect. Meta-regression analyses were performed to examine the possible sources of heterogeneity. Quality assessment and publication bias of the included studies were also evaluated. RESULTS thirteen studies which consisted of 2,781 CEUS cases were included in the analysis. The pooled weighted estimates of sensitivity and specificity were 0.90 (95% CI, 0.84 to 0.95) and 1.00 (95% CI, 1.00 to 1.00), the diagnostic odds ratio (DOR) was 431.96 (95% CI, 164.60 to 1,133.59) and the area under the curve (AUC) of SROC was 0.9741. According to the sensitivity analysis, age, study design and sample size had an insignificant influence on the diagnostic performance of CEUS. The meta-regression analyses did not reveal a strong correlation between CEUS accuracy and study design, treatment time of patients and experience of the radiologists. CONCLUSION the results of our meta-analysis showed a high sensitivity, specificity and accuracy of the CEUS modality for the identification of vascular complications in patients after liver transplantation. Since this is the first meta-analysis investigating in this aspect, more evidence is required to validate the clinical utility of CEUS for the identification of vascular complications in patients with a transplanted liver.
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The changes of intraoperative body temperature in adult liver transplantation: A retrospective study. Hepatobiliary Pancreat Dis Int 2018; 17:496-501. [PMID: 30205926 DOI: 10.1016/j.hbpd.2018.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Body temperature is poorly regulated in patients with end-stage liver disease. Due to the prolonged surgery time and anhepatic time as well as the complex surgical procedures performed in liver transplantation, the body temperature fluctuates greatly. This study investigated the effect of intraoperative body temperature fluctuations on the prognosis of liver recipients. METHODS The body temperatures of liver recipients recorded from the induction of anesthesia (T0) until the end of surgery (T14) were retrieved. The patients were divided into two groups: the hypothermia group (< 35 °C and ≥ 5 min) and the normothermia group (≥ 35 °C or < 35 °C but < 5 min). Intraoperative and postoperative variables were compared between the two groups, and the correlations between the duration of hypothermia and the medical variables were analyzed. RESULTS Of the 107 patients, 67 patients were in the normothermia group, and 40 in the hypothermia group. The lowest body temperature was at 5 min after reperfusion for the whole cohort. Compared with the normothermia group, patients in the hypothermia group were more prone to bleeding, had a longer intubation time and increased rates of bacterial infection and acute pulmonary edema after liver transplantation (P < 0.05). Hypothermia time was positively correlated with bleeding volume, intubation time, units of blood transfusions and intensive care stay, but negatively correlated with urine output. CONCLUSIONS The intraoperative body temperature exhibited a graphical "V" trend, and the lowest temperature was at 5 min after reperfusion. The longer the duration of hypothermia, the more unfavourable the prognosis.
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Linares I, Goldaracena N, Rosales R, Maza LDL, Kaths M, Kollmann D, Echeverri J, Selzner N, McCluskey SA, Sapisochin G, Lilly LB, Greig P, Bhat M, Ghanekar A, Cattral M, McGilvray I, Grant D, Selzner M. Splenectomy as Flow Modulation Strategy and Risk Factors of De Novo Portal Vein Thrombosis in Adult-to-Adult Living Donor Liver Transplantation. Liver Transpl 2018; 24:1209-1220. [PMID: 30146768 DOI: 10.1002/lt.25212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/14/2018] [Indexed: 02/07/2023]
Abstract
Portal vein thrombosis (PVT) is a severe complication after liver transplantation that can result in increased morbidity and mortality. Few data are available regarding risk factors, classification, and treatment of PVT after living donor liver transplantation (LDLT). Between January 2004 and November 2014, 421 adult-to-adult LDLTs were performed at our institution, and they were included in the analysis. Perioperative characteristics and outcomes from patients with no-PVT (n = 393) were compared with those with de novo PVT (total portal vein thrombosis [t-PVT]; n = 28). Ten patients had early portal vein thrombosis (e-PVT) occurring within 1 month, and 18 patients had late portal vein thrombosis (l-PVT) appearing later than 1 month after LDLT. Analysis of perioperative variables determined that splenectomy was associated with t-PVT (hazard ratio [HR], 3.55; P = 0.01), e-PVT (HR, 4.96; P = 0.04), and l-PVT (HR, 3.84; P = 0.03). In contrast, donor age was only found as a risk factor for l-PVT (HR, 1.05; P = 0.01). Salvage rate for treatment in e-PVT and l-PVT was 100% and 50%, respectively, without having an early event of rethrombosis. Mortality within 30 days did not show a significant difference between groups (no-PVT, 2% versus e-PVT, 10%; P = 0.15). No significant differences were found regarding 1-year (89% versus 92%), 5-year (79% versus 82%), and 10-year (69% versus 79%) graft survival between the t-PVT and no-PVT groups, respectively (P = 0.24). The 1-year (89% versus 96%), 5-year (82% versus 86%), and 10-year (79% versus 83%) patient survival was similar for the patients in the no-PVT and t-PVT groups, respectively (P = 0.70). No cases of graft loss occurred as a direct consequence of PVT. In conclusion, the early diagnosis and management of PVT after LDLT can lead to acceptable early and longterm results without affecting patient and graft survival.
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Affiliation(s)
- Ivan Linares
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Roizar Rosales
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Luis De la Maza
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Moritz Kaths
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Dagmar Kollmann
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Juan Echeverri
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Nazia Selzner
- Department of Medicine, Multi-Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stuart A McCluskey
- Department of Anesthesiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Gonzalo Sapisochin
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Leslie B Lilly
- Department of Medicine, Multi-Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Paul Greig
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mamatha Bhat
- Department of Medicine, Multi-Organ Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada
| | - Anand Ghanekar
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mark Cattral
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ian McGilvray
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - David Grant
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Markus Selzner
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
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Minimizing Hepatic Artery Thrombosis and Establishing Safety of Grafts With Dual Arteries in Living Donor Liver Transplantation. Transplant Proc 2018; 50:1378-1385. [DOI: 10.1016/j.transproceed.2018.02.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 01/03/2018] [Accepted: 02/06/2018] [Indexed: 12/26/2022]
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Postoperative Doppler Ultrasonography in Liver Transplantation. Transplant Proc 2018; 50:1100-1103. [PMID: 29731074 DOI: 10.1016/j.transproceed.2018.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Doppler ultrasonography plays an important role in the postoperative management of liver transplantation. We present our initial experiences evaluating liver transplants with the use of postoperative Doppler sonography. METHODS In our hospital, we performed 20 liver transplantations from July 2014 to October 2016. Among 20 patients, we performed 15 deceased-donor liver transplantations (DDLTs) and 5 living-donor liver transplantations (LDLTs). For deceased donors, inferior vena cava anastomoses were performed with the use of the piggyback technique, and for living donors, modified right grafts were used with middle hepatic vein reconstruction by Dacron graft. In the intensive care unit, we performed Doppler ultrasound at least once a day and at every clinical need. We checked hepatic blood flow by means of Doppler ultrasound. RESULTS Eighteen patients underwent Doppler ultrasonography once a day up to postoperative day 6. Of the patients who received LDLT, 2 patients underwent Doppler ultrasonography twice a day because the operator was concerned about the hepatic artery anastomosis. Findings on Doppler ultrasound showed no abnormal wave form in hepatic artery, portal vein and hepatic veins. No patient had abnormal findings on angiographic computerized tomography. There was 1 graft failure in 20 recipients. The graft failure was primary nonfunction, and retransplantation was done. During the hospitalizations, there were no vascular complications. CONCLUSIONS Doppler ultrasonography can be used to evaluate postoperative vascular complications in liver transplant patients. When the operator checks postoperative Doppler ultrasonography, it is possible to differentiate between patients, and it may help to detect the vascular complications earlier.
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Zhang R, Zhu ZJ, Sun LY, Wei L, Qu W, Zeng ZG, Liu Y. Outcomes of Pediatric Liver Transplantation: Deceased Donor Liver Transplantation vs Living Donor Liver Transplantation. Transplant Proc 2018; 50:3601-3605. [PMID: 30577244 DOI: 10.1016/j.transproceed.2018.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/16/2018] [Accepted: 04/12/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of pediatric donor liver for pediatric liver transplantation (LT) remains controversial and few studies have focused on pediatric deceased donors. To address this issue, we decided to perform a retrospective research, trying to compare the clinical effects between deceased donor LTs (DDLTs) and living donor LTs (LDLTs). METHODS A retrospective review of pediatric LTs using grafts from deceased donors and living donors from June 2013 to August 2016 was performed. The children were divided into a DDLT group and a LDLT group based on their donor styles. The incidence of early vascular complications (VC), biliary complications, and graft and patient survival rates were observed between the 2 groups. RESULTS There were 217 cases of pediatric LTs performed in our hospital from June 2013 to August 2016 (83 DDLTs and 134 LDLTs). The 1-year cumulative survival rates of grafts and recipients were 89.16% and 91.57% in DDLTs, and 95.47% and 95.52% in LDLTs, respectively (P > .05). The incidence of early VC was lower in LDLTs than that in DDLTs (3.7% vs 19.3%, P < .001). The incidence of HAT in children aged less than 1 year was significantly higher in the DDLT group (P < .001) and can be up to 31.82%. The incidence of biliary complications was similar in the 2 groups (8.4% vs 13.5%, P = .285). CONCLUSIONS Pediatric DDLTs have similar graft and patient survival rates with LDLT. The incidence of early VC was higher in DDLTs, and children aged less than 1 year are at a higher risk of developing HAT.
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Affiliation(s)
- R Zhang
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Department of Hepatobiliary and Pancreatic Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
| | - Z-J Zhu
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - L-Y Sun
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - L Wei
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - W Qu
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Z-G Zeng
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Y Liu
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Zhang R, Zhu ZJ, Sun LY, Wei L, Qu W. Outcomes of Liver Transplantation Using Pediatric Deceased Donor Livers: A Single-Center Analysis of 102 Donors. Chin Med J (Engl) 2018; 131:677-683. [PMID: 29521290 PMCID: PMC5865313 DOI: 10.4103/0366-6999.226901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The outcome of pediatric deceased donor liver transplantation (LT) has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT. METHODS A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed. The patients were divided into the pediatric-to-pediatric LT group and pediatric-to-adult LT group based on the ages of the recipients. The survival and incidence of early vascular complications (VCs) were observed between the two groups. We also analyzed the risk factors of early VCs in pediatric LT and the effect of donor hypernatremia on the prognosis of recipients. RESULTS There were 102 cases of LT using pediatric deceased donor livers in our hospital from June 2013 to August 2016, 83 pediatric-to-pediatric LT (recipients' age ≤13 years) and 19 pediatric-to-adult LT (recipients' age ≥19 years). The ratio of early VC was similar in the two groups (19.3% vs. 10.6%, P = 0.514). Low body weight of recipient was an independent risk factor of early VC in pediatric LT (odds ratio: 0.856, 95% confidence interval: 0.752-0.975, P = 0.019). The 1-year cumulative survival rates of grafts and patients were 89.16% and 91.57% in pediatric-to-pediatric LT and 89.47% and 94.74% in pediatric-to-adult LT, respectively (all P > 0.05). In all cases, patients using donors with hypernatremia (serum sodium levels ≥150 mmol/L) had worse graft survival (χ2=4.330, P = 0.037). CONCLUSIONS Pediatric-to-pediatric LT group has similar graft and patient survival rates with those of pediatric-to-adult LT group. Low body weight of recipients is an independent risk factor of early VC in pediatric LT. Patients using donors with hypernatremia have worse graft survival.
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Affiliation(s)
- Rui Zhang
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Department of Hepatobiliary and Pancreatic Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Zhi-Jun Zhu
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Li-Ying Sun
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lin Wei
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wei Qu
- Liver Transplantation Center, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Mantaka A, Augoustaki A, Kouroumalis EA, Samonakis DN. Portal vein thrombosis in cirrhosis: diagnosis, natural history, and therapeutic challenges. Ann Gastroenterol 2018; 31:315-329. [PMID: 29720857 PMCID: PMC5924854 DOI: 10.20524/aog.2018.0245] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/26/2017] [Indexed: 12/13/2022] Open
Abstract
Portal vein thrombosis (PVT) is a frequent complication in cirrhosis and its prevalence increases with disease severity. Several factors are involved in the development and progression of PVT. The challenge for the management of PVT is the precise evaluation of the bleeding risk as opposed to life-threatening extension of thrombosis. Nevertheless, the impact on the progression and outcome of liver disease is unclear. A critical evaluation of the available data discloses that treating PVT in cirrhotics is safe and effective. However, there are open issues, such as which anticoagulant could represent a safer therapeutic option, and when and for how long this treatment should be administered to cirrhotic patients with PVT.
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Affiliation(s)
- Aikaterini Mantaka
- Department of Gastroenterology and Hepatology, University Hospital of Crete, Heraklion, Crete, Greece
| | - Aikaterini Augoustaki
- Department of Gastroenterology and Hepatology, University Hospital of Crete, Heraklion, Crete, Greece
| | - Elias A Kouroumalis
- Department of Gastroenterology and Hepatology, University Hospital of Crete, Heraklion, Crete, Greece
| | - Dimitrios N Samonakis
- Department of Gastroenterology and Hepatology, University Hospital of Crete, Heraklion, Crete, Greece
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Li JW, Lu Q, Luo Y. Hepatic Venous Outflow Stenosis After Auxiliary Left Hemiliver Transplantation Diagnosed by Ultrasonic Shear Wave Elastography Combined With Doppler Ultrasonography. Ultrasound Q 2017; 33:289-292. [PMID: 29190228 PMCID: PMC5704733 DOI: 10.1097/ruq.0000000000000306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/03/2017] [Indexed: 02/05/2023]
Abstract
Hepatic vein stenosis after liver transplantation is a relatively rare complication that could even result in graft loss. However, it is difficult to arrive at a definite diagnosis at the early stage of postoperation, and there are few researches on ultrasonic shear wave elastography in the diagnosis of hepatic vein stenosis. We report the case of an 11-year-old male patient with cirrhosis due to hepatolenticular degeneration who received an auxiliary left hemiliver graft from his uncle. Massive ascites developed in 4 days after the operation. Stenosis was suspected at the site of anastomosis by Doppler ultrasonography when elevating the velocity of the left hepatic vein. Meanwhile, increased stiffness of the graft was revealed by ultrasonic shear wave elastography. The stenosis was confirmed by subsequent digital subtraction angiography. Ascites decreased gradually after the stent implantation. Our case indicates that ultrasonic shear wave elastography combined with Doppler ultrasonography is a promising method for noninvasive diagnosis of hepatic venous outflow stenosis following liver transplantation.
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Affiliation(s)
- Jia-Wu Li
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Thornburg B, Katariya N, Riaz A, Desai K, Hickey R, Lewandowski R, Salem R. Interventional radiology in the management of the liver transplant patient. Liver Transpl 2017; 23:1328-1341. [PMID: 28741309 DOI: 10.1002/lt.24828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023]
Abstract
Liver transplantation (LT) is commonly used to treat patients with end-stage liver disease. The evolution of surgical techniques, endovascular methods, and medical care has led to a progressive decrease in posttransplant morbidity and mortality. Despite these improvements, a multidisciplinary approach to each patient remains essential as the early diagnosis and treatment of the complications of transplantation influence graft and patient survival. The critical role of interventional radiology in the collaborative approach to the care of the LT patient will be reviewed. Liver Transplantation 23 1328-1341 2017 AASLD.
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Affiliation(s)
- Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Nitin Katariya
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Robert Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.,Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
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Shoreem H, Gad EH, Soliman H, Hegazy O, Saleh S, Zakaria H, Ayoub E, Kamel Y, Abouelella K, Ibrahim T, Marawan I. Small for size syndrome difficult dilemma: Lessons from 10 years single centre experience in living donor liver transplantation. World J Hepatol 2017; 9:930-944. [PMID: 28824744 PMCID: PMC5545138 DOI: 10.4254/wjh.v9.i21.930] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/14/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the incidence, risk factors, prevention, treatment and outcome of small for size syndrome (SFSS) after living donor liver transplantation (LDLT). METHODS Through-out more than 10 years: During the period from April 2003 to the end of 2013, 174 adult-to-adults LDLT (A-ALDLT) had been performed at National Liver Institute, Menoufiya University, Shibin Elkoom, Egypt. We collected the data of those patients to do this cohort study that is a single-institution retrospective analysis of a prospectively collected database analyzing the incidence, risk factors, prevention, treatment and outcome of SFSS in a period started from the end of 2013 to the end of 2015. The median period of follow-up reached 40.50 m, range (0-144 m). RESULTS SFSS was diagnosed in 20 (11.5%) of our recipients. While extra-small graft [small for size graft (SFSG)], portal hypertension, steatosis and left lobe graft were significant predictors of SFSS in univariate analysis (P = 0.00, 0.04, 0.03, and 0.00 respectively); graft size was the only independent predictor of SFSS on multivariate analysis (P = 0.03). On the other hand, there was lower incidence of SFSS in patients with SFSG who underwent splenectomy [4/10 (40%) SFSS vs 3/7 (42.9%) no SFSS] but without statistical significance, However, there was none significant lower incidence of the syndrome in patients with right lobe (RL) graft when drainage of the right anterior and/or posterior liver sectors by middle hepatic vein, V5, V8, and/or right inferior vein was done [4/10 (28.6%) SFSS vs 52/152 (34.2%) no SFSS]. The 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients with SFSS were 30%, 30%, 25%, 25%, 25% and 25% respectively, while, the 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients without SFSS were 70.1%, 65.6%, 61.7%, 61%, 59.7%, and 59.7% respectively, with statistical significant difference (P = 0.00). CONCLUSION SFSG is the independent and main factor for occurrence of SFSS after A-ALDLT leading to poor outcome. However, the management of this catastrophe depends upon its prevention (i.e., selecting graft with proper size, splenectomy to decrease portal venous inflow, and improving hepatic vein outflow by reconstructing large draining veins of the graft).
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Affiliation(s)
- Hany Shoreem
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Emad Hamdy Gad
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Hosam Soliman
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Osama Hegazy
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Sherif Saleh
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Hazem Zakaria
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Eslam Ayoub
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Yasmin Kamel
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Kalid Abouelella
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Tarek Ibrahim
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
| | - Ibrahim Marawan
- Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt
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