Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and...Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and use of sizable collaterals(pericholedochal varix[8,9],coronary vein,peripancreatic or perigastroesophageal varices[10],right superior colic vein[11],ileocolic vein[12],and left gastric vein[13]),or combined liverpancreas-small bowel transplant[14]are required for portal inflow in patients with total portosplenomesenteric thrombosis.展开更多
Salvage liver transplantation(LT)is frequently performed on patients who experience recurrent hepatocellular carcinoma(HCC)after primary hepatectomy for HCC[1,2].The main concern in these patients is the technical fea...Salvage liver transplantation(LT)is frequently performed on patients who experience recurrent hepatocellular carcinoma(HCC)after primary hepatectomy for HCC[1,2].The main concern in these patients is the technical feasibility of salvage LT,especially as prior hepatectomy may result in heavy adhesions[3,4].Salvage living donor LT(LDLT)is a more demanding procedure than salvage deceased donor LT(DDLT)using an entire donor graft with a long vascular pedicle[5,6].Because less than optimal dissection of perihepatic adhesions could result in uncontrollable pinpoint bleedings at the dissection surface[1,5],many transplant surgeons avoid performing salvage LDLT.Minimally invasive laparoscopic hepatectomy(LH)results in fewer intraperitoneal adhesions than the open method,reducing the difficulty of surgical dissection during future LT[7–10].To date,however,no study has compared salvage LDLT for recurrent HCC after LH to that after open hepatectomy(OH).展开更多
To the Editor:In Korea,the annual number of deceased donors for or gan transplantation per million people is still less than10.Thus,approximately 40%of patients with acute liver failure or acute-on-chronic liver failu...To the Editor:In Korea,the annual number of deceased donors for or gan transplantation per million people is still less than10.Thus,approximately 40%of patients with acute liver failure or acute-on-chronic liver failure undergo living donor liver transplantation（LDLT）.;Although the use of ABO-incompatible（ABOi）living donors is an attrac tive option,ABOi LDLT has very restricted applications展开更多
Salvage liver transplantation (LT) has been performed for recurred hepatocellular carcinoma(HCC) or for deterioration of liver function after resection of HCC. Controversies arise, howeverover the technical feasibilit...Salvage liver transplantation (LT) has been performed for recurred hepatocellular carcinoma(HCC) or for deterioration of liver function after resection of HCC. Controversies arise, howeverover the technical feasibility of salvage LT in patientswho underwent liver surgery,展开更多
Background:Despite remarkable advances in surgical techniques and perioperative management,left hepatic trisectionectomy(LHT)remains a challenging procedure with a somewhat high postoperative morbidity rate compared w...Background:Despite remarkable advances in surgical techniques and perioperative management,left hepatic trisectionectomy(LHT)remains a challenging procedure with a somewhat high postoperative morbidity rate compared with less-extensive resections.This study aimed to analyze the short-and long-term outcomes of LHT and identify factors associated with the postoperative morbidity of this technically demanding surgical procedure.Methods:The medical records of 53 patients who underwent LHT between June 2005 and October 2019 at a single institution were retrospectively reviewed.The independent prognostic factor of postoperative morbidity was analyzed using the logistic regression model.Results:Hepatocellular carcinoma was the most common indication for surgery(n=21),followed by hilar cholangiocarcinoma(n=14),intrahepatic cholangiocarcinoma(n=10),and other pathologies(including colorectal liver metastasis,hepatolithiasis,gallbladder cancer,living donor,hemangioma,and multilocular biliary cyst;n=8).The rates of postoperative morbidities of Clavien-Dindo grade 3 or higher and 90-day mortality were 39.6% and 1.9%,respectively.The 1-,3-,and 5-year overall survival rates were 81.1%,61.4%,and 44.6%,respectively.Multivariate analysis revealed that preoperative jaundice[hazard ratio(HR)=6.15,95%confidence interval(CI):1.57-24.17,P=0.009]and operative time>420 min(HR=4.66,95%CI:1.27–17.17,P=0.021)were independent predictors of postoperative morbidity.Conclusions:The in-hospital mortality of LHT surgery can be minimalized by a reliable preoperative evaluation of liver function and selection of the dominant anatomic features of right posterior sector,active and appropriate preoperative management for obstructive cholangitis and compensatory hypertrophy of the future remnant posterior sector,and the experience of the surgeon.展开更多
BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidenc...BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its in-cidence. METHODS: We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131). RESULTS: The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS. CONCLUSIONS: Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.展开更多
文摘Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and use of sizable collaterals(pericholedochal varix[8,9],coronary vein,peripancreatic or perigastroesophageal varices[10],right superior colic vein[11],ileocolic vein[12],and left gastric vein[13]),or combined liverpancreas-small bowel transplant[14]are required for portal inflow in patients with total portosplenomesenteric thrombosis.
文摘Salvage liver transplantation(LT)is frequently performed on patients who experience recurrent hepatocellular carcinoma(HCC)after primary hepatectomy for HCC[1,2].The main concern in these patients is the technical feasibility of salvage LT,especially as prior hepatectomy may result in heavy adhesions[3,4].Salvage living donor LT(LDLT)is a more demanding procedure than salvage deceased donor LT(DDLT)using an entire donor graft with a long vascular pedicle[5,6].Because less than optimal dissection of perihepatic adhesions could result in uncontrollable pinpoint bleedings at the dissection surface[1,5],many transplant surgeons avoid performing salvage LDLT.Minimally invasive laparoscopic hepatectomy(LH)results in fewer intraperitoneal adhesions than the open method,reducing the difficulty of surgical dissection during future LT[7–10].To date,however,no study has compared salvage LDLT for recurrent HCC after LH to that after open hepatectomy(OH).
文摘To the Editor:In Korea,the annual number of deceased donors for or gan transplantation per million people is still less than10.Thus,approximately 40%of patients with acute liver failure or acute-on-chronic liver failure undergo living donor liver transplantation（LDLT）.;Although the use of ABO-incompatible（ABOi）living donors is an attrac tive option,ABOi LDLT has very restricted applications
文摘Salvage liver transplantation (LT) has been performed for recurred hepatocellular carcinoma(HCC) or for deterioration of liver function after resection of HCC. Controversies arise, howeverover the technical feasibility of salvage LT in patientswho underwent liver surgery,
文摘Background:Despite remarkable advances in surgical techniques and perioperative management,left hepatic trisectionectomy(LHT)remains a challenging procedure with a somewhat high postoperative morbidity rate compared with less-extensive resections.This study aimed to analyze the short-and long-term outcomes of LHT and identify factors associated with the postoperative morbidity of this technically demanding surgical procedure.Methods:The medical records of 53 patients who underwent LHT between June 2005 and October 2019 at a single institution were retrospectively reviewed.The independent prognostic factor of postoperative morbidity was analyzed using the logistic regression model.Results:Hepatocellular carcinoma was the most common indication for surgery(n=21),followed by hilar cholangiocarcinoma(n=14),intrahepatic cholangiocarcinoma(n=10),and other pathologies(including colorectal liver metastasis,hepatolithiasis,gallbladder cancer,living donor,hemangioma,and multilocular biliary cyst;n=8).The rates of postoperative morbidities of Clavien-Dindo grade 3 or higher and 90-day mortality were 39.6% and 1.9%,respectively.The 1-,3-,and 5-year overall survival rates were 81.1%,61.4%,and 44.6%,respectively.Multivariate analysis revealed that preoperative jaundice[hazard ratio(HR)=6.15,95%confidence interval(CI):1.57-24.17,P=0.009]and operative time>420 min(HR=4.66,95%CI:1.27–17.17,P=0.021)were independent predictors of postoperative morbidity.Conclusions:The in-hospital mortality of LHT surgery can be minimalized by a reliable preoperative evaluation of liver function and selection of the dominant anatomic features of right posterior sector,active and appropriate preoperative management for obstructive cholangitis and compensatory hypertrophy of the future remnant posterior sector,and the experience of the surgeon.
文摘BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its in-cidence. METHODS: We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131). RESULTS: The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS. CONCLUSIONS: Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.
