Outcomes With Split Liver Transplantation in 106 Recipients The University of California, San Francisco, Experience From 1993 to 2010
ABSTRACT Split liver transplantation (SLT) allows for expansion of the deceased donor pool.
To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients.
Single-center retrospective review (September 18, 1993, to July 1, 2010).
University medical center.
One hundred six SLT recipients.
Postoperative graft and patient survival and postoperative complications.
In adults, 1-, 5-, and 10-year overall patient survival was 93%, 77%, and 73%, respectively; overall graft survival was 89%, 76%, and 65%, respectively; ex vivo split patient survival was 93%, 85%, and 74%, respectively; and ex vivo graft survival was 86%, 77%, and 63%, respectively. In situ split patient and graft survival was 94% at 1 year and 75% at 5 years. Postoperative complications included biliary (29%), vascular (11%), unplanned reexploratory surgery (11%), incisional hernia (8%), small-for-size syndrome (n = 1), need for shunt at the time of SLT (n = 1), and primary nonfunction (n = 1). In children, 1-, 5-, and 10-year overall patient survival was 84%, 75%, and 69%, respectively; overall graft survival was 77%, 63%, and 57%, respectively; ex vivo split patient survival was 83%, 73%, and 73%, respectively; and ex vivo graft survival was 75%, 59%, and 59%, respectively. In situ split patient and graft survival was 86% at 1 and 5 years. Postoperative complications included biliary (40%), vascular (26%), and primary nonfunction (n = 1).
Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.
SourceAvailable from: Koji Hashimoto[Show abstract] [Hide abstract]
ABSTRACT: Under the “sickest first” Model for End-Stage Liver Disease (MELD) allocation, livers amenable to splitting are most often allocated to patients unsuitable for split liver transplantation (SLT). Our experience with SLT using hemilivers was reviewed. From April 2004 to June 2012, we used 25 lobar grafts (10 left lobes and 15 right lobes) for adult-sized recipients. Twelve recipients were transplanted with primary offers, and 13 were transplanted with leftover grafts. Six grafts were shared with other centers. The data were compared with matched whole liver grafts (n = 121). In 92% of donors, the livers were split in situ. Hemiliver recipients with severe portal hypertension had a greater graft-to-recipient weight ratio than those without severe portal hypertension (1.96% vs. 1.40%, p < 0.05). Hemiliver recipients experienced biliary complications more frequently (32.0% vs. 10.7%, p = 0.01); however, the 5-year graft survival for hemilivers was comparable to whole livers (80.0% vs. 81.5%, p = 0.43). The secondary recipients with leftover grafts did not have increased incidences of graft failure (p = 0.99) or surgical complications (p = 0.43) compared to the primary recipients. In conclusion, while routine application is still controversial due to various challenges, hemiliver SLT can achieve excellent outcomes under the MELD allocation.American Journal of Transplantation 06/2014; 14(9). DOI:10.1111/ajt.12791 · 6.19 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: In order to mitigate overheated interior of a vehicle parked in the hot summer sun and thereby to make the entering into the vehicle more comfortable, microcontroller managed module for automatic ventilation of vehicle interior is made. The module is implemented using a microcontroller as a central logical unit and a series of sensors which provide sufficient data to ensure functional, but also efficient, reliable and safe ventilation. The ventilation process is performed by opening vehicle windows slightly, which enables air to circulate. Microcontroller controls the position of the windows autonomously and independently of the driver's presence, following predefined algorithm that uses sensors data obtained from the vehicle's surroundings. Besides temperature, the most important factors to ensure quality implementation of ventilation are detected movements around the vehicle, the presence of precipitation and other. This paper shows the components, their purpose and capabilities, advantages and disadvantages, as well as potential implementations and upgrades. The test results give insight into utilization options of this module and its usefulness.2014 37th International Convention on Information and Communication Technology, Electronics and Microelectronics (MIPRO); 05/2014
[Show abstract] [Hide abstract]
ABSTRACT: Regenerative medicine has the promise to alleviate morbidity and mortality caused by organ dysfunction, longstanding injury and trauma. Although regenerative approaches for a few diseases have been highly successful, some organs either do not regenerate well or have no current treatment approach to harness their intrinsic regenerative potential. In this Review, we describe the modeling of human disease and tissue repair in zebrafish, through the discovery of disease-causing genes using classical forward-genetic screens and by modulating clinically relevant phenotypes through chemical genetic screening approaches. Furthermore, we present an overview of those organ systems that regenerate well in zebrafish in contrast to mammalian tissue, as well as those organs in which the regenerative potential is conserved from fish to mammals, enabling drug discovery in preclinical disease-relevant models. We provide two examples from our own work in which the clinical translation of zebrafish findings is either imminent or has already proven successful. The promising results in multiple organs suggest that further insight into regenerative mechanisms and novel clinically relevant therapeutic approaches will emerge from zebrafish research in the future.Disease Models and Mechanisms 07/2014; 7(7):769-776. DOI:10.1242/dmm.016352 · 5.54 Impact Factor