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Choubey AP, Chou J, Ilagan C, Steinharter J, Heiselman JS, Chakraborty J, Soares KC, Wei AC, Gonen M, Balachandran VP, Drebin J, Kingham TP, D'Angelica MI, Jarnagin WR. Precision in Liver Surgery: A Comparative Analysis of Volumetry Techniques. Ann Surg Oncol 2025:10.1245/s10434-025-17462-y. [PMID: 40402422 DOI: 10.1245/s10434-025-17462-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 04/27/2025] [Indexed: 05/23/2025]
Abstract
BACKGROUND Future liver remnant volume (FLRV) is a critical determinant of safety for hepatectomy. This study assesses concordance between imaging-based measured FLRV (mFLRV), and body surface area (BSA)-based standardized FLRV (sFLRV), and their association with post-hepatectomy complications. MATERIALS AND METHODS All major hepatectomy between 1999 and 2021 were assessed for agreement between mFLRV and sFLRV using concordance correlation coefficient (CCC). Association between each method and major postoperative complications, post-hepatectomy liver failure (PHLF), or grade 4/5 morbidity was compared using logistic regression model and area under the receiver-operating characteristic (AUC) curve to evaluate the discriminatory power of each volumetry method separately. RESULTS A total of 1749 patients were included, 49% were female, median age was 60 years, 70.2% had metastatic disease, and 49.7% received preoperative chemotherapy. Median sFLRV (41.3%) was higher than mFLRV (39.4%). Major complications were observed in 5.1% (n = 90). Concordance between mFLRV and sFLRV was moderate, CCC = 0.78 (95% CI 0.75-0.79) but was poor (CCC = 0.39; 95% CI 0.32-0.43) among patients with mFLRV ≤ 35% (n = 528). In this subset, sFLRV overestimated remnant volume in 63% (n = 333) with ≥ 5% overprediction in 145 patients (27.5%). Factors associated with ≥ 5% variation were lower weight (p = 0.003), lower BMI (p = 0.003), and lower BSA (p = 0.004). Both methods performed similarly in predicting major complications with AUC of 0.64 and 0.63 for sFLRV and mFLRV, respectively. CONCLUSIONS Imaging- and BSA-based volumetry are moderately correlated, with poor concordance among patients with smaller FLRV where sFLRV overestimated remnant volume. Both techniques can be safely used for volumetric assessment before major hepatectomy.
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Affiliation(s)
- Ankur P Choubey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne Chou
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Crisanta Ilagan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Steinharter
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jon S Heiselman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jayasree Chakraborty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Fu H, Gordon-Weeks A, Kerr R, Qamhawi Z, Kearns D, Macdonald A. Iatrogenic Subcapsular Haematoma Leads to 151% Growth of Future Liver Remnant. Cardiovasc Intervent Radiol 2025:10.1007/s00270-025-04068-w. [PMID: 40399703 DOI: 10.1007/s00270-025-04068-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Accepted: 04/30/2025] [Indexed: 05/23/2025]
Affiliation(s)
- Howell Fu
- John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | | | - Rachel Kerr
- John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Zahi Qamhawi
- John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Daniel Kearns
- John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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Tran LCD, Nguyen TQ, Dadam MN, Nguyen TD, Le DT, Dang VQ, Pham PH, Phan NP, Vo TQ, Cucè F, Abdallfatah A, Huy NT. Portal vein embolization and subsequent major hepatectomy for hepatocellular carcinoma with insufficient residual liver volume: experience of a tertiary center. Updates Surg 2025:10.1007/s13304-025-02190-5. [PMID: 40261573 DOI: 10.1007/s13304-025-02190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 03/27/2025] [Indexed: 04/24/2025]
Abstract
Portal vein embolization (PVE) allows for liver regeneration to enhance reduced residual liver volume before resection in hepatocellular carcinoma (HCC) patients with systemic liver disease. A retrospective review of medical records was conducted, including patients who underwent PVE and subsequent major hepatectomy to treat resectable non-metastatic HCC at the University Medical Center in Ho Chi Minh City between 01/2016 and 6/2023. Patient demographics, timing of procedures, surgical interventions, intra- and postoperative complications, pattern of recurrence, and survival were analyzed. A total of 58 patients with HCC were included, and the median length of stay after surgery was 8 days (range 5-24). Post-hepatectomy liver failure (PHLF) occurred with an overall incidence of 31% (18/58 cases). Severe PHLF occurred in 6 cases: grade B in 5 cases (8.6%) and grade C in 1 case (1.7%), resulting in patient death. Postoperative bleeding and bile leak each occurred in 1 case (1.7%). Univariable and multivariable analyses identified portal vein pressure (PVP) after PVE as the only significant preoperative parameter associated with outcomes, correlating with PHLF occurrence (OR 1.27, p = 0.009) at a cut-off of 15 mmHg (p = 0.018). The overall survival at 3, 6, and 12 months was 96%, 94%, and 94%, respectively, with disease-free survival rates of 94%, 90%, and 87%, respectively. Major hepatectomy can be performed safely and effectively in HCC patients who have PVE-induced liver hypertrophy (sFLR ≥ 40%) and preserved liver function (Child-Pugh A) maintaining low morbidity. Multivariate analysis revealed that a post-PVE PVP cutoff of 15 mmHg significantly correlated with perioperative parameters, including operating time, blood loss, and PHLF occurrence.
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Affiliation(s)
- Long Cong Duy Tran
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thanh Quoc Nguyen
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Mohammad Najm Dadam
- Online Research Club, Nagasaki, Japan
- Department of Orthopedics and Trauma Surgery, Helios Klinikum Schwelm, Schwelm, Germany
| | - Thuan Duc Nguyen
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dat Tien Le
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Viet Quoc Dang
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Phu Hong Pham
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nghia Phuoc Phan
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thinh Quan Vo
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Federica Cucè
- General and Upper G.I. Surgery Division, Surgery, Dentistry, Maternity and Infant Department, University of Verona, Verona, Italy
| | | | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam.
- School of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam.
- Graduate School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, 852-8523, Japan.
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Xiao M, Song J, Lyu Z, Huang X, Zhang Y, Wang L, He Z, Ma T, Li C, Cao H, Zhang Q, Xiang C, Dong J. Regional Liver Function Assessment Using 99mTc-GSA SPECT/CT Scintigraphy in Malignant Perihilar Biliary Tumor Undergoing Major Liver Resection: A Dual-Center Cohort Study. Ann Surg Oncol 2025:10.1245/s10434-025-17207-x. [PMID: 40244351 DOI: 10.1245/s10434-025-17207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 03/03/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Cholestasis can lead to unreliable results of routine liver function assessment tests in clinical practice and the functional cutoff value of hepatectomy is still unclear. The aim of this study was to determine which 99mTc-GSA scintigraphy functional indicators can predict post-hepatectomy liver failure (PHLF) in patients before major liver resection due to malignant perihilar biliary disease. In addition, it aimed to assess the efficiency of functional future liver remnant (FLR) assessment of 99mTc-GSA scintigraphy indicators. PATIENTS AND METHODS A 99mTc-GSA scintigraphy was performed prior to planned surgery in 187 patients, including 81 patients with major liver resection. The 99mTc-GSA scintigraphy parameters including functional liver volume (FLV), ratio of the FLR functional volume to body weight (FLVFLR-BWR), and predictive residual index (PRI) were calculated from radioactive count in regions of FLR and total liver (TOTAL). Morphological liver volume (MLV) was calculated from computed tomography and standardized by standard liver volume (SLV). The efficacy of these parameters in predicting PHLF was compared using generalized linear mixed models and receiver operating characteristic (ROC) curve analysis. RESULTS PHLF occurred in 22 patients, who showed lower MLVFLR/SLV, FLVFLR, FLVFLR/FLVTOTAL, FLVFLR-BWR, and PRI and higher resection rate (P < 0.05 for all) than patients without PHLF. After adjusting for clinical parameters, a decreased FLVFLR-BWR (odds ratio, OR 0.17; 95% confidence intervals, CI 0.05-0.53) was found to be an independently significant indicator in the model of GLMM. FLVFLR-BWR (0.835) had the highest ROC among all liver functional indicators. CONCLUSIONS The FLR functional parameter preoperatively estimated from preoperative 99mTc-GSA scintigraphy protocol is a promising tool for regional liver function assessment, and it can distinguish high-risk patients who may develop PHLF with malignant perihilar biliary tumor undergoing major liver resection.
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Affiliation(s)
- Ming Xiao
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Jianping Song
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Zhenlei Lyu
- Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Xin Huang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Yuewei Zhang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Liang Wang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Zuoxiang He
- Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Tianyu Ma
- Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Can Li
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Han Cao
- Medical Data Science Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Qijia Zhang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Canhong Xiang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
| | - Jiahong Dong
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China.
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
- Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences, Beijing, China.
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Ikehara T, Shimizu A, Kubota K, Notake T, Kitagawa N, Masuo H, Yoshizawa T, Hosoda K, Sakai H, Soejima Y. Appropriate methods of evaluating future liver remnant volume to predict postoperative liver failure after major hepatectomy based on the body mass of patients with normal hepatic reserve. Surg Today 2025:10.1007/s00595-025-03030-0. [PMID: 40146336 DOI: 10.1007/s00595-025-03030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 02/02/2025] [Indexed: 03/28/2025]
Abstract
PURPOSE Several parameters are used to assess future liver remnant (FLR) size before major hepatectomy. This study aimed to clarify which is the most appropriate method to use for the prediction of post-hepatectomy liver failure (PHLF). METHODS The subjects of this study were 307 patients with Child-Pugh class A only, who underwent major hepatectomy, to focus on FLR size. The parameters we evaluated for their accuracy in predicting Grade B/C PHLF (PHLF B/C) using receiver operating characteristic curve analysis were FLR volume (FLRV), the FLRV to total liver volume ratio (FLRV/TLV), standard liver volume (FLRV/SLV), and body weight (FLRV/BW) according to body mass. RESULTS The predictive value accuracy of these four parameters for PHLF was similar for the entire cohort. However, in the subgroup analysis based on body mass index, FLRV/BW accuracy was highest in the obese group, whereas that of FLRV/TLV was highest in the lean group. Multivariate analysis identified that FLRV/BW (< 0.7%) and blood loss (≥ 1000 ml) were independent risk factors for PHLF B/C in the obese group. In the lean group, FLRV/TLV (< 40%) and biliary reconstruction were risk factors for PHLF B/C. CONCLUSIONS The FLR size evaluation method for predicting PHLF should be appropriately selected based on the patient's body mass.
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Affiliation(s)
- Tomohiko Ikehara
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan.
| | - Koji Kubota
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Tsuyoshi Notake
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Noriyuki Kitagawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Hitoshi Masuo
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Takahiro Yoshizawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Kiyotaka Hosoda
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroki Sakai
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
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Semash K, Dzhanbekov T. Large-for-size syndrome prophylaxis in infant liver recipients with low body mass. World J Transplant 2025; 15:99452. [PMID: 40104200 PMCID: PMC11612882 DOI: 10.5500/wjt.v15.i1.99452] [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: 07/23/2024] [Revised: 09/27/2024] [Accepted: 10/25/2024] [Indexed: 11/26/2024] Open
Abstract
Transplantation of the left lateral section (LLS) of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children, with variants of the LLS primarily used in infants. However, the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant. This review explores historical developments, various approaches to measuring the required functional liver mass, and techniques to prevent complications associated with large-for-size grafts in infants.
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Affiliation(s)
- Konstantin Semash
- Department of Mini-Invasive Surgery, National Children's Medical Center, Tashkent 100171, Toshkent, Uzbekistan
| | - Timur Dzhanbekov
- Department of Mini-Invasive Surgery, National Children's Medical Center, Tashkent 100171, Toshkent, Uzbekistan
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Fuchs J, Rabaux-Eygasier L, Husson T, Fouquet V, Guerin F, Hery G, Branchereau S. Too Big to Fail: Volumetric Analyses and Incidence of Posthepatectomy Liver Failure in 125 Major Hepatectomies in Children. Ann Surg 2025; 281:476-484. [PMID: 39584774 DOI: 10.1097/sla.0000000000006595] [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: 11/26/2024]
Abstract
OBJECTIVE To assess the incidence of posthepatectomy liver failure (PHLF) and the role of the future liver remnant (FLR) in children undergoing major hepatectomy. BACKGROUND Incidence and risk factors of PHLF in children are unclear, with no validated definition for this age group. Consequently, the role of the FLR in pediatric hepatectomy and evidence-based preoperative guidelines remains undefined. METHODS All pediatric patients undergoing major hepatectomy at a tertiary care center over a 10-year study period were analyzed. Preoperative imaging was used for volumetry. The incidence of PHLF was assessed by applying predefined definitions, and the prognostic impact of the FLR on PHLF and complications was evaluated. RESULTS A total of 125 children underwent major hepatectomy, including 35 trisectionectomies. There was a strong correlation between imaging-based measured total liver volume (TLV) and calculated standard liver volume ( r = 0.728, P < 0.001). The median TLV-to-body weight (BW) ratio was 3.4%, and the median FLR/BW ratio was 1.5%. The median FLR-to-TLV ratio was 44% (range: 18%-97%). No clinically relevant PHLF occurred. FLR/TLV and FLR/BW ratios had low predictive value for postoperative liver dysfunction and morbidity. CONCLUSIONS This is the largest reported single-center series of pediatric major hepatectomies. PHLF is exceedingly rare in children. The liver volume-to-BW ratio is higher in children compared with adults, and the FLR is sufficient even in extreme resections with <20% of the liver remnant. These findings strongly question the use of asociating liver partition and portal vein ligation for staged hepatectomy, portal vein embolization, or transplantation based on suspected insufficient liver remnants in children.
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Affiliation(s)
- Juri Fuchs
- Department of Pediatric Surgery, Hôpital Kremlin-Bicêtre, APHP, University of Paris-Saclay, Paris, France
- Department of General, Visceral, Pediatric and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lucas Rabaux-Eygasier
- Department of Pediatric Surgery, Hôpital Kremlin-Bicêtre, APHP, University of Paris-Saclay, Paris, France
- Department of Hepato-Biliary-Pancreatic Surgery, and Liver Transplantation, Hôpital Paul Brousse, APHP, University of Paris-Saclay, Paris, France
| | - Thomas Husson
- Department of Hepato-Biliary-Pancreatic Surgery, and Liver Transplantation, Hôpital Paul Brousse, APHP, University of Paris-Saclay, Paris, France
| | - Virginie Fouquet
- Department of Pediatric Surgery, Hôpital Kremlin-Bicêtre, APHP, University of Paris-Saclay, Paris, France
| | - Florent Guerin
- Department of Pediatric Surgery, Hôpital Kremlin-Bicêtre, APHP, University of Paris-Saclay, Paris, France
| | - Geraldine Hery
- Department of Pediatric Surgery, Hôpital Kremlin-Bicêtre, APHP, University of Paris-Saclay, Paris, France
| | - Sophie Branchereau
- Department of Pediatric Surgery, Hôpital Kremlin-Bicêtre, APHP, University of Paris-Saclay, Paris, France
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Park S, Choi GS, Kim JM, Lee S, Joh JW, Rhu J. Improved graft survival by using three-dimensional printing of intra-abdominal cavity to prevent large-for-size syndrome in liver transplantation. Ann Hepatobiliary Pancreat Surg 2025; 29:21-31. [PMID: 39322234 PMCID: PMC11830894 DOI: 10.14701/ahbps.24-153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/02/2024] [Accepted: 09/02/2024] [Indexed: 09/27/2024] Open
Abstract
Backgrounds/Aims While large-for-size syndrome is uncommon in liver transplantation (LT), it can result in fatal outcome. To prevent such fatality, we manufactured 3D-printed intra-abdominal cavity replicas to provide intuitive understanding of the sizes of the graft and the patient's abdomen in patients with small body size between July 2020 and February 2022. Methods Clinical outcomes were compared between patients using our 3D model during LT, and patients who underwent LT without 3D model by using 1 : 5 ratio propensity score-matched analysis. Results After matching, a total of 20 patients using 3D-printed abdominal cavity model and 100 patients of the control group were included in this study. There were no significant differences in 30-day postoperative complication (50.0% vs. 64.0%, p = 0.356) and the incidence of large-for-size syndrome (0% vs. 7%, p = 0.599). Overall survival of the 3D-printed group was similar to that of the control group (p = 0.665), but graft survival was significantly superior in the 3D-printed group, compared to the control group (p = 0.034). Conclusions Since it showed better graft survival, as well as low cost and short production time, our 3D-printing protocol can be a feasible option for patients with small abdominal cavity to prevent large-for-size syndrome after LT.
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Affiliation(s)
- Sunghae Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Aini A, Lu Q, Wen H, Wang WT, Aji T, Chen ZY, Zhang LD, Yang ZY, Yang JY, Fan HN, Wang WL, Li XC, Zhang Y, Dong JH. Particular Chinese contributions to extracorporeal liver surgery. Hepatobiliary Pancreat Dis Int 2025; 24:57-66. [PMID: 39753427 DOI: 10.1016/j.hbpd.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 12/13/2024] [Indexed: 03/17/2025]
Abstract
Extracorporeal liver surgery (ELS), also known as liver autotransplantation, is a hybrid (cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently became more embraced and popularized among leading centers. ELS could be summarized into three major categories, namely, ex-situ liver resection and autotransplantation (ELRA), ante-situm liver resection and autotransplantation (ALRA) and auxiliary partial liver autotransplantation (APLA). The successful development of ELS during the past 37 years is definitely inseparable from continuous efforts done by Chinese surgeons and researchers. Especially, the precision liver surgery paradigm has allowed to transform ELS into a modularized, more simplified, and standardized surgery, to upgrade surgical skills, to improve peri-operative outcome and long-term survival, to increase the capability of surgeons to select more complex diseases and to expand the level of medical service to the population. This review highlights the Chinese contributions to the field of ELS, focusing thereby on features of different surgical types, technical innovations, disease selection and surgical indication, patient prognosis and future perspectives.
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Affiliation(s)
- Abudusalamu Aini
- Hepatopancreatobiliary Center, Organ Transplantation Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China; Key Laboratory of Digital Intelligence Hepatology (Chinese Ministry of Education), School of Clinical Medicine, Tsinghua University, Beijing 100084, China; Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences, Beijing 100010, China; Institute for Organ Transplantation and Bionics, Institute for Precision Medicine, School of Clinical Medicine, Tsinghua University, Beijing 100010, China
| | - Qian Lu
- Hepatopancreatobiliary Center, Organ Transplantation Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China; Key Laboratory of Digital Intelligence Hepatology (Chinese Ministry of Education), School of Clinical Medicine, Tsinghua University, Beijing 100084, China; Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences, Beijing 100010, China; Institute for Organ Transplantation and Bionics, Institute for Precision Medicine, School of Clinical Medicine, Tsinghua University, Beijing 100010, China
| | - Hao Wen
- Hepatobiliary & Echinococcosis Surgery, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Wen-Tao Wang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Tuerganaili Aji
- Hepatobiliary & Echinococcosis Surgery, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, The Army Medical University, Chongqing 100089, China
| | - Lei-Da Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, The Army Medical University, Chongqing 100089, China
| | - Zhan-Yu Yang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People's Army General Hospital, Beijing 400038, China
| | - Jia-Yin Yang
- Liver Transplantation Center & Organ Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Hai-Ning Fan
- Hepatopancreatobiliary Surgery, School of Clinical Medicine, Qinghai University Affiliated Hospital, Xining 810006, China
| | - Wei-Lin Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Zhejiang Univeristy School of Medicine, Hangzhou 310009, China
| | - Xiang-Cheng Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yu Zhang
- Department of Hepatobiliary Surgery, Sichuan Provincial People's Hospital, Chengdu 610072, China
| | - Jia-Hong Dong
- Hepatopancreatobiliary Center, Organ Transplantation Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China; Key Laboratory of Digital Intelligence Hepatology (Chinese Ministry of Education), School of Clinical Medicine, Tsinghua University, Beijing 100084, China; Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences, Beijing 100010, China; Institute for Organ Transplantation and Bionics, Institute for Precision Medicine, School of Clinical Medicine, Tsinghua University, Beijing 100010, China.
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10
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Li Z, Raptis D, Rammohan A, Gunasekaran V, Hong S, Chen ICY, Kim J, Hervera Marquez KA, Hsu SC, Kirimker EO, Akamatsu N, Shaked O, Finotti M, Yeow M, Genedy L, Braun J, Yebyo H, Dutkowski P, Nadalin S, Boehnert MU, Polak WG, Bonney GK, Mathur A, Samstein B, Emond JC, Testa G, Olthoff KM, Rosen CB, Heimbach JK, Taner T, Wong TC, Lo CM, Hasegawa K, Balci D, Cattral M, Sapisochin G, Selzner N, Jeng LB, Joh JW, Chen CL, Suh KS, Rela M, Broering D, Clavien PA. Validation of a Pretransplant Risk Prediction Model for Early Allograft Dysfunction After Living-donor Liver Transplantation. Transplantation 2025:00007890-990000000-00995. [PMID: 39883022 DOI: 10.1097/tp.0000000000005331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
BACKGROUND Early allograft dysfunction (EAD) affects outcomes in liver transplantation (LT). Existing risk models developed for deceased-donor LT depend on posttransplant factors and fall short in living-donor LT (LDLT), where pretransplant evaluations are crucial for preventing EAD and justifying the donor's risks. METHODS This retrospective study analyzed data from 2944 adult patients who underwent LDLT at 17 centers between 2016 and 2020. We developed a logistic regression model to predict EAD based on this development cohort. We used data from 1020 patients at the King Faisal Transplant Center for external validation. RESULTS In the development cohort, 321 patients (10.9%) experienced EAD. These patients had poorer health status, more liver decompensation, and higher requirements of hospitalization than those without EAD. Multivariable logistic regression identified independent pretransplant predictors of EAD: laboratory Model for End-Stage Liver Disease score (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.06-1.09), the necessity for hospitalization at the time of transplant (OR, 2.58; 95% CI, 2.00-3.30), and graft weight in kilogram (OR, 0.27; 95% CI, 0.17-0.45). Using these predictors, we developed the model for EAD after LDLT, which demonstrated strong discriminative ability in the development cohort with an area under the curve (AUC) of 0.71 (95% CI, 0.68-0.74). The model maintained high discrimination during internal validation (AUC, 0.70; 95% CI, 0.67-0.73) and showed a modest reduction in discriminative power in external validation (AUC, 0.65; 95% CI, 0.61-0.68). CONCLUSIONS EAD post-LDLT is influenced by the recipient's pretransplant health condition and the graft weight. Integrating the model for EAD after LDLT into the pretransplant process of pairing donors and recipients can enhance the safety and efficacy of LDLT.
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Affiliation(s)
- Zhihao Li
- University of Zurich, Wyss Translational Center, Zurich, Switzerland
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Dimitri Raptis
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ashwin Rammohan
- The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Vasanthakumar Gunasekaran
- The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Suyoung Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Itsuko Chih-Yi Chen
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Kris Ann Hervera Marquez
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Shih-Chao Hsu
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | | | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Division and Hepato-Biliary-Pancreatic Surgery, University of Tokyo, Tokyo, Japan
| | - Oren Shaked
- Division of Transplantation, University of Pennsylvania, Philadelphia, PA
| | - Michele Finotti
- Division of Abdominal Transplantation, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Marcus Yeow
- University of Zurich, Wyss Translational Center, Zurich, Switzerland
| | - Lara Genedy
- Department of General Visceral and Transplant Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Julia Braun
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - Henock Yebyo
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - Philipp Dutkowski
- University of Zurich, Wyss Translational Center, Zurich, Switzerland
| | - Silvio Nadalin
- Department of General Visceral and Transplant Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Markus U Boehnert
- Department of Surgery, Division of HPB & Transplant Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wojciech G Polak
- University of Zurich, Wyss Translational Center, Zurich, Switzerland
| | - Glenn K Bonney
- Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore
| | - Abhishek Mathur
- Liver and Abdominal Transplant Surgery, Columbia University Irving Medical Center, New York, NY
| | - Benjamin Samstein
- Liver and Abdominal Transplant Surgery, Columbia University Irving Medical Center, New York, NY
| | - Jean C Emond
- Liver and Abdominal Transplant Surgery, Columbia University Irving Medical Center, New York, NY
| | - Giuliano Testa
- Division of Abdominal Transplantation, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Kim M Olthoff
- Division of Transplantation, University of Pennsylvania, Philadelphia, PA
| | - Charles B Rosen
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Julie K Heimbach
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Timucin Taner
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Tiffany Cl Wong
- Department of Surgery, University of Hong Kong, Hong Kong, People's Republic of China
| | - Chung-Mau Lo
- Department of Surgery, University of Hong Kong, Hong Kong, People's Republic of China
| | - Kiyoshi Hasegawa
- Artificial Organ and Transplantation Division and Hepato-Biliary-Pancreatic Surgery, University of Tokyo, Tokyo, Japan
| | - Deniz Balci
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Mark Cattral
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gonzalo Sapisochin
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nazia Selzner
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Chao-Long Chen
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Mohamed Rela
- The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India
| | - Dieter Broering
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Fukushima M, Miyaaki H, Sasaki R, Nakao Y, Haraguchi M, Takahashi K, Ozawa E, Miuma S, Nakao K. Benefits of Liver Volume and Serum Zinc Level Assessment for the Screening of Covert Hepatic Encephalopathy in Patients with Child-Pugh Class A Cirrhosis. Diagnostics (Basel) 2024; 15:23. [PMID: 39795551 PMCID: PMC11719456 DOI: 10.3390/diagnostics15010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 12/23/2024] [Accepted: 12/24/2024] [Indexed: 01/13/2025] Open
Abstract
Background/Objectives: Covert hepatic encephalopathy (CHE) is associated with decreased quality of life. Detection of Child-Pugh class A is necessary for its early diagnosis. This study aimed to establish a simple diagnostic method of CHE in patients with Child-Pugh class A. Methods: One hundred patients with liver cirrhosis without overt hepatic encephalopathy and sixty-eight with liver cirrhosis and Child-Pugh class A who visited our institution were enrolled. CHE was diagnosed using number connection test B in the neuropsychiatric test (NPT). Clinical data were compared. Results: The liver volume/body surface area ratio (LV/BSA) was associated with CHE in patients with all-cause and Child-Pugh class A liver cirrhosis. Multiple logistic regression analysis revealed that low LV/BSA and low serum zinc (Zn) levels were significantly associated with CHE in Child-Pugh class A liver cirrhosis. The best cutoff values in the receiver operating characteristic curve analysis showed that the complication rate of CHE was 54.8% in patients with LV/BSA < 620 mL/m2, which was 2.9 times higher than that in patients with larger liver volume. Referring to the cutoff values for LV/BSA and Zn (<70 µg/dL), in cases with LV/BSA < 620 mL/m2 and Zn < 70 µg/dL, 64.2% had CHE, whereas in cases with LV/BSA ≥ 620 mL/m2 and Zn ≥ 70 µg/dL, 94.5% did not have CHE. Conclusions: Liver volume can be used as a risk assessment tool for CHE. LV/BSA and serum Zn levels are considered effective diagnostic tools for CHE, serving as alternatives to NPT in patients with Child-Pugh class A liver cirrhosis.
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Affiliation(s)
- Masanori Fukushima
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City 852-8501, Nagasaki, Japan; (H.M.)
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12
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Nakamura M, Ashida R, Ohgi K, Yamada M, Kato Y, Otsuka S, Kakuda Y, Uesaka K, Sugiura T. Positive impact of laparoscopic hepatectomy versus open hepatectomy on body size-corrected bleeding in obese patients. Surg Today 2024; 54:1461-1471. [PMID: 38871859 DOI: 10.1007/s00595-024-02865-3] [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: 02/26/2024] [Accepted: 04/16/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Laparoscopic hepatectomy (LH) is reported to cause less bleeding than open hepatectomy (OH) in obese patients; however, there are no reports addressing this issue in terms of body size-corrected bleeding. METHODS The subjects of this study were 31 obese and 149 non-obese patients who underwent LH and 32 obese and 245 non-obese patients who underwent OH. Bleeding corrected for body surface area (C-BL) was compared between the obese and non-obese patients who underwent each procedure. A multivariate analysis for increased C-BL was performed using the median C-BL for each procedure. RESULTS The median C-BL tended to be higher in the obese patients than in the non-obese patients who underwent LH, but there was no significant difference (72 vs. 42 mL/m2, P = 0.050). However, it was significantly higher in the obese patients than in the non-obese patients who underwent OH (542 vs. 333 mL/m2, P = 0.002). In a multivariate analysis, for OH, sectionectomy or more (OR 3.20, P < 0.001) and a high BMI (OR 2.76, P = 0.018) were found to be independent risk factors, whereas for LH, a high BMI was not (OR 1.58, P = 0.301). CONCLUSIONS Obesity was identified as a risk factor for increased bleeding with body size correction for OH, but the risk was reduced for LH.
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Affiliation(s)
- Masanori Nakamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan.
| | - Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Mihoko Yamada
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Yoshiyasu Kato
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Shimpei Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Yuko Kakuda
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
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13
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Fu B, Feng X, Liu J, Ren J, Wang J, Yi S, Yang Y. Chinese clinical practice guidelines for pediatric split liver transplantation. LIVER RESEARCH 2024; 8:207-217. [PMID: 39958917 PMCID: PMC11771280 DOI: 10.1016/j.livres.2024.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 11/07/2024] [Indexed: 02/18/2025]
Abstract
Liver transplantation is an effective treatment for end-stage liver disease in children, and its clinical efficacy has been validated. Split liver transplantation (SLT) can effectively expand the donor liver pool for children. SLT for children has unique clinical characteristics and principles. Establishing technical operation specifications for pediatric SLT plays a significant role in improving clinical efficacy. In this paper, clinical practice guidelines on pediatric SLT were established in the aspect of donor and donor liver evaluation, donor-recipient matching, and ductal segmentation and reconstruction of donor liver, aiming to standardize the technical process, optimize surgical operational details, minimize the risk of complications of SLT for children, further promoting the rapid development of pediatric SLT in China.
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Affiliation(s)
- Binsheng Fu
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiao Feng
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jianrong Liu
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jie Ren
- Department of Medical Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jin Wang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuhong Yi
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yang Yang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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14
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Nakayama T, Akabane M, Imaoka Y, Esquivel CO, Melcher ML, Sasaki K. Revisiting the Prognostic Influences of Donor-Recipient Size Mismatch in Deceased Donor Liver Transplantation. Transplant Direct 2024; 10:e1722. [PMID: 39440201 PMCID: PMC11495742 DOI: 10.1097/txd.0000000000001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 08/28/2024] [Indexed: 10/25/2024] Open
Abstract
Background Liver transplantation (LT) outcomes are influenced by donor-recipient size mismatch. This study re-evaluated the impact on graft size discrepancies on survival outcomes. Methods Data from 53 389 adult LT recipients from the United Network for Organ Sharing database (2013-2022) were reviewed. The study population was divided by the body surface area index (BSAi), defined as the ratio of donor body surface area (BSA) to recipient BSA, into small-for-size (BSAi < 0.78), normal-for-size (BSAi 0.78-1.24), and large-for-size (BSAi > 1.24) grafts in deceased donor LT (SFSD, NFSD, and LFSD). Multivariate Cox regression and Kaplan-Meier survival analyses were conducted. Results The frequency of size mismatch in deceased donor LT increased over the past 10 y. SFSD had significantly worse 90-d graft survival (P < 0.01), and LFSD had inferior 1-y graft survival among 90-d survivors (P = 0.01). SFSD was hazardous within 90 d post-LT because of vascular complications. Beyond 1 y, graft size did not affect graft survival. LFSD risk within the first year was mitigated with lower model for end-stage liver disease (MELD) 3.0 scores (<35) or shorter cold ischemia time (<8 h). Conclusions The negative impacts on donor-recipient size mismatch on survival outcomes are confined to the first year post-LT. SFSD is associated with a slight decrease in 90-d survival rates. LFSD should be utilized more frequently by minimizing cold ischemia time to <8 h, particularly in patients with MELD 3.0 scores below 35. These findings could improve donor-recipient matching and enhance LT outcomes.
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Affiliation(s)
- Toshihiro Nakayama
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Miho Akabane
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Yuki Imaoka
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Carlos O. Esquivel
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Marc L. Melcher
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Kazunari Sasaki
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA
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15
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Kuksin M, Bidault Jourdainne V, Rossignol G, Aegerter P, Hery G, Teglas JP, Fouquet V, Branchereau S, Guérin F. Prediction of Whole Liver Graft Weight Based on Biometric Variables in Paediatric and Adult Liver Donors. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1248. [PMID: 39457213 PMCID: PMC11506035 DOI: 10.3390/children11101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 10/07/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND/OBJECTIVES In paediatric liver transplantation, donor-recipient compatibility depends on graft size. We explored whether the graft weight can be predicted using the donor's biometric parameters. METHODS We used seven easily available biometric variables in 142 anonymised paediatric and adult donors, with data collected between 2016 and 2022. The whole or partial liver was transplanted in our hospital from these donors. We identified the variables that had the strongest correlation to our response variable: whole liver graft weight. RESULTS In child donors, we determined two linear models: using donor weight and height on the one hand and using donor weight and right liver span on the other hand. Both models had a coefficient of determination R2 = 0.86 and p-value < 10-5. We also determined two models in adult donors using donor weight and height (R2 = 0.33, p < 10-4) and donor weight and sternal height (R2 = 0.38, p < 10-4). The models proved valid based on our external dataset of 245 patients from two institutions. CONCLUSIONS In clinical practise, our models could provide rapidly accessible estimates to determine whole graft dimension compatibility in liver transplantation in children and adults. Determining similar models predicting the left lobe and lateral segment weight could prove invaluable in paediatric transplantation.
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Affiliation(s)
- Maria Kuksin
- Department of Clinical Research, Assistance Publique—Hôpitaux de Paris, Université Paris-Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (M.K.); (J.-P.T.)
| | - Valeska Bidault Jourdainne
- Department of Paediatric Surgery, Hôpital Mère-Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (V.B.J.); (G.R.)
| | - Guillaume Rossignol
- Department of Paediatric Surgery, Hôpital Mère-Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (V.B.J.); (G.R.)
| | - Philippe Aegerter
- Department of Public Health—U1018 UVSSQ INSERM, GIRCI IdF—UFR Médecine Paris—Ile de France Ouest Université Versailles Saint Quentin, 9 Avenue Charles de Gaulle, 92100 Boulogne, France;
| | - Géraldine Hery
- Department of Paediatric Surgery, Assistance Publique—Hôpitaux de Paris, Université Paris-Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (G.H.); (V.F.); (S.B.)
| | - Jean-Paul Teglas
- Department of Clinical Research, Assistance Publique—Hôpitaux de Paris, Université Paris-Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (M.K.); (J.-P.T.)
| | - Virginie Fouquet
- Department of Paediatric Surgery, Assistance Publique—Hôpitaux de Paris, Université Paris-Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (G.H.); (V.F.); (S.B.)
| | - Sophie Branchereau
- Department of Paediatric Surgery, Assistance Publique—Hôpitaux de Paris, Université Paris-Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (G.H.); (V.F.); (S.B.)
| | - Florent Guérin
- Department of Paediatric Surgery, Assistance Publique—Hôpitaux de Paris, Université Paris-Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (G.H.); (V.F.); (S.B.)
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16
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Semash K. Evaluation and Management of Living Donors in the Setting of Living Donor Liver Transplant Program in the Republic of Uzbekistan. EXP CLIN TRANSPLANT 2024; 22:664-674. [PMID: 39431833 DOI: 10.6002/ect.2024.0148] [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: 10/22/2024]
Abstract
In the Republic of Uzbekistan, the history of liver transplantation began in 2018, but this type of medical care was introduced regularly only in 2021. The selection, preparation, and perioperative management of living liver donors can be complicated and have importance in the type of responsible medical care, which requires maximum doctor involvement at all stages. This review has detailed the donor selection algorithm in the Republic of Uzbekistan, donor preparation for liver resection, and basic principles of liver resection surgery in living donors. Algorithms for postoperative donor management and rehabilitation have also been described in detail.
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Toriigahara Y, Matsuura T, Takahashi Y, Uchida Y, Kajihara K, Maeda S, Kawakubo N, Nagata K, Tajiri T. A retrospective study investigating the risk of graft loss in living donor liver transplant cases where size mismatching is predicted from graft-to-recipient weight ratio. Pediatr Surg Int 2024; 40:229. [PMID: 39152284 DOI: 10.1007/s00383-024-05814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND/PURPOSE Living donor liver transplantation (LDLT) is vital for pediatric end-stage liver disease due to organ shortages. The graft-to-recipient weight ratio (GRWR) preoperatively measured predicts the outcomes of LDLT. We typically target between 0.8 and 3.0-4.0%, but the ideal GRWR remains controversial. We compared the outcomes of LDLT according to the GRWR to examine whether the criteria could be expanded while ensuring safety. METHODS We retrospectively reviewed 99 patients who underwent LDLT in our department by dividing them into three groups according to their GRWR: Group S, with GRWR values lower than the normal range (GRWR < 0.8%); Group M, with GRWR values in the normal range (GRWR ≥ 0.8 to < 3.5%); and Group L, with GRWR values above the normal range (GRWR ≥ 3.5%). RESULTS In Groups S and L, 46.2 and 44.4% of patients underwent splenectomy and delayed abdominal wall closure, respectively. After these intraoperative adjustments, there were no significant differences between the groups in 5-year patient survival, 5-year graft survival, or the occurrence of post-transplantation thrombosis. CONCLUSION When the GRWR is beyond the normal threshold, the risk of complications associated with graft size might be reduced by adjustments to provide appropriate portal blood flow and by delayed abdominal wall closure.
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Affiliation(s)
- Yukihiro Toriigahara
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Yoshiaki Takahashi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yasuyuki Uchida
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Keisuke Kajihara
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shohei Maeda
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Naonori Kawakubo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kouji Nagata
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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18
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Ye TW, Fu TW, Du CF, Yue RC, Jiang QT, Zhong ZH, Zhao Q, Zhang CW, Liu J, Liu JW, Luo ZY, Fan XM, Hong DF, Cheng J, Xiao ZQ. Comparison of percutaneous microwave/radiofrequency ablation liver partition and portal vein embolization versus transarterial chemoembolization and portal vein embolization for planned hepatectomy with insufficient future liver remnant. BMC Cancer 2024; 24:985. [PMID: 39123182 PMCID: PMC11312699 DOI: 10.1186/s12885-024-12666-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND In China, both percutaneous microwave/radiofrequency ablation liver partition plus portal vein embolization (PALPP) and transarterial chemoembolization (TACE) plus portal vein embolization (PVE) have been utilized in planned hepatectomy. However, there is a lack of comparative studies on the effectiveness of these two techniques for cases with insufficient future liver remnant (FLR). METHODS Patients were categorized into either the PALPP group or the TACE + PVE group. Clinical data, including FLR growth rate, complications, secondary resection rate, and overall survival rate, were compared and analyzed for both groups retrospectively. RESULTS Between December 2014 and October 2021, a total of 29 patients underwent TACE + PVE (n = 12) and PALPP (n = 17). In the TACE + PVE group, 7 patients successfully underwent two-stage hepatectomy, while in the PALPP group, 13 patients underwent the procedure (two-stage resection rate: 58.3% vs. 76.5%, P = 0.42). There were no significant differences in postoperative complications of one-stage procedures (11.8% vs. 8.3%, P > 0.05) and second-stage resection complication (0% vs. 46.2%, P = 0.05) between the TACE + PVE and PALPP groups. However, the PALPP group demonstrated a shorter time to FLR volume growth for second-stage resection (18.5 days vs. 66 days, P = 0.001) and KGR (58.5 ml/week vs. 7.7 ml/week, P = 0.001). CONCLUSIONS Compared with TACE + PVE, PALPP results in a more significant increase in FLR volume and a higher rate of two-stage resection without increasing postoperative complications.
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Affiliation(s)
- Tai-Wei Ye
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Tian-Wei Fu
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Cheng-Fei Du
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Ru-Chi Yue
- Three Gorges University, Yichang, Hubei, 443000, China
| | - Qi-Tao Jiang
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
| | - Zhi-Hang Zhong
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
| | - Qin Zhao
- Dalian Medical University, Dalian, Liaoning, 116000, China
| | - Cheng-Wu Zhang
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
| | - Jie Liu
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
| | - Jun-Wei Liu
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
| | - Zu-Yan Luo
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
| | - Xiao-Ming Fan
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China
| | - De-Fei Hong
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine(DeFei Hong), No.3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Jian Cheng
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China.
| | - Zun-Qiang Xiao
- General Surgery, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Cancer Center, Hangzhou, Zhejiang, 310014, China.
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Sheftel J, Davis CR, Phiri CB, Crenshaw TD, Tanumihardjo SA. Repeated High-Dose Vitamin A Supplements, Standard of Care for Treating Xerophthalmia, Leads to Hypervitaminosis A in Piglets. J Nutr 2024; 154:2363-2373. [PMID: 38797483 DOI: 10.1016/j.tjnut.2024.05.023] [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: 02/13/2024] [Revised: 04/30/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Vitamin A (VA) deficiency and excess negatively affect development, growth, and bone health. The World Health Organization's standard of care for xerophthalmia due to VA deficiency, is 3 high-dose VA supplements of 50,000-200,000 IU, based on age, which may cause hypervitaminosis A in some individuals. OBJECTIVES This study measured VA status following 3 VA doses in 2 piglet studies. METHODS In Study 1, 5 groups of piglets (n = 10/group) were weaned 10 d postbirth to VA-free feed and orally administered 0; 25,000; 50,000; 100,000; or 200,000 IU VA ester on days 0, 1, and 7. On days 14 and 15, the piglets underwent the modified relative dose-response (MRDR) test for VA deficiency, and were killed. Tissues were collected for high-pressure liquid chromatography analysis. Study 2 used the same design in 3 groups (n = 13/group) weaned at 16 d and administered 0; 25,000; and 200,000 IU doses. RESULTS In Study 1 (final weight: 3.6 ± 0.7 kg), liver VA concentration was hypervitaminotic in 40%, 90%, and 100% of 50,000; 100,000; and 200,000 IU groups, respectively. The 25,000 IU group was 100% adequate, and the placebo group was 40% deficient. In Study 2 (final weight: 8.7 ± 0.8 kg), where 200,000 IU could be prescribed to infants with a similar body weight, 31% of the piglets were hypervitaminotic, the 25,000 IU group was 100% VA adequate, and the placebo group was 100% deficient. The MRDR test measured deficiency in 50% and 70% of the placebo group in each study but had 3 false positives among hypervitaminotic piglets in Study 1. CONCLUSIONS Repeated high-dose VA may cause hypervitaminosis, indicating dose sizes may need reduction. The MRDR resulted in false positives in a hypervitaminotic state during malnutrition and should be paired with serum retinyl ester evaluation to enhance VA status assessment in populations with overlapping interventions.
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Affiliation(s)
- Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Department of Nutritional Sciences, Madison, WI, United States
| | - Christopher R Davis
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Department of Nutritional Sciences, Madison, WI, United States
| | - Cacious B Phiri
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Department of Nutritional Sciences, Madison, WI, United States
| | - Thomas D Crenshaw
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Department of Nutritional Sciences, Madison, WI, United States.
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20
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Mizuno H, Besse W, Sekine A, Long KT, Kurihara S, Oba Y, Yamanouchi M, Hasegawa E, Suwabe T, Sawa N, Ubara Y, Somlo S, Hoshino J. Genetic Analysis of Severe Polycystic Liver Disease in Japan. KIDNEY360 2024; 5:1106-1115. [PMID: 38689396 PMCID: PMC11371350 DOI: 10.34067/kid.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024]
Abstract
Key Points Among patients with severe polycystic liver disease (PLD) (height-adjusted total liver volume of <1800 ml/m), PKD2 variants were found in 34%. Three patients with PKD1 or PKD2 variants are reported with severe PLD but normal-sized kidneys (hTKV of < 250 ml/m). Background Polycystic liver disease (PLD) is present in most patients with autosomal dominant polycystic kidney disease (ADPKD). PLD can alternatively be found with few, if any, kidney cysts as a diagnosis of isolated PLD (autosomal dominant PLD [ADPLD]). Several genes are identified as causative for this spectrum of phenotypes; however, the relative incidence of genetic etiologies among patients with severe PLD is unknown. Methods Patients with ADPKD or ADPLD having severe PLD defined as height-adjusted total liver volume (hTLV) >1800 ml/m were recruited. Subsequent clinical care was followed. Genetic analysis was performed using whole exome sequencing. Results We enrolled and sequenced 49 patients (38 women, 11 men). Pathogenic or suspected pathogenic variants in polycystic disease genes were found in 44 of 49 patients (90%). The disease gene was PKD1 in 20 of 44 patients (45%), PKD2 in 15 of 44 patients (34%), PRKCSH in 5 of 44 patients (11%), GANAB in 2 of 44 patients (5%), SEC63 in 1 of 44 patients (2%), and ALG8 in 1 of 44 patients (2%). The median hTLV was no different between genetically defined ADPKD and ADPLD groups (4431 [range, 1817–9148] versus 3437 [range, 1860–8211]) ml, P = 0.77), whereas height-adjusted kidney volume was larger as expected in ADPKD than in ADPLD (607 [range, 190–2842] versus 179 [range, 138–234] ml/m, P < 0.01). Of the clinically defined ADPKD patients, 20 of 38 patients (53%) were PKD1 , 15 of 38 (39%) were PKD2 , and 3 (8%) remained genetically unsolved. Among patients with a pathogenic PKD1 or PKD2 variant, we found three patients with a liver-dominant ADPKD (severe PLD with height-adjusted total kidney volume <250 ml/m). Conclusions ADPLD-related genes represent 20% of patients with severe PLD in our cohort. Of those enrolled with ADPKD, we observed a higher frequency of PKD2 carriers than in any previously reported ADPKD cohorts. Although there was no significant difference in the hTLV between patients with PKD1 and PKD2 in this cohort, our data suggest that enrollment on the basis of severe PLD may enrich for patients with PKD2 .
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Affiliation(s)
- Hiroki Mizuno
- Nephrology Center Toranomon Hospital Kajigaya, Kawasaki, Japan
- Nephrology Center Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Whitney Besse
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Akinari Sekine
- Nephrology Center Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Kelly T. Long
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Yuki Oba
- Nephrology Center Toranomon Hospital Kajigaya, Kawasaki, Japan
| | | | | | - Tatsuya Suwabe
- Nephrology Center Toranomon Hospital Kajigaya, Kawasaki, Japan
| | - Naoki Sawa
- Nephrology Center Toranomon Hospital Kajigaya, Kawasaki, Japan
| | - Yoshifumi Ubara
- Nephrology Center Toranomon Hospital Kajigaya, Kawasaki, Japan
| | - Stefan Somlo
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Junichi Hoshino
- Nephrology Center Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
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21
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Hung KC, Wang HP, Li WF, Lin YC, Wang CC. Single center experience with ALPPS and timing with stage 2 in patients with fibrotic/cirrhotic liver. Updates Surg 2024; 76:1213-1221. [PMID: 38494567 PMCID: PMC11341627 DOI: 10.1007/s13304-024-01782-x] [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: 06/02/2023] [Accepted: 02/03/2024] [Indexed: 03/19/2024]
Abstract
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel procedure for major resection in patients with insufficient future liver remnant (FLR). Effective FLR augmentation is pivotal in the completion of ALPPS. Liver fibrosis/cirrhosis associated with chronic viral hepatitis impairs liver regeneration. To investigate the augmentation of FLR in associating ALPPS between patients with fibrotic/cirrhotic livers (FL) and non-fibrotic livers (NFL) and compare their short-term clinical outcomes and long-term survival. Patients were divided into two groups based on the Ishak modified staging: non-fibrotic liver group (NFL, stage 0) and fibrotic/cirrhotic liver group (FL, stage 1-5/6). Weekly liver regeneration in FLR, perioperative data, and survival outcomes were investigated. Twenty-seven patients with liver tumors underwent ALPPS (NFL, n = 7; FL, n = 20). NFL and FL patients had viral hepatitis (28.6% [n = 2] and 95% [n = 19]), absolute FLR volume increments of 134.90 ml and 161.85 ml (p = 0.825), and rates of hypertrophy were 16.46 ml/day and 13.66 ml/day (p = 0.507), respectively. In the FL group, baseline FLR volume was 360.13 ml, postoperatively it increased to a plateau (542.30 ml) in week 2 and declined (378.45 ml) in week 3. One patient (3.7%) with cirrhotic liver (stage 6) failed to proceed to ALPPS-II. The overall ALPPS-related major complication rate was 7.4%. ALPPS is feasible for fibrotic liver patients classified by Ishak modified stages ≤ 5. After ALPPS-I, 14 days for FLR augmentation seems an appropriate waiting time to reach a maximum FLR volume in these patients.
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Affiliation(s)
- Kuo-Chen Hung
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
- Chang Gung University College of Medicine, Taoyüan, Taiwan
| | - Hao-Ping Wang
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
- Chang Gung University College of Medicine, Taoyüan, Taiwan
| | - Wei-Feng Li
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
- Chang Gung University College of Medicine, Taoyüan, Taiwan
| | - Yu-Cheng Lin
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
- Chang Gung University College of Medicine, Taoyüan, Taiwan
| | - Chih-Chi Wang
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
- Chang Gung University College of Medicine, Taoyüan, Taiwan.
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22
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Tan Y, Zhu JY, Li J, Wu LM, Ouyang Z, Liu WY, Song H, Huang CY. Application of 3-dimensional visualization and image fusion technology in liver cancer with portal vein tumor thrombus surgery. Medicine (Baltimore) 2024; 103:e38980. [PMID: 39058856 PMCID: PMC11272227 DOI: 10.1097/md.0000000000038980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Liver cancer with portal vein tumor thrombus (PVTT) is a frequent finding and is related to poor prognosis. Surgical resection provides a more promising prognosis in selected patients. The purpose of this study was to explore the application of 3D (3-dimensional) visualization and image fusion technology in liver cancer with PVTT surgery. 12 patients were treated with surgery between March 2019 and August 2022. The preoperative standard liver volume (SLV), estimated future liver remnant (FLR), FLR/SLV, 3D visualization models, PVTT classification, operation programs, surgical results, and prognosis were collected and analyzed. Twelve patients who had complete data of 3D visualization and underwent hemihepatectomy combined with portal vein tumor thrombectomy. The operation plan was formulated by 3D visualization and was highly consistent with the actual surgery. The SLV was 1208.33 ± 63.22 mL, FLR was 734.00 mL and FLR/SLV was 61.62 ± 19.38%. The accuracy of classification of PVTT by 3D visualization was 100%, Cheng type Ⅱa (4 cases), Ⅱb (2 cases), Ⅲa (4 cases), and Ⅲb (2 cases). The 3D visualization model was a perfect fusion with the intraoperative live scene and precise guidance for hepatectomy. No patient was suffering from postoperative liver failure and without procedure‑associated death. 6 patients died of tumor recurrence, and 2 patients died of other reasons. The 12-month cumulative survival rate was 25.9%. 3D visualization and image fusion technology could be used for precise assessment of FLR, classification of PVTT, surgery navigation, and which was helpful in improving the safety of hepatectomy.
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Affiliation(s)
- Yong Tan
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Jian Yong Zhu
- Senior Department of Hepato-Pancreato-Biliary Surgery, the First Medical Center of PLA General Hospital, Beijing, P.R. China
| | - Jing Li
- Department of Pathology, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Li Ming Wu
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Zaixing Ouyang
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Wen Ying Liu
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Hao Song
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
| | - Cong Yun Huang
- Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shaoguan, P.R. China
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23
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Pang NQ, Chan ACY, Kow AWC. Trends of liver transplantation in Asia. Updates Surg 2024:10.1007/s13304-024-01924-1. [PMID: 39046632 DOI: 10.1007/s13304-024-01924-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/18/2024] [Indexed: 07/25/2024]
Abstract
Liver transplantation (LT) in Asia started comparatively early in 1964, just 1 year after Starzl's trail-blazing first attempt. Despite the quick start, LT was slow to develop in this region. Limited access to universal healthcare, lack of public understanding and support as well as the absence of strong legislation, on a backdrop of a wide range of diverse social, religious, economic and cultural background are all contributory factors. Through strong administrative efforts, the number of DDLTs in selected Asian countries has been slowly rising in recent years. However, Asians are generally still less likely to donate organs than Caucasians after death. The strong demand for LT with limited access to deceased organs has, therefore, led to constant need for innovation in LT this region, with the pioneering of various LDLT techniques and safe expansion of donor pool being driven primarily by Asian centers. Familiarity and the development of technical expertise in donor surgery have also resulted in Asian centers repeatedly pushing the boundaries on minimally invasive donor and recipient surgery. In this article, we focus on the past and present states of LT in Asia and explore the future trends of LT in this region.
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Affiliation(s)
- Ning Qi Pang
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, NUHS Tower Block, 1E, Kent Ridge Road, Level 8, Singapore, 119228, Singapore
- National University Centre for Organ Transplantation (NUCOT), National University Hospital, National University Health System, Singapore, Singapore
| | - Albert C Y Chan
- Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Alfred Wei Chieh Kow
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, NUHS Tower Block, 1E, Kent Ridge Road, Level 8, Singapore, 119228, Singapore.
- National University Centre for Organ Transplantation (NUCOT), National University Hospital, National University Health System, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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24
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Toshima T, Harada N, Itoh S, Tomiyama T, Toshida K, Morita K, Nagao Y, Kurihara T, Tomino T, Kosai-Fujimoto Y, Mimori K, Yoshizumi T. What Are Risk Factors for Graft Loss in Patients Who Underwent Simultaneous Splenectomy During Living-donor Liver Transplantation? Transplantation 2024; 108:1593-1604. [PMID: 38409686 DOI: 10.1097/tp.0000000000004952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND The consensus that portal venous pressure modulation, including splenectomy (Spx), prevents portal hypertension-related complications after living-donor liver transplantation (LDLT) has been established. However, little evidence about the risk factors for graft loss after simultaneous Spx during LDLT is available. This study aimed to identify the independent predictors of graft loss after simultaneous Spx during LDLT. METHODS Data of 655 recipients who underwent LDLT between 1997 and 2021 were collected and separated into the simultaneous Spx group (n = 461) and no-Spx group (n = 194). RESULTS The simultaneous Spx group had significantly lower serum total bilirubin levels, drained ascites volumes, and prothrombin time-international normalized ratios on postoperative day 14 than the no-Spx group ( P < 0.001 for each). Incidences of small-for-size graft syndrome ( P < 0.001), acute cellular rejection ( P = 0.002), and sepsis ( P = 0.007) were significantly lower in the Spx group. Graft survival of the Spx group was significantly better than that of the no-Spx group ( P < 0.001; hazard ratio [HR], 1.788; 95% confidence interval, 1.214-2.431). A multivariate analysis revealed that 3 variables, platelet count ≤4.0 × 10 4 /mm 3 ( P = 0.029; HR, 2.873), donor age ≥60 y old ( P = 0.013; HR, 6.693), and portal venous pressure at closure ≥20 mm Hg ( P = 0.010; HR, 3.891), were independent predictors of graft loss within 6 mo after simultaneous Spx during LDLT. CONCLUSIONS Spx is a safe inflow modulation procedure with a positive impact on both postoperative complications and prognosis for most patients. However, patients with the 3 aforementioned independent factors could experience graft loss after LDLT.
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Affiliation(s)
- Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiro Tomiyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuya Toshida
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazutoyo Morita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Nagao
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Kurihara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiro Tomino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukiko Kosai-Fujimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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25
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Yoshiya S, Itoh S, Toshima T, Izumi T, Iseda N, Tsutsui Y, Toshida K, Nakayama Y, Ishikawa T, Tanaka Y, Ninomiya M, Yoshizumi T. Is preoperative weight reduction of living-donor liver transplant recipients and donors harmful to postoperative outcomes? J Gastrointest Surg 2024; 28:1033-1038. [PMID: 38631611 DOI: 10.1016/j.gassur.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Although the incidence of recipients and donors with overweight and obesity is increasing worldwide, few reports have focused on outcomes of preoperative weight reduction (WR) in living-donor liver transplantation (LDLT). Therefore, we examined the outcomes and the impact of WR on the postoperative course. METHODS We analyzed 217 consecutive LDLT procedures performed from 2017 to 2022. We divided the recipients and donors into a WR group and non-WR group. RESULTS Twenty-two recipients (10.1%) achieved WR (preoperative recipient WR [RWR] group), reducing their weight by 6.8% ± 6.0% within 2.2 ± 1.4 months with a significant decrease in body mass index (BMI) (P < .0001). The RWR group showed no significant differences in short-term postoperative outcomes (operative factors, postoperative liver function tests, amount of ascites, and morbidity) or in the graft survival rate as a long-term outcome (P = .24) compared with the non-RWR group. Forty-one donors (18.9%) achieved WR (preoperative donor WR [DWR] group), reducing their weight by 9.7% ± 6.3% within 3.2 ± 5.8 months with a significant decrease in BMI (P < .0001). Compared with the non-DWR group, the DWR group showed no significant differences in short-term postoperative outcomes between themselves and recipients or in the graft survival rate (P = .49). Furthermore, WR resulted in an increase to 32 donor-eligible and 6 recipient-eligible patients. CONCLUSION WR in LDLT recipients and donors had no harmful effect on postoperative outcomes and should lead to increase recipients' chance of undergoing LDLT and to expand the donor pool.
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Affiliation(s)
- Shohei Yoshiya
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuma Izumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Norifumi Iseda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuriko Tsutsui
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuya Toshida
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuki Nakayama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuma Ishikawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasushi Tanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mizuki Ninomiya
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ye JZ, Lu HZ, Zeng C, Lei G, Wang XB, Chen J, Bai T, Wu FX, Mai RY, Guo WX, Li LQ. A novel surgical scheme for hepatectomy in hepatocellular carcinoma patients with clinically significant portal hypertension. BMC Cancer 2024; 24:764. [PMID: 38918786 PMCID: PMC11202348 DOI: 10.1186/s12885-024-12535-9] [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: 09/26/2023] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE Clinically significant portal hypertension (CSPH) seriously affects the feasibility and safety of surgical treatment for hepatocellular carcinoma (HCC) patients. The aim of this study was to establish a new surgical scheme defining risk classification of post-hepatectomy liver failure (PHLF) to facilitate the surgical decision-making and identify suitable candidates for individual hepatectomy among HCC patients with CSPH. BACKGROUNDS Hepatectomy is the preferred treatment for HCC. Surgeons must maintain a balance between the expected oncological outcomes of HCC removal and short-term risks of severe PHLF and morbidity. CSPH aggravates liver decompensation and increases the risk of severe PHLF thus complicating hepatectomy for HCC. METHODS Multivariate logistic regression and stochastic forest algorithm were performed, then the independent risk factors of severe PHLF were included in a nomogram to determine the risk of severe PHLF. Further, a conditional inference tree (CTREE) through recursive partitioning analysis validated supplement the misdiagnostic threshold of the nomogram. RESULTS This study included 924 patients, of whom 137 patients (14.8%) suffered from mild-CSPH and 66 patients suffered from (7.1%) with severe-CSPH confirmed preoperatively. Our data showed that preoperative prolonged prothrombin time, total bilirubin, indocyanine green retention rate at 15 min, CSPH grade, and standard future liver remnant volume were independent predictors of severe PHLF. By incorporating these factors, the nomogram achieved good prediction performance in assessing severe PHLF risk, and its concordance statistic was 0.891, 0.850 and 0.872 in the training cohort, internal validation cohort and external validation cohort, respectively, and good calibration curves were obtained. Moreover, the calculations of total points of diagnostic errors with 95% CI were concentrated in 110.5 (range 76.9-178.5). It showed a low risk of severe PHLF (2.3%), indicating hepatectomy is feasible when the points fall below 76.9, while the risk of severe PHLF is extremely high (93.8%) and hepatectomy should be rigorously restricted at scores over 178.5. Patients with points within the misdiagnosis threshold were further examined using CTREE according to a hierarchic order of factors represented by the presence of CSPH grade, ICG-R15, and sFLR. CONCLUSION This new surgical scheme established in our study is practical to stratify risk classification in assessing severe PHLF, thereby facilitating surgical decision-making and identifying suitable candidates for individual hepatectomy.
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Affiliation(s)
- Jia-Zhou Ye
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Hua-Ze Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Can Zeng
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Guo Lei
- Department of Hepatic Suegery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200438, China
| | - Xiao-Bo Wang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Jie Chen
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Tao Bai
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Fei-Xiang Wu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Rong-Yun Mai
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China.
| | - Wei-Xing Guo
- Department of Hepatic Suegery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200438, China.
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China.
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Cebula M, Biernacka A, Bożek O, Kokoszka B, Kazibut S, Kujszczyk A, Kulig-Kulesza M, Modlińska S, Kufel J, Azierski M, Szydło F, Winder M, Pilch-Kowalczyk J, Gruszczyńska K. Evaluation of Various Methods of Liver Measurement in Comparison to Volumetric Segmentation Based on Computed Tomography. J Clin Med 2024; 13:3634. [PMID: 38999200 PMCID: PMC11242708 DOI: 10.3390/jcm13133634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
Background: A reliable assessment of liver volume, necessary before transplantation, remains a challenge. Our work aimed to assess the differences in the evaluation and measurements of the liver between independent observers and compare different formulas calculating its volume in relation to volumetric segmentation. Methods: Eight researchers measured standard liver dimensions based on 105 abdominal computed tomography (CT) scans. Based on the results obtained, the volume of the liver was calculated using twelve different methods. An independent observer performed a volumetric segmentation of the livers based on the same CT examinations. Results: Significant differences were found between the formulas and in relation to volumetric segmentation, with the closest results obtained for the Heinemann et al. method. The measurements of individual observers differed significantly from one another. The observers also rated different numbers of livers as enlarged. Conclusions: Due to significant differences, despite its time-consuming nature, the use of volumetric liver segmentation in the daily assessment of liver volume seems to be the most accurate method.
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Affiliation(s)
- Maciej Cebula
- Individual Medical Practice, 40-754 Katowice, Poland
| | - Angelika Biernacka
- Department of Radiodiagnostics and Invasive Radiology, University Clinical Center Prof. Kornel Gibiński of the Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Oskar Bożek
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Bartosz Kokoszka
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Sylwia Kazibut
- Department of Radiodiagnostics and Invasive Radiology, University Clinical Center Prof. Kornel Gibiński of the Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Anna Kujszczyk
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Monika Kulig-Kulesza
- Department of Radiology and Radiodiagnostics in Zabrze, Medical University of Silesia, 41-800 Katowice, Poland
| | - Sandra Modlińska
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Jakub Kufel
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Michał Azierski
- Students’ Scientific Association of MedTech, Medical University of Silesia, 40-055 Katowice, Poland
- Students’ Scientific Association of Computer Analysis and Artificial Intelligence, Department of Radiology and Nuclear Medicine, Medical University of Silesia, 40-752 Katowice, Poland
| | - Filip Szydło
- Department of Radiodiagnostics and Invasive Radiology, University Clinical Center Prof. Kornel Gibiński of the Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Mateusz Winder
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Joanna Pilch-Kowalczyk
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Katarzyna Gruszczyńska
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
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Little CJ, Biggins SW, Perkins JD, Kling CE. Evaluating the Correlation Between Anteroposterior Diameter, Body Surface Area, and Height for Liver Transplant Donors and Recipients. Transplant Direct 2024; 10:e1630. [PMID: 38769984 PMCID: PMC11104725 DOI: 10.1097/txd.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 05/22/2024] Open
Abstract
Background Small stature and female sex correlate to decreased deceased donor liver transplant (DDLT) access and higher waitlist mortality. However, efforts are being made to improve access and equity of allocation under the new continuous distribution (CD) system. Liver anteroposterior diameter (APD) is a method used by many centers to determine size compatibility for DDLT but is not recorded systematically, so it cannot be used for allocation algorithms. We therefore seek to correlate body surface area (BSA) and height to APD in donors and recipients and compare waitlist outcomes by these factors to support their use in the CD system. Methods APD was measured from single-center DDLT recipients and donors with cross-sectional imaging. Linear, Pearson, and PhiK correlation coefficient were used to correlate BSA and height to APD. Competing risk analysis of waitlist outcomes was performed using United Network for Organ Sharing data. Results For 143 pairs, donor BSA correlated better with APD than height (PhiK = 0.63 versus 0.20). For recipient all comers, neither BSA nor height were good correlates of APD, except in recipients without ascites, where BSA correlated well (PhiK = 0.63) but height did not. However, among female recipients, BSA, but not height, strongly correlated to APD regardless of ascites status (PhiK = 0.80 without, PhiK = 0.70 with). Among male recipients, BSA correlated to APD only in those without ascites (PhiK = 0.74). In multivariable models, both BSA and height were predictive of waitlist outcomes, with higher values being associated with increased access, decreased delisting for death/clinical deterioration, and decreased living donor transplant (model concordance 0.748 and 0.747, respectively). Conclusions Taken together, BSA is a good surrogate for APD and can therefore be used in allocation decision making in the upcoming CD era to offset size and gender-based disparities among certain candidate populations.
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Affiliation(s)
| | - Scott W. Biggins
- Department of Surgery, Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, WA
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - James D. Perkins
- Department of Surgery, Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, WA
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Catherine E. Kling
- Department of Surgery, Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, WA
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA
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You X, Zuo B, Jiang J, Cheng D, Li P, Xing H, Yang C, Zhang Y. Liver resection with two-step vascular exclusion, in situ hypothermic portal perfusion for the treatment of end-stage hepatic alveolar echinococcosis. Langenbecks Arch Surg 2024; 409:168. [PMID: 38819706 DOI: 10.1007/s00423-024-03351-7] [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: 04/14/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of two-step vascular exclusion and in situ hypothermic portal perfusion in patients with end-stage hepatic hydatidosis. METHODS This study involved patients with advanced hepatic hydatid disease undergoing surgical treatment between 2022 and 2023, which included resection and reconstruction of the hepatic veins, inferior vena cava (IVC), and portal vein (PV). We described the technical details of liver resection and vascular reconstruction, as well as the use of two-step vascular exclusion and in situ hypothermic portal perfusion techniques during the vascular reconstruction process. RESULT We included 7 patients with advanced hepatic hydatid disease who underwent surgical resection using two-step vascular exclusion and in situ hypothermic portal perfusion. The mean duration of surgery was 12.5 h (range, 7.5-15.0 h). The average hepatic ischemia time was 45 min (range, 25-77 min), while the occlusion time of the IVC was 87 min (range, 72-105 min). The total blood loss was 1000 milliliters (range, 500-1250 milliliters). Postoperatively, patients exhibited good recovery of liver and renal function. The mean ICU stay was 2 days (range, 1-3 days), and the mean postoperative hospital stay was 13 days (range, 9-16 days), with no Grade III or above complications observed during a mean follow-up period of 15 months (range, 9-24 months), CONCLUSION: two-step vascular exclusion and in situ hypothermic portal perfusion for surgical resection of end-stage hepatic hydatid disease is safe and effective. This significantly reduces the anhepatic time.
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Affiliation(s)
- Xinyu You
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- School of Medicine, Southwest Medical University, Luzhou, 646000, P. R. China
| | - Bangyou Zuo
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jipeng Jiang
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Donghui Cheng
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Peng Li
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongming Xing
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chong Yang
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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30
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Lin X, Shao YM, Zhang RQ, Aji T. Applying LASSO logistic regression for the prediction of biliary complications after ex vivo liver resection and autotransplantation in patients with end-stage hepatic alveolar echinococcosis. Eur J Med Res 2024; 29:301. [PMID: 38812045 PMCID: PMC11134669 DOI: 10.1186/s40001-024-01898-1] [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: 12/13/2023] [Accepted: 05/21/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The purpose of this study was to explore the relevant risk factors associated with biliary complications (BCs) in patients with end-stage hepatic alveolar echinococcosis (HAE) following ex vivo liver resection and autotransplantation (ELRA) and to establish and visualize a nomogram model. METHODS This study retrospectively analysed patients with end-stage HAE who received ELRA treatment at the First Affiliated Hospital of Xinjiang Medical University between August 1, 2010 and May 10, 2023. The least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize the feature variables for predicting the incidence of BCs following ELRA. Multivariate logistic regression analysis was used to develop a prognostic model by incorporating the selected feature variables from the LASSO regression model. The predictive ability, discrimination, consistency with the actual risk, and clinical utility of the candidate prediction model were evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Internal validation was performed by the bootstrapping method. RESULTS The candidate prediction nomogram included predictors such as age, hepatic bile duct dilation, portal hypertension, and regular resection based on hepatic segments. The model demonstrated good discrimination ability and a satisfactory calibration curve, with an area under the ROC curve (AUC) of 0.818 (95% CI 0.7417-0.8958). According to DCA, this prediction model can predict the risk of BCs occurrence within a probability threshold range of 9% to 85% to achieve clinical net benefit. CONCLUSIONS A prognostic nomogram with good discriminative ability and high accuracy was developed and validated to predict BCs after ELRA in patients with end-stage HAE.
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Affiliation(s)
- Xin Lin
- Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830000, Xinjiang, China
| | - Ying-Mei Shao
- Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830000, Xinjiang, China
| | - Rui-Qing Zhang
- Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830000, Xinjiang, China
| | - Tuerganaili Aji
- Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China.
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830000, Xinjiang, China.
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Haddad A, Lendoire M, Maki H, Kang HC, Habibollahi P, Odisio BC, Huang SY, Vauthey JN. Liver volumetry and liver-regenerative interventions: history, rationale, and emerging tools. J Gastrointest Surg 2024; 28:766-775. [PMID: 38519362 DOI: 10.1016/j.gassur.2024.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Postoperative hepatic insufficiency (PHI) is the most feared complication after hepatectomy. Volume of the future liver remnant (FLR) is one objectively measurable indicator to identify patients at risk of PHI. In this review, we summarized the development and rationale for the use of liver volumetry and liver-regenerative interventions and highlighted emerging tools that could yield new advancements in liver volumetry. METHODS A review of MEDLINE/PubMed, Embase, and Cochrane Library databases was conducted to identify literature related to liver volumetry. The references of relevant articles were reviewed to identify additional publications. RESULTS Liver volumetry based on radiologic imaging was developed in the 1980s to identify patients at risk of PHI and later used in the 1990s to evaluate grafts for living donor living transplantation. The field evolved in the 2000s by the introduction of standardized FLR based on the hepatic metabolic demands and in the 2010s by the introduction of the degree of hypertrophy and kinetic growth rate as measures of the FLR regenerative and functional capacity. Several liver-regenerative interventions, most notably portal vein embolization, are used to increase resectability and reduce the risk of PHI. In parallel with the increase in automation and machine assistance to physicians, many semi- and fully automated tools are being developed to facilitate liver volumetry. CONCLUSION Liver volumetry is the most reliable tool to detect patients at risk of PHI. Advances in imaging analysis technologies, newly developed functional measures, and liver-regenerative interventions have been improving our ability to perform safe hepatectomy.
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Affiliation(s)
- Antony Haddad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Mateo Lendoire
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Hyunseon Christine Kang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
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Gan YX, Yang ZL, Pan YX, Ou-Yang LY, Tang YH, Zhang YJ, Chen MS, Xu L. Change of indocyanine green clearance ability and liver function after transcatheter intra-arterial therapies and its impact on outcomes of resectable hepatocellular carcinoma: a retrospective cohort study. Int J Surg 2024; 110:2832-2844. [PMID: 38363991 DOI: 10.1097/js9.0000000000001156] [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: 10/06/2023] [Accepted: 01/26/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Indocyanine green (ICG) clearance test is a classical measurement of hepatic reserve, which involves surgical safety and patient recovery of hepatocellular carcinoma (HCC). The authors aim to compare effects of hepatic arterial infusion chemotherapy (HAIC) and transcatheter arterial chemoembolization (TACE) on liver function and outcomes of subsequent hepatectomy. MATERIAL AND METHODS HCC patients receiving HAIC/TACE in SYSUCC with repeated ICG clearance tests were retrospectively enrolled. ICG eliminating rate (ICG-K), ICG retention rate at 15 min (ICG-R15) and ordinary laboratory tests were collected. Peri-therapeutic changes of values were compared between the groups. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) were employed to validate findings. Post-hepatectomy liver failure (PHLF), overall survival (OS) and recurrence-free survival (RFS) were analyzed in patients with subsequent curative hepatectomy. RESULTS Two hundred and four patients treated with HAIC ( n =130) and TACE ( n =74) were included. ΔICG-R15 was greater in the HAIC arm before matching (mean, 3.8% vs. 0.7%, P <0.001), after PSM (mean, 4.7% vs. 1.1%, P =0.014) and IPTW (mean, 2.0% vs. -3.6%, P <0.001). No difference was found for ΔALB, ΔALBI, ΔTBIL, ΔALT, ΔAST and ΔPT-INR. Multivariable analyses revealed elder age, cirrhosis, HAIC, greater ΔTBIL and ΔALBI were associated with deteriorating ICG-R15. Among those (105 for HAIC and 48 for TACE) receiving hepatectomy, occurrence of grade B/C PHLF (4.8% vs. 8.3%, P =0.616), OS (median, unreached vs. unreached, P =0.94) and RFS (median, 26.7 vs. 17.1 months, P =0.096) were comparable between the two arms. In subgroup analyses, preoperative HAIC yield superior RFS (median, 26.7 vs. 16.2 months, P =0.042) in patients with baseline ICG-R15 less than or equal to 10%. CONCLUSION Preoperative FOLFOX-HAIC caused apparent impairment of ICG clearance ability than TACE yet comparable impact on liver function and post-hepatectomy outcomes.
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Affiliation(s)
| | | | | | - Li-Ying Ou-Yang
- Intensive Care Unit, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center
| | - Yu-Hao Tang
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | | | - Li Xu
- Department of Liver Surgery
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Matsushima H, Soyama A, Hara T, Maruya Y, Fujita T, Imamura H, Adachi T, Hidaka M, Eguchi S. Outcomes of living donor liver transplant recipients receiving grafts with the graft-to-recipient weight ratio less than 0.6%: A matched pair analysis. Liver Transpl 2024; 30:519-529. [PMID: 37788305 DOI: 10.1097/lvt.0000000000000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
We sometimes experience living donor liver transplantation (LDLT) involving very small grafts with graft-to-recipient weight ratio (GRWR) < 0.6% when the actual graft size is smaller than predicted. The outcomes in this situation have not been fully investigated. The present study aimed to determine the graft outcomes of LDLT with GRWR < 0.6%. We retrospectively reviewed 280 cases of adult LDLT performed at our institution between January 2000 and March 2021. In our institution, the lower limit for graft volume/standard liver volume ratio was 30%. The patients were divided into 2 groups according to the cutoff value of 0.6% for actual GRWR. Graft survival and surgical outcomes, including small-for-size syndrome (SFSS), were compared between the groups using propensity score matching analysis. Risk factors associated with SFSS in recipients with GRWR < 0.6% were also evaluated. Fifty-nine patients received grafts with GRWR < 0.6%. After propensity score matching, similar graft survival rates were observed for GRWR < 0.6% (n = 53) and GRWR ≥ 0.6% (n = 53) ( p = 0.98). However, patients with GRWR < 0.6% had a significantly worse 3-month graft survival rate (86.8% vs. 98.1%, p = 0.03) and higher incidence of SFSS ( p < 0.001) than patients with GRWR ≥0.6%. On multivariate analysis, Model for End-Stage Liver Disease score and donor age were associated with SFSS in patients with GRWR < 0.6%. The same factors were also associated with graft survival. In conclusion, although similar overall graft survival rates were observed for LDLT with GRWR < 0.6% and GRWR ≥ 0.6%, GRWR < 0.6% was associated with an increased risk of SFSS. Appropriate donor and recipient selection is important for successful LDLT with very small grafts.
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Affiliation(s)
- Hajime Matsushima
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Ng KKC, Lok HT, Lee KF, Cheung TT, Chia NH, Ng WK, Law CK, Cheung CY, Cheng KC, Cheung SYS, Lai PBS. Comparison of post-hepatectomy long-term survival outcome between non-colorectal non-neuroendocrine and colorectal liver metastases: A population-based propensity-score matching analysis. Surgeon 2024; 22:e100-e108. [PMID: 38081758 DOI: 10.1016/j.surge.2023.11.007] [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: 02/28/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Hepatectomy is an established treatment for colorectal liver metastasis (CLM) or neuroendocrine liver metastasis. However, its role in non-colorectal non-neuroendocrine liver metastasis (NCNNLM) is controversial. This study aims to compare long-term survival outcomes after hepatectomy between NCNNLM and CLM in a population-based cohort. METHODS From 2009 to 2018, curative hepatectomy were performed in 964 patients with NCNNLM (n = 133) or CLM (n = 831). Propensity score (PS) matching was performed. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. RESULTS There were 133 patients in the NCNNLM group and 266 patients in the CLM group. The mortality (1.5 % vs 1.5 %) and morbidity (19.5 % vs 20.3 %) rates were comparable between the two groups. There was no statistically significant difference in 5-year overall (48.9 % vs 39.8 %) and recurrence-free (25.1 % vs 23.4 %) survival rates between NCNNLM and CLM groups. A high pre-operative serum bilirubin level, severe postoperative complications and multiple tumors were independent prognostic factors for poor survival. CONCLUSION Hepatectomy for selected patients with NCNNLM can achieve similar long-term oncological outcomes as those with CLM. High serum bilirubin, severe postoperative complication and multiple tumors are poor prognostic factors for survival.
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Affiliation(s)
- Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong.
| | - Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Nam-Hung Chia
- Department of Surgery, Queen Elizabeth Hospital, Hong Kong
| | - Wai-Kuen Ng
- Department of Surgery, Princes Margaret Hospital, Hong Kong
| | - Cho-Kwan Law
- Department of Surgery, Tuen Mun Hospital, Hong Kong
| | | | - Kai-Chi Cheng
- Department of Surgery, Kwong Wah Hospital, Hong Kong
| | | | - Paul B S Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
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Akabane M, Imaoka Y, Esquivel CO, Melcher ML, Kwong A, Sasaki K. Overcoming the hurdles of steatotic grafts in liver transplantation: Insights into survival and prognostic factors. Liver Transpl 2024; 30:376-385. [PMID: 37616509 DOI: 10.1097/lvt.0000000000000245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
With increasing metabolic dysfunction-associated steatotic liver disease, the use of steatotic grafts in liver transplantation (LT) and their impact on postoperative graft survival (GS) needs further exploration. Analyzing adult LT recipient data (2002-2022) from the United Network for Organ Sharing database, outcomes of LT using steatotic (≥30% macrosteatosis) and nonsteatotic donor livers, donors after circulatory death, and standard-risk older donors (age 45-50) were compared. GS predictors were evaluated using Kaplan-Meier and Cox regression analyses. Of the 35,345 LT donors, 8.9% (3,155) were fatty livers. The initial 30-day postoperative period revealed significant challenges with fatty livers, demonstrating inferior GS. However, the GS discrepancy between fatty and nonfatty livers subsided over time ( p = 0.10 at 5 y). Long-term GS outcomes showed comparable or even superior results in fatty livers relative to nonsteatotic livers, conditional on surviving the initial 90 postoperative days ( p = 0.90 at 1 y) or 1 year ( p = 0.03 at 5 y). In the multivariable Cox regression analysis, the high body surface area (BSA) ratio (≥1.1) (HR 1.42, p = 0.02), calculated as donor BSA divided by recipient BSA, long cold ischemic time (≥6.5 h) (HR 1.72, p < 0.01), and recipient medical condition (intensive care unit hospitalization) (HR 2.53, p < 0.01) emerged as significant adverse prognostic factors. Young (<40 y) fatty donors showed a high BSA ratio, diabetes, and intensive care unit hospitalization as significant indicators of a worse prognosis ( p < 0.01). Our study emphasizes the initial postoperative 30-day survival challenge in LT using fatty livers. However, with careful donor-recipient matching, for example, avoiding the use of steatotic donors with long cold ischemic time and high BSA ratios for recipients in the intensive care unit, it is possible to enhance immediate GS, and in a longer time, outcomes comparable to those using nonfatty livers, donors after circulatory death livers, or standard-risk older donors can be anticipated. These novel insights into decision-making criteria for steatotic liver use provide invaluable guidance for clinicians.
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Affiliation(s)
- Miho Akabane
- Department of Surgery, Division of Abdominal Transplant, Stanford University Medical Center, Stanford, California, USA
| | - Yuki Imaoka
- Department of Surgery, Division of Abdominal Transplant, Stanford University Medical Center, Stanford, California, USA
| | - Carlos O Esquivel
- Department of Surgery, Division of Abdominal Transplant, Stanford University Medical Center, Stanford, California, USA
| | - Marc L Melcher
- Department of Surgery, Division of Abdominal Transplant, Stanford University Medical Center, Stanford, California, USA
| | - Allison Kwong
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Kazunari Sasaki
- Department of Surgery, Division of Abdominal Transplant, Stanford University Medical Center, Stanford, California, USA
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Kinoshita K, Moore G, Murakami M. Body Weight as a Preferred Method for Normalizing the Computed Tomography-Derived Liver Volume in Dogs without Hepatic Disease. Vet Sci 2024; 11:153. [PMID: 38668420 PMCID: PMC11054289 DOI: 10.3390/vetsci11040153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024] Open
Abstract
The assessment of liver size is usually performed using radiography in dogs. However, due to wide variations in patients' sizes and body conformations, accurate diagnosis of hepatomegaly or microhepatia is difficult. Computed tomographic (CT) volumetry can quantitatively and accurately measure liver volume. However, a reliable method for the standardization or normalization of volume in dogs without hepatic disease using CT has not yet been established. The purpose of this study was to assess seven different anatomic measures for normalizing liver volume in dogs and determine the tentative range of liver volume in dogs without hepatic disease. We retrospectively searched medical records from 1 January 2017 through to 1 June 2020 and included dogs with abdominal computed tomography without hepatic disease. The liver volume, lengths of four vertebrae (T11, T12, L2, L3), diameter of the abdominal aorta, body weight, and body condition scores (BCSs) of the dogs were recorded. Forty-one client-owned dogs without evidence of hepatic disease were included. The CT-derived liver volume was 813.8 ± 326.5 cm3 (mean ± SD). Body weight was determined to be the most reliable single-variable method for normalizing liver volume, with a raw CT-derived liver-volume-to-body-weight ratio of 22.1 cm3/kg (95% CI: 12.9-31.3 cm3/kg) and regression prediction model of volume = 19 × BWkg + 97. However, a better normalizing factor would likely be provided by the fat-free mass if it can be accurately measured.
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Affiliation(s)
- Kosuke Kinoshita
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - George Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Masahiro Murakami
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
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Hsieh RCE, Lee CH, Huang HC, Wu SW, Chou CY, Hung SP, Lee CW, Krishnan S, Venkatesulu BP, Lee JC, Chou YC, Chan KM, Lin PT, Lee WC, Lin CC, Lin SY, Hong JH. Clinical and Dosimetric Results of Proton or Photon Radiation Therapy for Large (>5 cm) Hepatocellular Carcinoma: A Retrospective Analysis. Int J Radiat Oncol Biol Phys 2024; 118:712-724. [PMID: 37778426 DOI: 10.1016/j.ijrobp.2023.09.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Our purpose was to report the clinical and dosimetric attributes of patients with large unresectable hepatocellular carcinoma (HCC) undergoing proton or photon radiation therapy. METHODS AND MATERIALS We retrospectively analyzed the outcomes and dosimetric indices of 159 patients with >5 cm nonmetastatic HCC who underwent definitive radiation therapy using either protons (N = 105) or photons (N = 54) between 2014 and 2018. Additional photon plans were performed in the 105 proton-treated patients using the same dose prescription criteria for intragroup dosimetric comparison. RESULTS After a median follow-up of 47 months, patients with biologically effective dose (BED10) ≥ 75 Gy exhibited significantly better local control (LC; 2-year: 85.6% vs 20.5%; P < .001), progression-free survival (PFS; median, 7.4 vs 3.2 months; P < .001), and overall survival (OS; median, 18.1 vs 7.3 months; P < .001) compared with those with BED10 < 75 Gy. Notably, proton-treated patients had a significantly higher BED10 (96 vs 67 Gy; P < .001) and improved LC (2-year: 88.5% vs 33.8%; P < .001), PFS (median, 7.4 vs 3.3 months; P = .001), and OS (median, 18.9 vs 8.3 months; P < .001) than those undergoing photon radiation therapy. Furthermore, patients treated with protons had significantly lower V1 of the liver (P < .001), mean upper gastrointestinal tract dose (P < .001), and mean splenic dose (P < .001), with significantly decreased incidences of radiation-induced liver disease (P = .007), grade ≥3 upper gastrointestinal bleeding (P = .001), and grade ≥3 lymphopenia (P = .003). On multivariate analysis, proton radiation therapy consistently correlated with superior LC (P < .001), PFS (P < .001), and OS (P < .001). In intragroup dosimetric comparison, photon plans demonstrated significantly higher mean liver dose (P < .001) compared with actually delivered proton treatments, and 72 (69%) of them had mean liver dose exceeding 28 Gy, which necessitated target dose de-escalation. CONCLUSIONS In the context of large HCC radiation therapy, a higher target BED10 was associated with improved outcomes. Notably, proton therapy has demonstrated the capability to deliver ablative doses while also being accompanied by fewer instances of severe toxicity.
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Affiliation(s)
- Rodney Cheng-En Hsieh
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan; Department of Medical Imaging and Radiological Science, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan; Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas; Cancer Genome Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan.
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Hsiao-Chieh Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Shu-Wei Wu
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Chen-Yu Chou
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Sheng-Ping Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Sunil Krishnan
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas
| | - Bhanu Prasad Venkatesulu
- Department of Radiation Oncology, Loyola University, Chicago, Illinois; Edward Hines Veteran Affairs Hospital, Chicago, Illinois
| | - Jin-Chiao Lee
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Yung-Chih Chou
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan; Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Kun-Ming Chan
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Po-Ting Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Wei-Chen Lee
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Shen-Yen Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
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Kirichenko A, Uemura T, Liang Y, Hasan S, Abel S, Renz P, Shamsesfandabadi P, Carpenter J, Yin Y, Thai N. Stereotactic Body Radiation Therapy (SBRT) for Hepatocellular Carcinoma (HCC) With Single Photon Emission Computed Tomography (SPECT) Functional Treatment Planning in Patients With Advanced Hepatic Cirrhosis. Adv Radiat Oncol 2024; 9:101367. [PMID: 38405302 PMCID: PMC10885583 DOI: 10.1016/j.adro.2023.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/19/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose We report on the feasibility and outcomes of liver stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) with single-photon emission computed tomography (SPECT) functional treatment planning in patients with Child-Pugh (CP) B/C cirrhosis. Methods and Materials Liver SPECT with 99mTc-sulfur colloid was coregistered to treatment planning computed tomography (CT) for the guided avoidance of functional hepatic parenchyma during SBRT. Functional liver volumes (FLVs) obtained from SPECT were compared with anatomic liver volumes defined on the planning CT. Radiation dose constraints were adapted exclusively to FLV. Local control, toxicity, and survival were reported with at least 6 months of radiographic follow-up. Pre- and posttransplant outcomes were analyzed in a subset of patients who completed SBRT as a bridge to liver transplant. Model of End-Stage Liver Disease was used to score hepatic function before and after SBRT completion. Results With a median follow-up of 32 months, 45 patients (58 lesions) with HCC and CP-B/C cirrhosis received SBRT to a median dose of 45 Gy (3-5 fractions). FLV loss (34%, P < .001) was observed in all patients, and the functional and anatomic liver volumes matched well in a control group of noncirrhotic/non-HCC patients. Despite marked functional parenchyma retraction, the amount of FLV on SPECT exposed to the threshold irradiation was significantly less than the CT liver volumes (P < .001) because of the optimized beam placement during dosimetry planning. Twenty-three patients (51%) successfully completed orthotopic liver transplant, with a median time to transplant of 9.2 months. With 91% in-field local control, the overall 2-year survival was 65% (90% after the orthotopic liver transplant), with no incidence of radiation-induced liver disease observed within 3 to 4 months or accelerated CP class migration from B to C within the first 6 months post-SBRT. Mean Model of End-Stage Liver Disease-Na score was not significantly elevated at 3-month intervals after SBRT completion. Conclusions Functional treatment planning with 99mTc sulfur colloid SPECT/CT allows identification and avoidance of functional hepatic parenchyma in patients with CP-B/C cirrhosis, leading to low toxicity and satisfactory transplant outcomes.
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Affiliation(s)
- Alexander Kirichenko
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - Tadahiro Uemura
- Division of Abdominal Transplantation and Hepato-Biliary Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Yun Liang
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | | | - Steven Abel
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - Paul Renz
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - Parisa Shamsesfandabadi
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - Jennifer Carpenter
- Division of Abdominal Transplantation and Hepato-Biliary Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Yue Yin
- Allegheny-Singer Research Institute, Biostatistics, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ngoc Thai
- Division of Abdominal Transplantation and Hepato-Biliary Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
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Sanchez-Garcia J, Lopez-Verdugo F, Shorti R, Krong J, Kastenberg ZJ, Walters S, Gagnon A, Paci P, Zendejas I, Alonso D, Fujita S, Contreras AG, Botha J, Esquivel CO, Rodriguez-Davalos MI. Three-dimensional Liver Model Application for Liver Transplantation. Transplantation 2024; 108:464-472. [PMID: 38259179 DOI: 10.1097/tp.0000000000004730] [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: 01/24/2024]
Abstract
BACKGROUND Children are removed from the liver transplant waitlist because of death or progressive illness. Size mismatch accounts for 30% of organ refusal. This study aimed to demonstrate that 3-dimensional (3D) technology is a feasible and accurate adjunct to organ allocation and living donor selection process. METHODS This prospective multicenter study included pediatric liver transplant candidates and living donors from January 2020 to February 2023. Patient-specific, 3D-printed liver models were used for anatomic planning, real-time evaluation during organ procurement, and surgical navigation. The primary outcome was to determine model accuracy. The secondary outcome was to determine the impact of outcomes in living donor hepatectomy. Study groups were analyzed using propensity score matching with a retrospective cohort. RESULTS Twenty-eight recipients were included. The median percentage error was -0.6% for 3D models and had the highest correlation to the actual liver explant (Pearson's R = 0.96, P < 0.001) compared with other volume calculation methods. Patient and graft survival were comparable. From 41 living donors, the median percentage error of the allograft was 12.4%. The donor-matched study group had lower central line utilization (21.4% versus 75%, P = 0.045), shorter length of stay (4 versus 7 d, P = 0.003), and lower mean comprehensive complication index (3 versus 21, P = 0.014). CONCLUSIONS Three-dimensional volume is highly correlated with actual liver explant volume and may vary across different allografts for living donation. The addition of 3D-printed liver models during the transplant evaluation and organ procurement process is a feasible and safe adjunct to the perioperative decision-making process.
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Affiliation(s)
- Jorge Sanchez-Garcia
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Fidel Lopez-Verdugo
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Rami Shorti
- Emerging Technologies, Intermountain Health, Murray, UT
| | - Jake Krong
- Transplant Research Department, Intermountain Medical Center, Murray, UT
| | - Zachary J Kastenberg
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Shannon Walters
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Andrew Gagnon
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Philippe Paci
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Ivan Zendejas
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Diane Alonso
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Shiro Fujita
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Alan G Contreras
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Jean Botha
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Carlos O Esquivel
- Division of Abdominal Transplantation, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA
| | - Manuel I Rodriguez-Davalos
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Division of Transplant Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Puri P, Kumar A, Qaleem M. Donor Evaluation Protocol for Live and Deceased Donors. J Clin Exp Hepatol 2024; 14:101217. [PMID: 38076356 PMCID: PMC10709134 DOI: 10.1016/j.jceh.2023.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/09/2023] [Indexed: 01/05/2025] Open
Abstract
Donor evaluation is a critical step before proceeding with liver transplantation (LT) in both deceased donor LT (DDLT) and living donor LT (LDLT). A good, healthy graft is necessary for the success of the transplantation. Other issues in selecting a donor include the transmission of infections and malignancies from the donor. Because of the scarcity of cadaver organs, an increasing number of extended-criteria donors, or 'marginal donors', are being utilized. LDLT also has potential risks to the donor, and donor safety needs to be kept in mind before proceeding with LT. The current review highlights the factors to be considered during donor evaluation for living and deceased donors before LT.
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Affiliation(s)
- Pankaj Puri
- Fortis Escorts Liver and Digestive Diseases Institute, Fortis Escorts Hospital, New Delhi-110025, India
| | - Abhinav Kumar
- Fortis Escorts Liver and Digestive Diseases Institute, Fortis Escorts Hospital, New Delhi-110025, India
| | - Mohd Qaleem
- Department of Liver Transplantation, Minimal Access & GI Surgery, Fortis Escorts Hospital, New Delhi-110025, India
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Eguchi S, Umeshita K, Soejima Y, Eguchi H, Egawa H, Fukumoto T, Haga H, Hasegawa K, Kasahara M, Nagano H, Takada Y, Tokushige K, Ueda Y, Mochida S, Matsushima H, Adachi T, Ohdan H. An Analysis of 10,000 Cases of Living Donor Liver Transplantation in Japan: Special Reference to the Graft-Versus-Recipient Weight Ratio and Donor Age. Ann Surg 2024; 279:94-103. [PMID: 38112092 DOI: 10.1097/sla.0000000000006121] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To analyze 10,000 cases of living donor liver transplantation (LDLT) recipient data to elucidate outcomes with special reference to the graft-versus-recipient weight ratio (GRWR), based on the Japanese Liver Transplantation Society (JLTS) registry. BACKGROUND The JLTS registry has been accurate and complete in characterizing and following trends in patient characteristics and survival of all patients with LDLT. METHODS Between November 1989 and August 2021, 10,000 patients underwent LDLT in Japan. The procedures performed during the study period included pediatric liver transplantation (age <18 years, n = 3572) and adult liver transplantation (age ≥18 years, n=6428). Factors related to patient survival (PS) and graft survival (GS) were also analyzed. RESULTS The GRWR was <0.7, 0.7 to <0.8, 0.8 to <3, 3 to <5, and ≥5 in 0.2%, 2.0%, 61.8%, 31.8%, and 2.6% of pediatric patients and <0.6, 0.6 to <0.7, 0.7 to <0.8, and ≥0.8 in 8.0%, 12.7%, 17.7%, and 61.5% of adult patients, respectively. Among pediatric recipients, the PS rate up to 5 years was significantly better in cases with a GRWR ≤5 than in those with a GRWR >5. When the GRWR and donor age were combined, among adult recipients 50 to 60 years old, the early PS and GS up to 5 years were significantly better in cases with a GRWR ≥0.7, than in those with a GRWR <0.7. (P = 0.02). In adults, a multivariate analysis showed that GRWR <0.6, transplant era (<2011), donor age (>60 years), recipient age (>60 years), model for end-stage liver disease score (≥20), and center volume (<10) were significant prognostic factors for long-term PS. CONCLUSION Although a satisfactory long-term PS and GS, especially in the recent era (2011-2021), was achieved in the JLTS series, a GRWR ≥5 in pediatric cases and relatively old donors with a GRWR <0.7 in adult cases should be managed with caution.
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Affiliation(s)
- Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koji Umeshita
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yuji Soejima
- Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hidetoshi Eguchi
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical, University, Tokyo, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Kiyoshi Hasegawa
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasutsugu Takada
- Department of Hepato-Pancreatic-Biliary and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Katsutoshi Tokushige
- Department of Internal Medicine and Gastroenterology, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihide Ueda
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Mochida
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Hajime Matsushima
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Jeong JY, Jun DY, Moon YJ, Kang DH, Jung HD, Jeon SH, Lee JY. Training ultrasound-guided percutaneous nephrostomy technique with porcine model. Investig Clin Urol 2024; 65:62-68. [PMID: 38197752 PMCID: PMC10789536 DOI: 10.4111/icu.20230298] [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: 09/01/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE There is increasing interest in the use of ultrasound for endoscopic and percutaneous procedures. Access can be achieved without radiation exposure under ultrasound guidance. Our aim was to develop a porcine-based training model for ultrasound-guided percutaneous renal access that could also be personalized to a specific patient. MATERIALS AND METHODS The Institutional Animal Care and Use Committee of Severance Hospital approved the study protocol. An anesthetized pig was placed in the dorsal lithotomy position. For the nephrostomy puncture, a Chiba biopsy needle with an echo tip was used under ultrasound guidance. Eight residents and three consultants in urology participated. Puncture time was defined as the nephrostomy time to confirm the flow of irrigation via the needle. After training, satisfaction survey results for clinical usability and procedural difficulty were evaluated. RESULTS The 5-point Likert scale satisfaction survey for clinical usability and procedural difficulty found mean results of 4.64 and 4.09 points, respectively. There were no differences between residents and consultants for either variable. For all participants combined, there was a significant difference for nephrostomy time between the first and second trials (278.8±70.6 s vs. 244.5±47.0 s; p=0.007). The between-trial difference was greater for residents (291.5±71.2 s vs. 259.1±41.9 s; p=0.039). The difference for the consultant was not significant (245.0±69.4 s vs. 205.7±42.5 s; p=0.250). CONCLUSIONS We developed a porcine-based ultrasound-guided nephrostomy puncture training model. Satisfaction survey results indicated high clinical usability and procedural difficulty. For nephrostomy time, the model was more effective for urology residents than for consultants.
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Affiliation(s)
- Jae Yong Jeong
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Dae Young Jun
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Joon Moon
- Department of Urology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University College of Medicine, Incheon, Korea
| | - Hae Do Jung
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea.
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Tiraboschi G, Marchionni D, Tuffal G, Fabre D, Martinez JM, Haack KA, Miossec P, Kittner B, Daba N, Hurbin F. Population pharmacokinetic modeling and dosing simulation of avalglucosidase alfa for selecting alternative dosing regimen in pediatric patients with late-onset pompe disease. J Pharmacokinet Pharmacodyn 2023; 50:461-474. [PMID: 37535240 PMCID: PMC10673948 DOI: 10.1007/s10928-023-09874-8] [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: 01/19/2023] [Accepted: 07/08/2023] [Indexed: 08/04/2023]
Abstract
Avalglucosidase alfa (AVAL) was approved in the United States (2021) for patients with late-onset Pompe disease (LOPD), aged ≥ 1 year. In the present study, pharmacokinetic (PK) simulations were conducted to propose alternative dosing regimens for pediatric LOPD patients based on a bodyweight cut-off. Population PK (PopPK) analysis was performed using nonlinear mixed effect modeling approach on pooled data from three clinical trials with LOPD patients, and a phase 2 study (NCT03019406) with infantile-onset Pompe disease (IOPD: 1-12 years) patients. A total of 2257 concentration-time points from 91 patients (LOPD, n = 75; IOPD, n = 16) were included in the analysis. The model was bodyweight dependent allometric scaling with time varying bodyweight included on clearance and distribution volume. Simulations were performed for two dosing regimens (20 mg/kg or 40 mg/kg) with different bodyweight cut-off (25, 30, 35 and 40 kg) by generating virtual pediatric (1-17 years) and adult patients. Corresponding simulated individual exposures (maximal concentration, Cmax and area under the curve in the 2-week dosing interval, AUC2W), and distributions were calculated. It was found that dosing of 40 mg/kg and 20 mg/kg in pediatric patients < 30 kg and ≥ 30 kg, respectively, achieved similar AVAL exposure (based on AUC2W) to adult patients receiving 20 mg/kg. PK simulations conducted on the basis of this model provided supporting data for the currently approved US labelling for dosing adapted bodyweight in LOPD patients ≥ 1 year by USFDA.
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Affiliation(s)
- Gilles Tiraboschi
- Pharmacokinetics Dynamics and Metabolism, Translational Medecine & Early Development, Sanofi R&D, 371 Rue du Pr Blayac, Montpellier, 34184, France.
| | - David Marchionni
- Pharmacokinetics Dynamics and Metabolism, Translational Medecine & Early Development, Sanofi R&D, 371 Rue du Pr Blayac, Montpellier, 34184, France
| | - Gilles Tuffal
- Pharmacokinetics Dynamics and Metabolism, Translational Medecine & Early Development, Sanofi R&D, 371 Rue du Pr Blayac, Montpellier, 34184, France
| | - David Fabre
- Pharmacokinetics Dynamics and Metabolism, Translational Medecine & Early Development, Sanofi R&D, 371 Rue du Pr Blayac, Montpellier, 34184, France
| | - Jean-Marie Martinez
- Pharmacokinetics Dynamics and Metabolism, Translational Medecine & Early Development, Sanofi R&D, 371 Rue du Pr Blayac, Montpellier, 34184, France
| | - Kristina An Haack
- Sanofi Chilly-Mazarin, 1 Avenue Pierre Brossolette, Chilly-Mazarin, 91385, France
| | - Patrick Miossec
- Sanofi Chilly-Mazarin, 1 Avenue Pierre Brossolette, Chilly-Mazarin, 91385, France
| | - Barbara Kittner
- Global Pharmacovigilance, Sanofi, Bridgewater, NJ, 08876, USA
| | - Nadia Daba
- Global Medical Affairs, Sanofi Gulf Level 3, One JLT, Jumeirah Lake Towers, PO Box 53899, Dubai, UAE
| | - Fabrice Hurbin
- Pharmacokinetics Dynamics and Metabolism, Translational Medecine & Early Development, Sanofi R&D, 371 Rue du Pr Blayac, Montpellier, 34184, France
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Kasahara M, Sakamoto S. Optimal graft size in pediatric living donor liver transplantation: How are children different from adults? Pediatr Transplant 2023; 27:e14543. [PMID: 37243395 DOI: 10.1111/petr.14543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Pediatric liver transplantation is an established treatment for end-stage liver disease in children. However, it is still posing relevant challenges, such as optimizing the graft selection according to the recipient size. Unlike adults, small children tolerate large-for-size grafts and insufficient graft volume might represent an issue in adolescents when graft size is disproportionate. METHODS Graft-size matching strategies over time were examined in pediatric liver transplantation. This review traces the measures/principles put in place to prevent large-for-size or small-for-size grafts in small children to adolescents with a literature review and an analysis of the data issued from the National Center for Child Health and Development, Tokyo, Japan. RESULTS Reduced left lateral segment (LLS; Couinaud's segment II and III) was widely applicable for small children less than 5 kg with metabolic liver disease or acute liver failure. There was significantly worse graft survival if the actual graft-to-recipient weight ratio (GRWR) was less than 1.5% in the adolescent with LLS graft due to the small-for-size graft. Children, particularly adolescents, may then require larger GRWR than adults to prevent small-for-size syndrome. The suggested ideal graft selections in pediatric LDLT are: reduced LLS, recipient body weight (BW) < 5.0 kg; LLS, 5.0 kg ≤ BW < 25 kg; left lobe (Couinaud's segment II, III, IV with middle hepatic vein), 25 kg ≤ BW < 50 kg; right lobe (Couinaud's segment V, VI, VII, VIII without middle hepatic vein), 50 kg ≤ BW. Children, particularly adolescents, may then require larger GRWR than adults to prevent small-for-size syndrome. CONCLUSION Age-appropriate and BW-appropriate strategies of graft selection are crucial to secure an excellent outcome in pediatric living donor liver transplantation.
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Affiliation(s)
- Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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Chouari T, Merali N, La Costa F, Santol J, Chapman S, Horton A, Aroori S, Connell J, Rockall TA, Mole D, Starlinger P, Welsh F, Rees M, Frampton AE. The Role of the Multiparametric MRI LiverMultiScan TM in the Quantitative Assessment of the Liver and Its Predicted Clinical Applications in Patients Undergoing Major Hepatic Resection for Colorectal Liver Metastasis. Cancers (Basel) 2023; 15:4863. [PMID: 37835557 PMCID: PMC10571783 DOI: 10.3390/cancers15194863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/05/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Liver biopsy remains the gold standard for the histological assessment of the liver. With clear disadvantages and the rise in the incidences of liver disease, the role of neoadjuvant chemotherapy in colorectal liver metastasis (CRLM) and an explosion of surgical management options available, non-invasive serological and imaging markers of liver histopathology have never been more pertinent in order to assess liver health and stratify patients considered for surgical intervention. Liver MRI is a leading modality in the assessment of hepatic malignancy. Recent technological advancements in multiparametric MRI software such as the LiverMultiScanTM offers an attractive non-invasive assay of anatomy and histopathology in the pre-operative setting, especially in the context of CRLM. This narrative review examines the evidence for the LiverMultiScanTM in the assessment of hepatic fibrosis, steatosis/steatohepatitis, and potential applications for chemotherapy-associated hepatic changes. We postulate its future role and the hurdles it must surpass in order to be implemented in the pre-operative management of patients undergoing hepatic resection for colorectal liver metastasis. Such a role likely extends to other hepatic malignancies planned for resection.
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Affiliation(s)
- Tarak Chouari
- MATTU, The Leggett Building, Daphne Jackson Road, Guildford GU2 7WG, UK; (T.C.)
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
- Oncology Section, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Science, University of Surrey, Guildford GU2 7WG, UK
| | - Nabeel Merali
- MATTU, The Leggett Building, Daphne Jackson Road, Guildford GU2 7WG, UK; (T.C.)
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
- Oncology Section, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Science, University of Surrey, Guildford GU2 7WG, UK
| | - Francesca La Costa
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
| | - Jonas Santol
- Department of Surgery, HPB Center, Vienna Health Network, Clinic Favoriten and Sigmund Freud Private University, 1090 Vienna, Austria
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
| | - Shelley Chapman
- Department of Radiology, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
| | - Alex Horton
- Department of Radiology, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
| | - Somaiah Aroori
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery and Transplant Surgery, Derriford Hospital, Plymouth PL6 8DH, UK
| | | | - Timothy A. Rockall
- MATTU, The Leggett Building, Daphne Jackson Road, Guildford GU2 7WG, UK; (T.C.)
- Oncology Section, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Science, University of Surrey, Guildford GU2 7WG, UK
| | - Damian Mole
- Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh EH10 5HF, UK
- Centre for Inflammation Research, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH105HF, UK
| | - Patrick Starlinger
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN 55902, USA
- Center of Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, General Hospital, 1090 Vienna, Austria
| | - Fenella Welsh
- Hepato-Biliary Unit, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire RG24 9NA, UK
| | - Myrddin Rees
- Hepato-Biliary Unit, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire RG24 9NA, UK
| | - Adam E. Frampton
- MATTU, The Leggett Building, Daphne Jackson Road, Guildford GU2 7WG, UK; (T.C.)
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
- Oncology Section, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Science, University of Surrey, Guildford GU2 7WG, UK
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Kow AWC, Liu J, Patel MS, De Martin E, Reddy MS, Soejima Y, Syn N, Watt K, Xia Q, Saraf N, Kamel R, Nasralla D, McKenna G, Srinvasan P, Elsabbagh AM, Pamecha V, Palaniappan K, Mas V, Tokat Y, Asthana S, Cherukuru R, Egawa H, Lerut J, Broering D, Berenguer M, Cattral M, Clavien PA, Chen CL, Shah S, Zhu ZJ, Emond J, Ascher N, Rammohan A, Bhangui P, Rela M, Kim DS, Ikegami T. Post Living Donor Liver Transplantation Small-for-size Syndrome: Definitions, Timelines, Biochemical, and Clinical Factors for Diagnosis: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference. Transplantation 2023; 107:2226-2237. [PMID: 37749812 DOI: 10.1097/tp.0000000000004770] [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: 09/27/2023]
Abstract
BACKGROUND When a partial liver graft is unable to meet the demands of the recipient, a clinical phenomenon, small-for-size syndrome (SFSS), may ensue. Clear definition, diagnosis, and management are needed to optimize transplant outcomes. METHODS A Consensus Scientific committee (106 members from 21 countries) performed an extensive literature review on specific aspects of SFSS, recommendations underwent blinded review by an independent panel, and discussion/voting on the recommendations occurred at the Consensus Conference. RESULTS The ideal graft-to-recipient weight ratio of ≥0.8% (or graft volume standard liver volume ratio of ≥40%) is recommended. It is also recommended to measure portal pressure or portal blood flow during living donor liver transplantation and maintain a postreperfusion portal pressure of <15 mm Hg and/or portal blood flow of <250 mL/min/100 g graft weight to optimize outcomes. The typical time point to diagnose SFSS is the postoperative day 7 to facilitate treatment and intervention. An objective 3-grade stratification of severity for protocolized management of SFSS is proposed. CONCLUSIONS The proposed grading system based on clinical and biochemical factors will help clinicians in the early identification of patients at risk of developing SFSS and institute timely therapeutic measures. The validity of this newly created grading system should be evaluated in future prospective studies.
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Affiliation(s)
- Alfred Wei Chieh Kow
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University of Singapore, Singapore
- Liver Transplantation, National University Center for Organ Transplantation (NUCOT), National University Health System Singapore, Singapore
| | - Jiang Liu
- Department of Surgery, Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
- Department of Surgery, LKS Faculty of Medicine, HKU-Shenzhen Hospital, University of Hong Kong, Hong Kong/Special Administrative Region (SAR), China
| | - Madhukar S Patel
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eleonora De Martin
- Department of Hepatology, APHP, Hospital Paul Brousse, Centre Hépato-Biliaire, INSERM Unit 1193, FHU Hepatinov, Villejuif, France
| | - Mettu Srinivas Reddy
- Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai, India
| | - Yuji Soejima
- Department of Surgery, Shinshu University, Japan
| | - Nicholas Syn
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University of Singapore, Singapore
- Liver Transplantation, National University Center for Organ Transplantation (NUCOT), National University Health System Singapore, Singapore
| | - Kymberly Watt
- Division of Gastroenterology/Hepatology, Mayo Clinic, Rochester, MN
| | - Qiang Xia
- Department of Surgery, Division of Liver Transplantation, Renji Hospital, Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Neeraj Saraf
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-the Medicity, New Delhi, India
| | - Refaat Kamel
- Department of Surgery, Ain Shams University, Cairo, Egypt
| | - David Nasralla
- Department of HPB Surgery and Liver Transplantation, Royal Free London, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Greg McKenna
- Department of Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Parthi Srinvasan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ahmed M Elsabbagh
- Gastroenterology Surgical Center, Department of Surgery, Mansoura University, Mansoura, Egypt
| | - Vinayendra Pamecha
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Kumar Palaniappan
- The Institute of Liver Disease and Transplantation, Dr Rela Institute, and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Valeria Mas
- Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD
| | - Yaman Tokat
- International Liver Center, Acibadem Healthcare Hospitals, Turkey
| | - Sonal Asthana
- Department of Surgery, Integrated Liver Care Aster CMI Hospital, Bangalore, India
| | - Ramkiran Cherukuru
- The Institute of Liver Disease and Transplantation, Dr Rela Institute, and Medical Centre, Chennai, Tamil Nadu, India
| | - Hiroto Egawa
- Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, Japan
| | - Jan Lerut
- Pôle de chirurgie expérimentale et transplantation, Université Catholique De Louvain, Louvain, Belgium
| | - Dieter Broering
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Marina Berenguer
- Hepatology and Liver Transplant Unit, Fundación Para La Investigación Del Hospital Universitario La Fe De La CCVV, IIS La Fe, Ciberehd, University of Valencia, Valencia, Spain
| | - Mark Cattral
- Department of Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | | | - Chao-Long Chen
- Department of Surgery, Chang Gung Memorial Hospital Kaoshiung, Taiwan
| | - Samir Shah
- Institute of Liver Disease, HPB Surgery and Rransplant, Global Hospitals, Mumbai, India
| | - Zhi-Jun Zhu
- Department of HPB Surgery and Liver Transplantation, Beijing Friendship Hospital, Beijing, China
| | - Jean Emond
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - Nancy Ascher
- Division of Transplant Surgery, University of California San Francisco, San Francisco, CA
| | - Ashwin Rammohan
- The Institute of Liver Disease and Transplantation, Dr Rela Institute, and Medical Centre, Chennai, Tamil Nadu, India
| | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-the Medicity, New Delhi, India
| | - Mohamed Rela
- The Institute of Liver Disease and Transplantation, Dr Rela Institute, and Medical Centre, Chennai, Tamil Nadu, India
| | - Dong-Sik Kim
- Department of Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Toru Ikegami
- Department of Surgery, Centennial Hall Kyushu University School of Medicine, Kyushu, Japan
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Choi JY, Lee SS, Kim NY, Park HJ, Sung YS, Lee Y, Yoon JS, Suk HI. The effect of hepatic steatosis on liver volume determined by proton density fat fraction and deep learning-measured liver volume. Eur Radiol 2023; 33:5924-5932. [PMID: 37012546 DOI: 10.1007/s00330-023-09603-2] [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: 10/03/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES We aimed to evaluate the effect of hepatic steatosis (HS) on liver volume and to develop a formula to estimate lean liver volume correcting the HS effect. METHODS This retrospective study included healthy adult liver donors who underwent gadoxetic acid-enhanced MRI and proton density fat fraction (PDFF) measurement from 2015 to 2019. The degree of HS was graded at 5% PDFF intervals from grade 0 (no HS; PDFF < 5.5%). Liver volume was measured with hepatobiliary phase MRI using deep learning algorithm, and standard liver volume (SLV) was calculated as the reference lean liver volume. The association between liver volume and SLV ratio with PDFF grades was evaluated using Spearman's correlation (ρ). The effect of PDFF grades on liver volume was evaluated using the multivariable linear regression model. RESULTS The study population included 1038 donors (mean age, 31 ± 9 years; 689 men). Mean liver volume to SLV ratio increased according to PDFF grades (ρ = 0.234, p < 0.001). The multivariable analysis indicated that SLV (β = 1.004, p < 0.001) and PDFF grade*SLV (β = 0.044, p < 0.001) independently affected liver volume, suggesting a 4.4% increase in liver volume per one-point increment in the PDFF grade. PDFF-adjusted lean liver volume was estimated using the formula, liver volume/[1.004 + 0.044 × PDFF grade]. The mean estimated lean liver volume to SLV ratio approximated to one for all PDFF grades, with no significant association with PDFF grades (p = 0.851). CONCLUSION HS increases liver volume. The formula to estimate lean liver volume may be useful to adjust for the effect of HS on liver volume. KEY POINTS • Hepatic steatosis increases liver volume. • The presented formula to estimate lean liver volume using MRI-measured proton density fat fraction and liver volume may be useful to adjust for the effect of hepatic steatosis on measured liver volume.
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Affiliation(s)
- Ji Young Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Na Young Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yedaun Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jee Seok Yoon
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Heung-Il Suk
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
- Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea
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Bambha K, Kim NJ, Sturdevant M, Perkins JD, Kling C, Bakthavatsalam R, Healey P, Dick A, Reyes JD, Biggins SW. Maximizing utility of nondirected living liver donor grafts using machine learning. Front Immunol 2023; 14:1194338. [PMID: 37457719 PMCID: PMC10344453 DOI: 10.3389/fimmu.2023.1194338] [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] [Received: 03/27/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Objective There is an unmet need for optimizing hepatic allograft allocation from nondirected living liver donors (ND-LLD). Materials and method Using OPTN living donor liver transplant (LDLT) data (1/1/2000-12/31/2019), we identified 6328 LDLTs (4621 right, 644 left, 1063 left-lateral grafts). Random forest survival models were constructed to predict 10-year graft survival for each of the 3 graft types. Results Donor-to-recipient body surface area ratio was an important predictor in all 3 models. Other predictors in all 3 models were: malignant diagnosis, medical location at LDLT (inpatient/ICU), and moderate ascites. Biliary atresia was important in left and left-lateral graft models. Re-transplant was important in right graft models. C-index for 10-year graft survival predictions for the 3 models were: 0.70 (left-lateral); 0.63 (left); 0.61 (right). Similar C-indices were found for 1-, 3-, and 5-year graft survivals. Comparison of model predictions to actual 10-year graft survivals demonstrated that the predicted upper quartile survival group in each model had significantly better actual 10-year graft survival compared to the lower quartiles (p<0.005). Conclusion When applied in clinical context, our models assist with the identification and stratification of potential recipients for hepatic grafts from ND-LLD based on predicted graft survivals, while accounting for complex donor-recipient interactions. These analyses highlight the unmet need for granular data collection and machine learning modeling to identify potential recipients who have the best predicted transplant outcomes with ND-LLD grafts.
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Affiliation(s)
- Kiran Bambha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, United States
- Center for Liver Investigation Fostering discovery (C-LIFE), University of Washington, Seattle, WA, United States
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
| | - Nicole J. Kim
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, United States
- Center for Liver Investigation Fostering discovery (C-LIFE), University of Washington, Seattle, WA, United States
| | - Mark Sturdevant
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - James D. Perkins
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Catherine Kling
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Ramasamy Bakthavatsalam
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Patrick Healey
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Pediatric Transplant Surgery Division, Department of Surgery, Seattle Children’s Hospital, Seattle, WA, United States
| | - Andre Dick
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Pediatric Transplant Surgery Division, Department of Surgery, Seattle Children’s Hospital, Seattle, WA, United States
| | - Jorge D. Reyes
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
- Pediatric Transplant Surgery Division, Department of Surgery, Seattle Children’s Hospital, Seattle, WA, United States
| | - Scott W. Biggins
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, United States
- Center for Liver Investigation Fostering discovery (C-LIFE), University of Washington, Seattle, WA, United States
- Clinical and Bio-Analytics Transplant Laboratory (C-BATL), University of Washington, Seattle, WA, United States
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49
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Shinkai T, Kuriyama N, Usui M, Hayasaki A, Fujii T, Iizawa Y, Tanemura A, Murata Y, Kishiwada M, Katoh D, Matsumoto T, Wada H, Yoshida T, Isaji S, Mizuno S. Clinical Significance of Plasma Tenascin-C Levels in Recipients With Prolonged Jaundice After Living Donor Liver Transplantation. Transplant Proc 2023; 55:913-923. [PMID: 36973145 DOI: 10.1016/j.transproceed.2023.01.028] [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: 12/22/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Focusing on tenascin-C (TNC), whose expression is enhanced during the tissue remodeling process, the present study aimed to clarify whether plasma TNC levels after living donor liver transplantation (LDLT) could be a predictor of irreversible liver damage in the recipients with prolonged jaundice (PJ). METHODS Among 123 adult recipients who underwent LDLT between March 2002 and December 2016, the subjects were 79 recipients in whom we could measure plasma TNC levels preoperatively (pre-) and on postoperative days 1 to 14 (POD1 to POD14). Prolonged jaundice was defined as serum total bilirubin level >10 mg/dL on POD14, and 79 recipients were divided into 2 groups: 56 in the non-PJ (NJ) group and 23 in the PJ group. RESULTS The PJ group had significantly increased pre-TNC; smaller grafts; decreased platelet counts POD14; increased TB-POD1, -POD7, and -POD14; increased prothrombin time-international normalized ratio on POD7 and POD14; and higher 90-day mortality than the NJ group. As for the risk factors for 90-day mortality, multivariate analysis identified TNC-POD14 as a single significant independent prognostic factor (P = .015). The best cut-off value of TNC-POD14 for 90-day survival was determined to be 193.7 ng/mL. In the PJ group, the patients with low TNC-POD14 (<193.7 ng/mL) had satisfactory survival, with 100.0 % at 90 days, while the patients with high TNC-POD14 (≥193.7 ng/mL) had significantly poor survival, with 38.5 % at 90 days (P = .004). CONCLUSIONS In PJ after LDLT, plasma TNC-POD14 is very useful for diagnosing postoperative irreversible liver damage early.
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Affiliation(s)
- Toru Shinkai
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan; Department of Disaster and Emergency Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Naohisa Kuriyama
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Masanobu Usui
- Department of Palliative Medicine, Fujita Health University Faculty of Medicine, Toyoake, Aichi, Japan
| | - Aoi Hayasaki
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takehiro Fujii
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yusuke Iizawa
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Tanemura
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yasuhiro Murata
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masashi Kishiwada
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Daisuke Katoh
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takeshi Matsumoto
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hideo Wada
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Toshimichi Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shuji Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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50
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Takase K, Ueno T, Matsuki K, Todo M, Iwasaki S, Deguchi K, Masahata K, Nomura M, Watanabe M, Kamiyama M, Tazuke Y, Kimura T, Okuyama H. Liver-Spleen Volume Ratio as a Predictor of Native Liver Survival in Patients with Biliary Atresia. Transplant Proc 2023:S0041-1345(23)00135-5. [PMID: 37087298 DOI: 10.1016/j.transproceed.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/13/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The appropriate timing of liver transplantation (LT) in patients with biliary atresia (BA) who survived with their native livers until adolescence remains controversial. The liver-spleen volume ratio (LSR) has been reported to be efficacious in predicting the prognosis of chronic liver disease. We investigated whether LSR could predict long-term native liver prognosis and serve as an indication for LT in patients with BA. METHODS Patients with BA who survived with their native liver until the age of 15 years were included. These patients were classified into 2 groups. The unfavorable prognosis group included patients who underwent or were awaiting LT or developed complications such as refractory cholangitis or gastrointestinal bleeding due to esophagogastric or intestinal varices. The favorable prognosis group included patients who survived with their native liver without complications. We compared the 2 groups regarding LSR, hematological, and histologic data. RESULTS Of 19 patients, 8 were in the unfavorable prognosis group, and 11 were in the favorable prognosis group. LSR was significantly lower in the unfavorable prognosis group (P = .009). Analysis of the receiver operating characteristic curve showed that the area under the curve of the LSR was 0.891, which was higher than the area under the curve of liver fibrosis markers. The optimal LSR cut-off value for predicting poor native liver prognosis was 1.97, with a sensitivity of 75.0% and a specificity of 87.5%. CONCLUSIONS The LSR reflects splenomegaly and liver atrophy. The LSR might be a reliable predictor of native liver prognosis and could guide decisions about LT in patients with BA.
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Affiliation(s)
- Koki Takase
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Kyoko Matsuki
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Marie Todo
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shun Iwasaki
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koihi Deguchi
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazunori Masahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motonari Nomura
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Miho Watanabe
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masafumi Kamiyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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