Split liver transplantation(SLT),while widely accepted in pediatrics,remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching,however,have allowed expansion of SLT from utiliza...Split liver transplantation(SLT),while widely accepted in pediatrics,remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching,however,have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience,better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly,more than two decades of experience have identified key requirements for successful SLT in adults. When these requirements are met,SLT can achieve outcomes equivalent to those achieved with other types of liver transplantation for adults. However,substantial challenges,such as surgical techniques,logistics,and ethics,persist as ongoing barriers to further expansion of this highly complex procedure. This review outlines the current state of SLT in adults,focusing on donor and recipient selection based on physiology,surgical techniques,surgical outcomes,and ethical issues.展开更多
Liver transplantation(LT)for hepatocellular carcinoma(HCC)within Milan criteria is a widely accepted optimal therapy.Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout d...Liver transplantation(LT)for hepatocellular carcinoma(HCC)within Milan criteria is a widely accepted optimal therapy.Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation.Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy.The data associated with newer modalities including drugeluting beads,radioembolization with Y90,stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates.The concept"ablate and wait"has gained the popularity where mandated observation period after neoadjuvant therapy allows for tumor biology to become apparent,thus has been recommended after downstaging.The role of neo-adjuvant therapy with conjunction of"ablate and wait"in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.展开更多
BACKGROUND There is a nationwide shortage of organs available for liver transplantation.Living donors help meet this growing demand.Not uncommonly,donors will have positive autoantibodies.However,it is unclear whether...BACKGROUND There is a nationwide shortage of organs available for liver transplantation.Living donors help meet this growing demand.Not uncommonly,donors will have positive autoantibodies.However,it is unclear whether donor positive autoantibodies are correlated with worse outcomes following living liver donor transplantations.AIM To analyze the significance of positive autoantibodies in donors on post-transplant outcomes in recipients.METHODS We performed a retrospective review of living liver donors who had undergone liver transplantation between January 1,2012 and August 31,2021.Demographic characteristics and pre-transplant data including antinuclear antibodies(ANA)and anti-smooth muscle antibody titers were collected in donors.Outcomes of interest were post-transplantation complications including mortality,biliary strictures,biliary leaks,infection,and rejection.Pediatric recipients and donors without measured pre-transplant autoantibody serologies were excluded from this study.RESULTS 172 living donor liver transplantations were performed during the study period,of which 115 patients met inclusion criteria.37(32%)living donors were autoantibody-positive with a median ANA titer of 1:160(range 1:80 to 1:1280)and median anti-SMA titer of 1:40(range 1:20 to 1:160).There were no significant differences in baseline demographics between the autoantibody positive and negative donors.Post-transplantation rates of death(P value=1),infections(P value=0.66),and overall rates of complications(P value=0.52)were similar between the autoantibody positive and negative groups.Higher incidences of anastomotic strictures and rejection were observed in the autoantibody positive group;however,these differences were not statistically significant(P value=0.07 and P value=0.30 respectively).CONCLUSION Isolated pre-transplant autoantibody positivity is not correlated to worse post-transplant outcomes in living liver donor transplants.展开更多
文摘Split liver transplantation(SLT),while widely accepted in pediatrics,remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching,however,have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience,better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly,more than two decades of experience have identified key requirements for successful SLT in adults. When these requirements are met,SLT can achieve outcomes equivalent to those achieved with other types of liver transplantation for adults. However,substantial challenges,such as surgical techniques,logistics,and ethics,persist as ongoing barriers to further expansion of this highly complex procedure. This review outlines the current state of SLT in adults,focusing on donor and recipient selection based on physiology,surgical techniques,surgical outcomes,and ethical issues.
文摘Liver transplantation(LT)for hepatocellular carcinoma(HCC)within Milan criteria is a widely accepted optimal therapy.Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation.Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy.The data associated with newer modalities including drugeluting beads,radioembolization with Y90,stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates.The concept"ablate and wait"has gained the popularity where mandated observation period after neoadjuvant therapy allows for tumor biology to become apparent,thus has been recommended after downstaging.The role of neo-adjuvant therapy with conjunction of"ablate and wait"in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.
文摘BACKGROUND There is a nationwide shortage of organs available for liver transplantation.Living donors help meet this growing demand.Not uncommonly,donors will have positive autoantibodies.However,it is unclear whether donor positive autoantibodies are correlated with worse outcomes following living liver donor transplantations.AIM To analyze the significance of positive autoantibodies in donors on post-transplant outcomes in recipients.METHODS We performed a retrospective review of living liver donors who had undergone liver transplantation between January 1,2012 and August 31,2021.Demographic characteristics and pre-transplant data including antinuclear antibodies(ANA)and anti-smooth muscle antibody titers were collected in donors.Outcomes of interest were post-transplantation complications including mortality,biliary strictures,biliary leaks,infection,and rejection.Pediatric recipients and donors without measured pre-transplant autoantibody serologies were excluded from this study.RESULTS 172 living donor liver transplantations were performed during the study period,of which 115 patients met inclusion criteria.37(32%)living donors were autoantibody-positive with a median ANA titer of 1:160(range 1:80 to 1:1280)and median anti-SMA titer of 1:40(range 1:20 to 1:160).There were no significant differences in baseline demographics between the autoantibody positive and negative donors.Post-transplantation rates of death(P value=1),infections(P value=0.66),and overall rates of complications(P value=0.52)were similar between the autoantibody positive and negative groups.Higher incidences of anastomotic strictures and rejection were observed in the autoantibody positive group;however,these differences were not statistically significant(P value=0.07 and P value=0.30 respectively).CONCLUSION Isolated pre-transplant autoantibody positivity is not correlated to worse post-transplant outcomes in living liver donor transplants.
