Prevent small-for-size syndrome using dual grafts in living donor liver transplantation.
ABSTRACT The growing gap between the number of patients waiting for transplantation and available organs is still the main issue facing the transplant community. The major limitation of adult-to-adult living donor liver transplantation (LDLT) is the small-for-size problem because of the concern of donor safety. We report preliminary experiences for preventing small-for-size syndrome using dual grafts from one right lobe without the middle hepatic vein and one left lateral segment in adult-to-adult LDLT.
One hundred ten cases of adult-to-adult LDLT were performed in West China Hospital of Sichuan University from January 2002 to August 2007, and there were 16 small-for-size (SFS) grafts in all grafts. Dual grafts LDLT was performed for six patients with end-stage liver disease, consisting of five cases from one right lobe without the middle hepatic vein and one left lateral segment, and one case from two left lobes.
All living donors underwent a full recovery from the operation without persistent complications. Four recipients died of sepsis, one recipient received re-transplantation, and three recipients received transplenic artery embolization in the recipients with SFS grafts. All recipients with dual grafts displayed good graft function and a majority of grafts showed normal triangular-shape regeneration of their respective liver grafts. Only in one left lateral segment atrophy occurred, graft hepatectomy was not required.
Dual grafts from one right lobe without the middle hepatic vein and one left lateral segment in adult-to-adult LDLT can prevent the small-for-size problem and yet secure the safety of the donors.
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ABSTRACT: To evaluate the dual-graft living donor liver transplantation (LDLT) with ultrasonography, with special emphasis on the postoperative complications. From January 2002 to August 2007, 110 adult-to-adult LDLTs were performed in West China Hospital of Sichuan University. Among them, dual-graft implantations were performed in six patients. Sonographic findings of the patients were retrospectively reviewed. All the six recipients survived the dual-graft adult-to-adult LDLT surgery. All had pleural effusion. Four patients had episodes of postoperative abdominal complications, including fluid collection between the grafts in three patients, intrahepatic biliary dilatation in two, hepatofugal portal flow of the left lobe in two, and atrophy of the left lobe in one. Although dual-graft LDLT takes more efforts and is technically complicated, it is safely feasible. Postoperative sonographic monitoring of the recipient is important.World Journal of Gastroenterology 08/2010; 16(31):3979-83. · 2.43 Impact Factor
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ABSTRACT: This study reports the preliminary experience of dual grafts living donor liver transplantation (LDLT) for patients with acute-on-chronic liver failure (AoCLF) caused by hepatitis B. Two patients who demonstrated acute-on-chronic hepatitis B liver failure and portal hypertension with Model for End-Stage Liver Disease (MELD) scores of 42 and 37, respectively, underwent dual LDLT grafts including one right lobe without a middle hepatic vein and one left lobe because the graft-to-recipient body weight ratio of the right lobe grafts were 0.53% and 0.66%. The donors and the recipients have been followed for over 1 year. Mortality and operative complications were not observed in the donors or recipients. At present, the donors and recipients have returned to their daily routine. No prisoners or organs from prisoners were used to obtain these data. Dual LDLT grafts including one right lobe without the middle hepatic vein and one left lobe may be a possible therapeutic option for subjects with acute-on-chronic hepatitis B-induced liver failure.Transplantation Proceedings 12/2010; 42(10):4552-4. DOI:10.1016/j.transproceed.2010.09.172 · 0.95 Impact Factor
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ABSTRACT: The site of Finch Camp in the middle Queen Creek area of Arizona, southeast of Phoenix, has produced some of the earliest evidence of utilitarian pottery use in the US Southwest. Using multiple lines of evidence from vessel morphology, surface alteration, and minute fatty acid residues in vessel walls, I evaluate the nascent function of the earliest vessels (mostly neckless jars, or tecomates) and infer a diachronic process of functional expansion from about 350 B.C.–A.D. 400. This evidence provides robust evidence for evaluating various theoretical models of pottery origins. I argue that utilitarian pottery was initially adopted in connection with the intensification of small particulate plant foods (e.g., seeds, grains) and increasing household-level control over resources. Further, vessel functions may have expanded during the early centuries A.D. in response to women’s task-scheduling conflicts stemming from increasing residential stability and growing reliance on low-level horticulture.Highlights► Pottery adoption at Finch Camp reflected utilitarian, subsistence-related concerns. ► The earliest pots were tecomates, which are versatile utilitarian containers. ► Tecomates were used to intensively process small particulate plant foods. ► Increased pottery use reflected changes in women’s subsistence obligations. ► Processes of pottery adoption were regionally variable and historically contingent.Journal of Anthropological Archaeology 06/2011; 30(2):220-234. DOI:10.1016/j.jaa.2011.03.001 · 1.51 Impact Factor