Kohei Ogawa

Kyoto University, Kioto, Kyōto, Japan

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Publications (97)266.42 Total impact

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    ABSTRACT: Hepatic venous outflow obstruction (HVOO) is a critical complication after living donor liver transplantation (LDLT). This study aimed to evaluate the incidence of HVOO and the risk factors for HVOO in adults. From 2005 to 2015, 430 adult LDLT patients (right lobe graft: 270 cases, left lobe graft: 160 cases) were enrolled and divided into no-HVOO (n = 413) and HVOO (n = 17) groups. Patient demographics and surgical data were compared, and risk factors for HVOO were analyzed. Furthermore, the long-term outcomes of percutaneous interventions as treatment for HVOO were assessed. HVOO occurred in 17 patients (4.0%). The incidence of HVOO in patients receiving a left lobe graft was significantly higher than in those receiving a right lobe graft (8.1% vs. 1.5%, p = 0.001). The body weight and caliber of hepatic vein anastomosis in the HVOO group were significantly lower compared with the no-HVOO group (p = 0.02 and 0.008, respectively). Multivariate analysis revealed that only left lobe graft was an independent risk factor for HVOO (OR: 4.782, 95% CI: 1.387-16.488, p = 0.01). Among 17 cases with HVOO, 7 patients were treated with single balloon angioplasty, and 9 patients who developed recurrence were treated with repeated interventions. Overall, 6 patients underwent stent placement: 1 at the initial procedure, 3 at the second procedure for early recurrence, and 2 following repeated balloon angioplasty (≥3 interventions). These 6 patients experienced no recurrence. Overall graft survival was not significantly different between the HVOO and no-HVOO groups (p = 0.99). In conclusion, the use of a left lobe graft was associated with HVOO, and percutaneous interventions were effective for treating adult HVOO after LDLT. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver Transplantation
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    ABSTRACT: Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas. Laparoscopic distal pancreatectomy (DP) is a feasible and safe procedure, and successful spleen preservation rates are higher using a laparoscopic approach. We hypothesized that certain patients with SPN would be good candidates for laparoscopic surgery; however, few surgeons have reported laparoscopic DP for SPN. We discuss the preoperative assessment and surgical simulation for two SPN cases. A simulation was designed because we consider that a thorough preoperative understanding of the procedure based on three-dimensional image analysis is important for successful laparoscopic DP. We also discuss the details of the actual laparoscopic DP with or without splenic preservation that we performed for our two SPN cases. It is critical to use appropriate instruments at appropriate points in the procedure; surgical instruments are numerous and varied, and surgeons should maximize the use of each instrument. Finally, we discuss the key techniques and surgical pitfalls in laparoscopic DP with or without splenic preservation. We conclude that experience alone is inadequate for successful laparoscopic surgery.
    Full-text · Article · Nov 2015
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    ABSTRACT: The complexity of hepatic hilar anatomy is an obstacle to precise diagnosis of tumor spread and appropriate operative planning for biliary malignancies. Three-dimensional (3D) cholangiography and angiography may overcome this obstacle and facilitate curative resection. The objective of this study was to evaluate the impact of 3D CT cholangiography on operative planning and outcomes of biliary malignancies. From 2009 to 2014, 3DCT cholangiography was performed on 49 patients with biliary malignancies requiring major hepatic resection and extrahepatic bile duct resection. The 3D cholangiogram was merged with 3D angiography and portography to create an all-in-one 3D image of the hepatic hilum. The cutting line of the bile duct and the type of liver resection were determined based on the spatial relationship between tumor spread and the landmark vessels. The necessity of vascular reconstruction was also evaluated. Preoperative imaging and operative findings were compared. Operative curability was compared with that of the historical cohort before the introduction of 3D cholangiography. Histologic examination of the bile duct stump showed a negative margin in 39 (80%), carcinoma in situ in 7 (14%), and invasive cancer (IC) in 3 patients (6%) on the first cutting. The IC-free rate (94%) on the first cutting was superior to that in the historical cohort (80%; P = .02). The necessity for portal and arterial reconstruction was predicted with 98 and 94% accuracy, respectively. We found 3D cholangiography to provide accurate information about hilar anatomy and plays a role in facilitating adequate operative planning. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · Surgery
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    ABSTRACT: Hepatic resection (HR) and liver transplantation (LT) are surgical treatment options for hepatocellular carcinoma (HCC). However, it is clinically impossible to perform a randomized, controlled study to determine the usefulness of these treatments. The present study compared survival rates and recurrence rates of HR versus living donor LT (LDLT) for HCC by using the propensity score method. Between January 1999 and August 2012, 936 patients (732 HR, 204 LDLT) underwent surgical therapy for HCC in our center. Using the propensity score matching, 80 well-balanced patients were defined. The 1- and 5-year overall survival rates were 90% and 53% in the HR group and 82% and 63% in the LT group, respectively. They were not significantly different between the two groups. The odds ratio estimated using the propensity score matching analysis was 0.842 (). The 1- and 5-year recurrence rates were significantly lower in the LT group (9% and 21%) than in the HR group (43% and 74%) (), and the odds ratio was 0.214 (). In conclusion, HR should be considered a valid alternative to LDLT taking into consideration the risk for the living donor based on the results of this propensity score-matching study.
    Full-text · Article · Apr 2015 · Disease markers
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    ABSTRACT: Background Liver transplantation (LT) used to be contraindicated in patients with portal vein thrombosis (PVT). In comparison to deceased donor LT, living donor LT (LDLT) still presents additional difficulties in determining appropriate vein grafts and overcoming small-for-size syndrome. Here, we introduce our LDLT strategies and assess their outcomes in adult patients with pre-existing PVT.Methods We performed 282 consecutive adult LDLTs between April 2006 and December 2011. Forty-eight patients (17%) had pre-existing PVT (grade I; 15, II; 20, III; 12, IV; 1).ResultsOur preferred treatments for PVT were thrombectomies/thromboendovenectomies in 30 patients, replaced grafts in seven, jump grafts in seven, renoportal anastomosis in one and no surgical intervention owing to minimal thrombosis in three. Post-transplant portal vein complications occurred in eight of 48 (17%) cases, which were treated by surgery, anticoagulation therapy, and/or interventional radiology. Post-transplant survival rates of patients with preexisting PVT at 1 year and 5 years were comparable to a PVT-free cohort (1 year; 81% vs. 77%, 5 years; 81% vs. 73%).Conclusions The excellent survival rates in patients with PVT who underwent LDLT could be attributed to our strategies, which included surgical techniques and timely treatment of postoperative complications.
    No preview · Article · Mar 2015 · Journal of Hepato-Biliary-Pancreatic Sciences
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    ABSTRACT: Background Sarcopenia has been shown to be an independent predictor of lower disease-free and overall survival in various kinds of diseases. The quality of skeletal muscle has recently attracted much attention as a new parameter of sarcopenia.Methods We performed a retrospective analysis of 477 patients undergoing hepatectomy for hepatocellular carcinoma (HCC) between April 2005 and August 2014. The quality of skeletal muscle was evaluated by intramuscular adipose tissue content (IMAC) using preoperative computed tomography (CT) imaging. The impact of IMAC on outcomes after hepatectomy for HCC was analyzed.ResultsPatients with high IMAC showed older age, higher body mass index, higher indocyanine green retention test at 15 min, and more operative blood loss. The overall and recurrence-free survival rates were significantly lower in patients with high IMAC than in patients with normal IMAC (P < 0.0001, P = 0.0012, respectively). Multivariate analysis showed that high IMAC was the significant risk factor for death (hazard ratio [HR] = 2.942; P < 0.0001) and for HCC recurrence (HR = 1.529; P = 0.0007) after hepatectomy.Conclusions Preoperative quality of skeletal muscle was closely correlated with postoperative mortality and HCC recurrence. IMAC could be incorporated into new selection criteria for hepatectomy for HCC.
    Full-text · Article · Mar 2015 · Journal of Hepato-Biliary-Pancreatic Sciences
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    ABSTRACT: To investigate the outcomes of living donor liver transplantation for advanced hepatocellular carcinoma in Child-Pugh A/B patients and the usefulness of our expanded selection criteria, the Kyoto criteria. A total of 82 recipients with a Child-Pugh class A (n = 27) or B (n = 55) status having either multiple hepatic nodules or solitary tumors ≥5 cm in size treated between February 1999 and August 2012 were enrolled in this study. The overall recurrence rate was significantly less for the Child-Pugh B patients than for the Child-Pugh A patients (P = 0.042), while the survival rates did not differ. In the Child-Pugh A and B patients, the survival rate was significantly greater, while the recurrence rate was lower among the patients meeting the Kyoto criteria than those exceeding these criteria (P = 0.006, P = 0.001, P = 0.032 and P < 0.001, respectively). In the Child-Pugh B patients, the overall survival and recurrence rates did not differ between the patients treated with and without pretreatment for hepatocellular carcinoma. In the Child-Pugh B patients treated with pretreatment, the overall survival rate was significantly greater, while the recurrence rate was lower among the patients meeting the Kyoto criteria than those exceeding these criteria (P < 0.001, P < 0.001, respectively). Living donor liver transplantation performed within the Kyoto criteria achieves excellent overall survival and recurrence rates, especially for Child-Pugh B patients, even those with advanced hepatocellular carcinoma.
    Full-text · Article · Feb 2015 · Surgery Today
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    ABSTRACT: Background: Protein-energy malnutrition is common in patients with end-stage liver disease undergoing liver transplantation. We examined the characteristics of nutritional status and impact of pre-admission branched-chain-amino-acids treatment on skeletal muscle mass, nutritional/metabolic parameters and on posttransplant outcomes. Methods: Preoperative skeletal muscle mass and nutritional/metabolic parameter levels were compared in 129 patients undergoing adult-to-adult living donor liver transplantation whether received branched-chain-amino-acids treatment before admission or not. We examined relationships among these parameters, and risk factors for posttransplant bacteremia and early mortality after LT focusing on nutritional parameters. Results: Prealbumin and branched-chain-amino-acids-to-tyrosine ratio were significantly higher while tyrosine was lower in branched-chain-amino-acids-pre-supplemented than non-pre-supplemented group, while skeletal muscle mass, total lymphocyte count, zinc, branched-chain-amino-acids and ammonia levels were not significantly different. Skeletal muscle mass positively correlated with tyrosine (r=0.437, P<0.001) and branched-chain-amino-acids (r=0.282, P=0.001) and negatively with branched-chain-amino-acids-to-tyrosine-ratio (r=-0.259, P=0.003). Multivariate predictors of posttransplant bacteremia were: Child-Pugh class C (P=0.012), low preoperative total lymphocyte count (P=0.027), operative blood loss ≥10 L (P=0.039) and absence of pre-admission branched-chain-amino-acids treatment (P=0.040). Nutritional/metabolic parameters and pre-admission branched-chain-amino-acids treatment were not crucial for posttransplant early mortality. Conclusions: Pre-admission branched-chain-amino-acid therapy reduced preoperative amino acid imbalance and the incidence of posttransplant bacteremia.
    Full-text · Article · Feb 2015 · Hepato-gastroenterology
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    ABSTRACT: Elderly donor grafts for liver transplantation (LT) are recognized to be marginal grafts. The present study investigated the impact of using elderly donors for LT. Between June 1990 and August 2012, 1631 patients received LT at Kyoto University hospital. Out of 1631, 1597 patients received living donor LT (LDLT), while the other 34 patients underwent deceased donor LT (DDLT). Seventy-five of grafts used were from individuals ≥ 60 years old. We retrospectively analyzed recipients' survival rates according to donor age. Overall survival rates of the recipients from all LDLT (p<0.001), adult-to-adult LDLT (p=0.007), all DDLT (p=0.026), and adult-to-adult DDLT (p=0.011) were significantly lower in the elderly donor group than in the younger one, especially in those with positive hepatitis C. Multivariate analysis revealed that donor age, ABO incompatibility (incompatible), and preoperative intensive care unit stay were independent risk factors for poor patient survival in adult-to-adult LDLT. However, there were no significant differences between both groups in those who received adult-to-adult LDLT after April 2006. No significant association was found between donor age and incidence of acute cellular rejection. In conclusion, donor age was closely related to the survival rate of LDLT and DDLT, while the impact of donor age was not shown in the recent cases. This article is protected by copyright. All rights reserved.
    Full-text · Article · Jan 2015 · Liver Transplantation
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    ABSTRACT: Pancreatic neuroendocrine tumor (P-NET) is a rare and slow-growing tumor. Unfortunately, there is no clear consensus on the role and timing of surgery for primary tumor and liver metastases, although current reports refer to liver surgery including LT for unresectable liver metastases. A thirty-nine-year-old man was diagnosed with nonfunctioning pancreatic neuroendocrine tumor (P-NET) in the pancreatic head, with multiple liver metastases. The tumor was 2.5 cm in diameter and he was asymptomatic. Small but multiple metastases were detected in the liver, and no extrahepatic metastases were observed. We initially intended to control the liver metastases before resection of the primary tumor. To begin with, transarterial chemoembolization (TACE) and transcatheter arterial infusion (TAI) were repeated. Thereafter, systemic chemotherapy and biotherapy were introduced according to follow-up assessments. Unfortunately, imaging assessment at about 10 months later revealed that liver metastases were partially enlarged, although some were successfully treated. Therefore, these therapies were switched to other regimens, and TACE/TAI, systemic chemotherapies and biotherapies were repeated. Although liver metastases seemed to be stable for a while, the primary tumor was enlarged even after therapy. At 3.5 years after initial diagnosis, the primary tumor became symptomatic (pain and jaundice). Liver metastases enlarged and massive swelling of the para-aortic lymph nodes was observed. Thereafter, palliative therapy was the main course of action. He died at 4.3 years after initial diagnosis. Our young patient could have been a candidate for initial surgery for primary tumor and might have had a chance of subsequent liver transplantation for unresectable metastases. Surgeons still face questions in deciding the best surgical scenario in patients with P-NET with liver metastases.
    No preview · Article · Dec 2014 · JOP: Journal of the pancreas
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    ABSTRACT: Intramuscular fat accumulation has come to be associated with loss of muscle strength and function, one of the components of sarcopenia. However, the impact of preoperative quality of skeletal muscle on outcomes after living donor liver transplantation (LDLT) is unclear. The present study evaluated the intramuscular adipose tissue content (IMAC) and psoas muscle mass index (PMI) in 200 adult patients undergoing LDLT at our institution between January 2008 and October 2013. Correlations of IMAC with other factors, overall survival rates in patients classified according to IMAC or PMI, and risk factors for poor survival after LDLT were analyzed. IMAC was significantly correlated with age (r = 0.229, P = 0.025) and PMI (r = -0.236, P = 0.021) in males, and with age (r = 0.349, P < 0.001) and branched-chain amino acid (BCAA)-to-tyrosine ratio (r = -0.250, P = 0.013) in females. The overall survival rates in patients with high IMAC or low PMI were significantly lower than in patients with normal IMAC or PMI (P < 0.001, P < 0.001, respectively). Multivariate analysis showed that high IMAC (odds ratio [OR] = 3.898, 95% confidence interval [CI], 2.025-7.757, P < 0.001) and low PMI (OR = 3.635, 95% CI, 1.896-7.174, P < 0.001) were independent risk factors for death after LDLT. In conclusion, high IMAC and low PMI were closely involved with posttransplant mortality. Preoperative quality and quantity of skeletal muscle could be incorporated into new selection criteria for LDLT. Perioperative nutritional therapy and rehabilitation could be important for good outcomes after LDLT. Liver Transpl , 2014. © 2014 AASLD.
    Full-text · Article · Nov 2014 · Liver Transplantation
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    ABSTRACT: During a prospective surveillance using PCR for the detection of plasmid-mediated AmpC β-lactamase (pAmpC)-producing Enterobacteriaceae, outbreaks due to pAmpC-producing Klebsiella pneumoniae (pAmpC-Kp) occurred in an adult liver transplantation unit (aLTU) and a paediatric liver transplantation unit (pLTU), with carbapenem-resistant (CR) variants. Between April 2010 and March 2012, a total of 32 patients infected with pAmpC-Kp were found by prospective surveillance using PCR detection at a Japanese university hospital. Multilocus sequence typing, analysis of outer membrane proteins, and detection of carbapenemases were performed. Clinical courses of patients with bloodstream infection (BSI) were reviewed. Of 32 pAmpC-Kp isolates from each patient, 20 (18 from aLTU patients) were DHA-1-producing sequence type 11 (DHA-1-ST11), 9 were CMY-2-ST45/778 (all from pLTU patients) and the other 3 isolates had different sequence types. CR variants were isolated from 8 aLTU patients with DHA-1-ST11 and from 1 pLTU patient with CMY-2-ST45. All of the pAmpC-Kp isolates, including CR variants, were negative for carbapenemases. All of the DHA-1-ST11 and CMY-2-ST45 isolates lacked OmpK35, and seven CR variants also lacked OmpK36. BSIs due to DHA-1-ST11 isolates, including CR variants, occurred in six aLTU patients, four of whom died. The outbreaks were controlled after application of intensified infection control measures. During pAmpC-Kp outbreaks involving 27 liver transplants, CR variants with porin loss developed in nine patients, and DHA-1-ST11 K. pneumoniae caused BSIs with high mortality.
    No preview · Article · Oct 2014 · International Journal of Antimicrobial Agents
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    ABSTRACT: Derangements of various serum biochemical nutritional/metabolic parameters are common in patients with end-stage liver disease who undergo liver transplantation. The aim of this study was to explain the benefit of liver transplantation with respect to parameter changes and to examine the impact of graft weight to recipient body weight ratio on such changes. We investigated each parameter's course in 208 adult recipients for one year after living donor liver transplantation and sub-analyzed changes in the parameters using a graft weight-to-recipient body weight ratio of 0.8% as the cutoff point. Bonferroni corrections were applied to account for multiple testing. Liver disease-induced high pre-transplant ammonia, tyrosine, low branched-chain-amino-acids-to-tyrosine-ratio and zinc normalized within two weeks after transplantation, and total lymphocyte count normalized in two months, while low pre-transplant prealbumin took one year to normalize. Branched-chain-amino-acids, zinc and total lymphocyte count transiently dropped shortly after transplantation, then corrected later on. An accelerated recovery of ammonia and tyrosine levels and the branched-chain-amino-acids-to-tyrosine-ratio was found with larger-sized grafts, especially early after transplantation, while, zinc, prealbumin, branched-chain amino acids and total lymphocyte count recovered irrespective of graft size. In conclusion, graft size had little impact on the recovery of nutritional/metabolic parameters except ammonia and tyrosine levels. Liver Transpl , 2014. © 2014 AASLD.
    Full-text · Article · Sep 2014 · Liver Transplantation
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    ABSTRACT: This study investigated adequate liver graft selection for donor safety by comparing postoperative donor liver function and morbidity between the right and left hemilivers (RL and LL, respectively) of living donors. Between April 2006 and March 2012, RL (n = 168) and LL (n = 140) donor operations were performed for liver transplantation at Kyoto University Hospital. Postoperative hyperbilirubinemia and coagulopathy persisted in RL donors, whereas the liver function of LL donors normalized more rapidly. The overall complication rate of the RL donors was significantly higher than that of the LL donors (59.5% vs 30.7%; P < 0.001). There were no significant differences in severe complications worse than Clavien grade IIIa or in biliary complication rates between the two donor groups. In April 2006, we introduced an innovative surgical procedure: hilar dissection preserving the blood supply to the bile duct during donor hepatectomy. Compared with our previous outcomes (1990-2006), the biliary complication rate of the RL donors decreased from 12.2% to 7.2%, and the severity of these complications was significantly lower. In conclusion, LL donors demonstrated good recovery in postoperative liver function and lower morbidity, and our surgical innovations reduced the severity of biliary complications in living donors.This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2014 · Transplant International
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    ABSTRACT: Background: Protein-energy malnutrition is common in patients with end-stage liver disease undergoing liver transplantation. We examined the characteristics of nutritional status and impact of pre-admission branched-chain-amino-acids treatment on skeletal muscle mass, nutritional/metabolic parameters and on posttransplant outcomes. Methods: Preoperative skeletal muscle mass and nutritional/metabolic parameter levels were compared in 129 patients undergoing adult-to-adult living donor liver transplantation whether received branched-chain-amino-acids treatment before admission or not. We examined relationships among these parameters, and risk factors for posttransplant bacteremia and early mortality after LT focusing on nutritional parameters. Results: Prealbumin and branched-chain-amino-acids-to-tyrosine ratio were significantly higher while tyrosine was lower in branched-chain-amino-acids-pre-supplemented than non-pre-supplemented group, while skeletal muscle mass, total lymphocyte count, zinc, branched-chain-amino-acids and ammonia levels were not significantly different. Skeletal muscle mass positively correlated with tyrosine (r=0.437, P<0.001) and branched-chain-amino-acids (r=0.282, P=0.001) and negatively with branched-chain-amino-acids-to-tyrosine-ratio (r=-0.259, P=0.003). Multivariate predictors of posttransplant bacteremia were: Child-Pugh class C (P=0.012), low preoperative total lymphocyte count (P=0.027), operative blood loss ≥10 L (P=0.039) and absence of pre-admission branched-chain-amino-acids treatment (P=0.040). Nutritional/metabolic parameters and pre-admission branched-chain-amino-acids treatment were not crucial for posttransplant early mortality. Conclusions: Pre-admission branched-chain-amino-acid therapy reduced preoperative amino acid imbalance and the incidence of posttransplant bacteremia.
    No preview · Conference Paper · Jun 2014
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    ABSTRACT: Introduction Right posterior segmental graft (RPSG) is an alternative procedure for living-donor liver transplantation (LDLT). Although the first case of RPSG was reported in 2001, it has not been disseminated because of the lack of popularity, technical concerns, and surgical difficulties. Presentation of Case: A 37-year-old man with primary sclerosing cholangitis. His spouse was the only transplantation candidate, although she was ABO incompatible. Preoperative investigations revealed that left-lobe graft was insufficient for the recipient and that right-lobe graft was accompanied by donor risk. In RPSG, estimated graft-to-recipient weight ratio (GRWR) and estimated ratio of liver remnant were reasonable. In the donor operation, the right hepatic vein (RHV) and demarcation line were confirmed, and intraoperative cholangiography was performed. The cut line was carefully considered based on the demarcation line and RHV. The RPSG was harvested. Actual GRWR was 0.54. Unfortunately, this recipient showed a poor course and outcome after LDLT. Discussion Segmental branches of vessels and biliary duct may be not suitable for reconstruction, and surgeons must exercise some ingenuity in the recipient operation. Segmental territory based on inflow and that based on outflow never overlap completely, even in the same segment. The selection of RPSG based only on liver volume may be unfeasible. Liver resection should be carefully considered based on preoperative imaging, and demarcation line and RHV during surgery. Conclusion RPSG is a useful tool for LDLT. However, detailed studies before surgery and careful consideration during surgery are important for RPSG harvest.
    Preview · Article · Jun 2014 · International Journal of Surgery Case Reports
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    ABSTRACT: The goal of this study was to examine whether the lower limit of the graft-to-recipient weight ratio (GRWR) can be safely reduced to make better use of the left lobe graft in adult-to-adult living donor liver transplantation in combination with portal pressure control. Beginning December 2007, the acceptable limit for GRWR was lowered to ≥0.7% and by April 2009, it was further lowered to ≥0.6%. A portal pressure control program targeting a final portal pressure <15 mm Hg was also introduced. The donor complication rate decreased from 13.8% to 9.3%. The overall survival of recipients with GRWR <0.8% did not differ from recipients with a GRWR ≥0.8%. In conclusion, the lower limit of the GRWR can be safely reduced to 0.6% using a left lobe graft in adult-to-adult living donor liver transplantation in combination with portal pressure control.
    No preview · Article · Apr 2014 · Transplantation
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    ABSTRACT: Living donor liver transplantation (LDLT) for patients with high model for end-stage liver disease score and acute liver failure patients have little or not gained any substantial following among Western centers because of the "donor high risk-low recipient benefit scenario" that puts the donor at a significant risk against the survival odds for a recipient who is receiving a partial graft and considered marginal by Western standards. In most Asian countries, there is sometimes no other source of live graft but a willing live liver donor. There are individual Asian center reports that conclude that LDLT has comparable outcome to deceased donor liver transplant. However, the outcomes of a large number of patients after undergoing adult LDLT for high model for end-stage liver disease scores and acute liver failure at a single center have not been investigated. Here in, we present our experience with such subgroup of patients undergoing LDLT.
    No preview · Article · Apr 2014 · Transplantation
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    ABSTRACT: An insufficient remnant in extended hepatectomy and small-for-size graft in liver transplantation are critical matters in the field of liver surgery, and reliable and reproducible animal models that can provide clinically relevant and reliable data are needed. We herein describe our detailed surgical procedures for performing 70 % hepatectomy in pigs, and discuss the critical anatomical features, key techniques and pitfalls based on our experience. The porcine liver is divided into four lobes. The right lateral lobe (RLL) accounts for 30 % of the liver volume. Important points, such as selective temporal clamping of the arterial branch, confirmation of a related demarcation line, a two-step process to skeletonize Glisson's capsules during liver resection and selective ligation of the portal venous branch to the right medial lobe without inducing any subtle injuries to Glisson's capsules from the RLL to common bile duct, are discussed.
    No preview · Article · Feb 2014 · Surgery Today
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    ABSTRACT: Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course. We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010. Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child-Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7 %, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9 %; 3 years: 58.9 vs. 77.7 %; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child-Pugh score were independent risk factors for the postoperative prognosis. Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable.
    No preview · Article · Feb 2014 · Surgery Today