[Show abstract][Hide abstract] ABSTRACT: Recently, the successful application of portal inflow modulation has led to renewed interest in the use of left lobe grafts in adult-to-adult living donor liver transplantation (LDLT). However, data on the hepatic hemodynamics supporting portal inflow modulation are limited, and the optimal portal circulation for a liver graft is still unclear. We analyzed 42 consecutive adult-to-adult left lobe LDLT cases without splenectomy or a portocaval shunt. The mean actual graft volume (GV)/recipient standard liver volume (SLV) ratio was 39.8% ± 5.7% (median = 38.9%, range = 26.1%-54.0%). The actual GV/SLV ratio was less than 40% in 24 of the 42 cases, and the actual graft-to-recipient weight ratio was less than 0.8% in 17 of the 42 recipients. The mean portal vein pressure (PVP) was 23.9 ± 7.6 mm Hg (median = 23.5 mm Hg, range = 9-38 mm Hg) before transplantation and 21.5 ± 3.6 mm Hg (median = 22 mm Hg, range = 14-27 mm Hg) after graft implantation. The mean portal pressure gradient (PVP - central venous pressure) was 14.5 ± 6.8 mm Hg (median = 13.5 mm Hg, range = 3-26 mm Hg) before transplantation and 12.4 ± 4.4 mm Hg (median = 13 mm Hg, range = 1-21 mm Hg) after graft implantation. The mean posttransplant portal vein flow was 301 ± 167 mL/minute/100 g of liver in the 38 recipients for whom it was measured. None of the recipients developed small-for-size syndrome, and all were discharged from the hospital despite portal hyperperfusion. The overall 1-, 3-, and 5-year patient and graft survival rates were 100%, 97%, and 91%, respectively. In conclusion, LDLT with a left liver graft without splenectomy or a portocaval shunt yields good long-term results for adult patients with a minimal donor burden.
[Show abstract][Hide abstract] ABSTRACT: A 38-year-old woman was admitted due to lymphangioleiomyomatosis (LAM)-associated massive chylous ascites and progressive cachexia. She was incidentally diagnosed to have ascites during her regular physical check-up two years previously and LAM was revealed as its underlying cause. Periodic paracentesis was required to ameliorate ascites-associated symptoms, but resulted in lymphocytopenia, malnutrition, and deterioration of general status. Ascites was refractory to diuretics and fat-restricted diet. Peritoneovenous shunt (Denver shunt) was placed and thereafter ascites has been managed successfully without any complications for one year after the placement. Peritoneovenous shunt should be considered in LAM patients whose chylous ascites can not be managed with conservative treatments.
Internal Medicine 02/2008; 47(4):281-5. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to clarify the role of the additional Hassab's operation to hepatectomy in cirrhotic patients with resectable hepatocellular carcinomas and esophagogastric varices.
Subjects were 36 cirrhotic patients with hepatocellular carcinomas and concomitant esophagogastric varices: 20 underwent hepatectomy alone (non-Hassab group) and 16 underwent hepatectomy with Hassab's operation (Hassab group).
Patients in the Hassab group had more advanced esophageal varices and the accompanied gastric varices, preoperatively (p<0.01). Both preoperative platelet counts (p<0.01) and prothrombin time (p<0.05) were significantly lower in the Hassab group, and serum albumin level also tended to be worse than those in the non-Hassab group. Portal pressure was significantly higher in the Hassab group (p<0.01). Despite these disadvantages, no significant differences were found in operative mortality, postoperative courses and long-term prognosis between the two groups. Comparing the cause of death, the incidence of the fatal variceal hemorrhage was significantly lower (0%) in the Hassab group than that (25%) in the non-Hassab group (p<0.05).
This study suggested that additional Hassab's operation to hepatectomy might have reduced the risk of variceal hemorrhage after hepatectomy.