Extension of the adult hepatic allograft pool using split liver transplantation
Liver Transplant Unit, Université catholique de Louvain, University Hospital St-Luc, Brussels, Belgium. Acta gastro-enterologica Belgica
(Impact Factor: 0.91).
The ever increasing number of, especially, adults waiting for a liver transplantation necessitates to develop techniques allowing to extend the available donor liver pool.
Between November 1988 and December 2004, 37 (6.6%) of 559 adults underwent split liver transplantation at Saint-Luc Hospitals. There were 36 were right and one left split procedures; 27 split grafts were obtained ex-situ and 10 in-situ. Results of these series are analysed and compared to literature data of split liver transplantation.
Three and 12 months patient survival rates were 89.2% and 78.4% respectively. Five years actuarial patient survival was 75.7%. Early (< 3 months) and late (> 3 months) mortality rates were 10.8% (4 pat.) and 21.6% respectively. Early mortality was significantly higher in case of urgent split liver transplantation (3/5 patients vs. 2/32 elective patients--p 0.001). At present 25 patients are alive, with a mean Karnofsky score of 90%. Three and 12 months graft survival rates were 91.7% and 87.1% respectively. Three and one grafts were lost due to primary and early graft non-function. In-situ split grafts had shorter mean warm, cold, total ischemia and operating times as well as less need for blood transfusion; all these differences were however not statistically significant. Surgical complications occurred in 19 (51%) patients. All but one complication occurred early (< 3 months). There were sixteen biliary complications in 13 (35.1%) patients: 9 anastomotic stenoses, 3 anastomotic and 4 transection margin leakages. Six vascular complications occurred in 6 (15.2%) patients: three arterial and 3 portal vein thromboses. Seven (18.9%) patients had a postoperative bleeding.
Graft and patient survival rates of split liver transplantation can be compared to those of classic liver transplantation. However the care of these patients is demanding due to the high number of technical complications. Results of split liver transplantation must be further improved in order to foster it's more widespread use necessary to overcome the actual shortage of liver allografts.
Available from: Imre Fehervari
- "A parenchymás csoportot a vírushepatitisek (HCV, HBV), az alkoholos, a cryptogen , az ismeretlen eredetű és az autoimmun cirrhosis alkotják. A cholestaticus csoportban a primer biliaris cirrhosis (PBC), a szekunder biliaris cirrhosis (SBC) és a primer szklerotizáló cholangitis (PSC) említhető . Ritkán metabolikus betegségek akut manifesztációi ( Wilson-kór), traumák és tumorok miatt is történik májátültetés . "
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ABSTRACT: The history of organ transplantation in Hungary dates back to 50 years, and the first succesful liver transplantation was performed in the United States in that time as well. The number of patients with end stage liver disease increased worldwide, and over 7000 patients die in each year due to liver disease in Hungary. The most effective treatment of end-stage liver disease is liver transplantation. The indications of liver transplantation represent a wide spectrum including viral, alcoholic or other parenchymal liver cirrhosis, but cholestatic liver disease and acute fulminant cases are also present in the daily routine. In pediatric patients biliary atresia and different forms of metabolic liver disorders represent the main indication for liver transplantation. The results of liver transplantation in Hungary are optimal with over 80% long-term survival. For better survival individual drug therapy and monitoring are introduced in liver transplant candidates. Orv. Hetil., 2013, 154, 858-862.
Orvosi Hetilap 06/2013; 154(22):858-862. DOI:10.1556/OH.2013.29636
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ABSTRACT: After liver resection a small-for-size syndrome may result from the reduction of liver volume and additional liver damage caused by hepatic hyperperfusion. Therefore the influence of the extent of liver resection on liver perfusion is investigated.
A stepwise liver resection (removal of 30%, 70%, 90%, 95% and 97% of the liver) was performed under inhalation anaesthesia with isoflurane in 6 male Lewis rats. Besides systemic arterial and venous blood pressure the portal pressure and flow was measured and the sinusoidal perfusion was visualized. Sinusoidal diameter, intersinusoidal diameter and functional capillary density were determined.
A decrease in the portal flow but an increase in the portal pressure was observed. Sinusoidal diameter showed a steady but low increase when up to 70% of the liver was removed but a high increase after 90% or more of the liver was resected. This indicates a decompensation of a regulatory mechanism of sinusoidal perfusion.
Acta gastro-enterologica Belgica 10/2007; 70(4):345-51. · 0.91 Impact Factor
Available from: Michael Silva
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ABSTRACT: Biliary complications continue to be a major cause of morbidity in liver transplant recipients with an incidence of 10-30% following whole-organ transplantation and a mortality rate of up to 10%. Biliary leaks and strictures are most common but sphincter of Oddi dysfunction, hemobilia, and biliary obstruction are also observed. Biliary complications may be related to various factors such as hepatic artery patency, preservation injury, cytomegalovirus infection, chronic ductopenic rejection, ABO incompatibility, and technical reasons. The latter include imperfect anastomosis, T-tube-related complications and the use of partial liver grafts when cut surface biliary leaks or inadvertent bile duct injuries may occur during parenchymal division. The usage of a T-tube for duct-to-duct anastomosis in whole-organ liver transplantation remains controversial, mainly because of the high rates of T-tube-related complications observed in many series. In this article we review the etiology, as well as the main types of biliary complications according to the technique of biliary reconstruction and liver transplant procedure performed. Their management is also discussed with interventional radiology and endoscopic techniques emerging as the preferred treatment option, obviating the need for surgery in a selected majority of patients.
Digestive surgery 10/2008; 25(4):245-57. DOI:10.1159/000144653 · 2.16 Impact Factor
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