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Liver transplantation and resection in patients with hepatocellular cancer and portal vein tumor thrombosis: Feasible and effective? 被引量:1
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作者 Prashant Bhangui 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2024年第2期123-128,共6页
Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for them.In recent years,effective systemic therapy,... Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for them.In recent years,effective systemic therapy,and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy,have given some hope to prolong survival in them.This review summarized recent evidence in literature regarding the possible role of liver resection(LR)and liver transplantation(LT)in patients with locally advanced HCC and PVTT with no extrahepatic disease.Downstaging therapies have helped make curative resection or LT a reality in selected patients.This review emphasizes on the key points to focus on when considering surgery in these patients,who are usually relegated to palliative systemic therapy alone.Meticulous patient selection based on tumor biology,documented downstaging based on imaging and decrease in tumor marker levels,and an adequate waiting period to demonstrate stable disease,may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT. 展开更多
关键词 Hepatocellular carcinoma Portal vein tumour thrombosis Downstaging therapies Living donor liver transplantation and resection OUTCOMES
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Risks faced by donors of right lobe for living donor liver transplantation 被引量:8
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作者 Ran, Shun Wen, Tian-Fu +8 位作者 Yan, Lu-Nan Li, Bo Zeng, Yong Chen, Zhe-Yu Zhang, Yu Liao, Zhi-Xue Liang, Guan-Lin Li, Guo Zhang, Xian-Hua 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2009年第6期581-585,共5页
BACKGROUND: Because of the shortage of deceased donors with livers fit for transplantation, living donor liver transplantation (LDLT) is becoming an attractive alternative. Attention should be paid to the donors, espe... BACKGROUND: Because of the shortage of deceased donors with livers fit for transplantation, living donor liver transplantation (LDLT) is becoming an attractive alternative. Attention should be paid to the donors, especially to those of the right lobe. In this study, we evaluated the risks faced by donors of the right lobe for adult-to-adult LDLT. METHODS: The perioperative data from 105 consecutive living donors of the right lobe performed in West China Hospital from January 2002 to December 2007 were retrospectively studied. Preoperative evaluation included CT, MRCP, and intraoperative cholangiography, showing liver volume, hepatic vasculature and the biliary system. The standard liver volume (SLV) and the ratio of left lobe volume to SLV were calculated. The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein without inflow vascular occlusion, using an ultrasonic dissector. After operation the donors were monitored in the Intensive Care Unit for about three days. Each donor was followed up for at least 6 months. RESULTS: There was no donor mortality. Major complications occurred in 14 donors (13.3%), of whom 3 received conservative treatment, 8 required invasive paracentesis, and 3 required further surgery. All donors were recovered well and resumed their previous occupations. CONCLUSIONS: Donors of the right lobe face low risks. The preoperative evaluation, especially evaluation of the volume of the remnant liver, should be exact. During the operation, the patency of the remnant hepatic vasculature and bile duct must be preserved, and the extent of injury to the remnant liver should be limited as much as possible. The detection and treatment of postoperative complications should be diligently performed. 展开更多
关键词 liver transplantation living donor right lobe RISK safety
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Measures for increasing the safety of donors in living donor liver transplantation using right lobe grafts 被引量:2
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作者 Wen, Tian-Fu Chen, Zhe-Yu +10 位作者 Yan, Lu-Nan Li, Bo Zeng, Yong Zhao, Ji-Chun Wang, Wen-Tho Yang, Jia-Yin Ma, Yu-Kui Xu, Ming-Qing Liu, Jiang-Wen Deng, Zhi-Gang Wu, Hong 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2007年第6期590-595,共6页
BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using r... BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS: We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inflow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS: There was no donor mortality in our group. Postoperative complications only included bile leakage (I donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease. CONCLUSIONS: The first consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume-of the remnant liver exceeds 35% of the total liver volume. 展开更多
关键词 living donor liver transplantation HEPATECTOMY right lobe graft SAFETY
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Major complications of adult right lobe living liver donors 被引量:4
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作者 Necdet Guler Onur Yaprak +5 位作者 Yusuf Gunay Murat Dayangac Murat Akyildiz Fisun Yuzer Yildiray Yuzer Yaman Tokat 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2015年第2期150-156,共7页
BACKGROUND:The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease.It is important to know the preoperative factors relating to the maj... BACKGROUND:The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease.It is important to know the preoperative factors relating to the major postoperative complications.We therefore evaluated the possible risk factors for predicting postoperative complications in right lobe liver donors.METHODS:Data from 378 donors who had undergone right lobe hepatectomy at our center were evaluated retrospectively. The factors we evaluated induded donor age, gender, body mass index (BMI), remnant liver volume, operation time, history of previous abdominal surgery, inclusion of the middle hepatic vein and variations in the portal and bile systems. RESUEI'S: Of the 378 donors, 219 were male and 159 female. None of the donors died, but 124 (32.8%) donors experienced complications including major complications (Clavien scores III and IV) in 27 (7.1%). Univariate analysis showed that complica- tions were significantly associated with male gender and higher BMI (P〈0.05), but not with donor age, remnant liver volume, operation time, graft with middle hepatic vein, variations in the portal and bile systems and previous abdominal surgery (P〉0.05). Multivariate logistic regression analysis showed that major complications were significantly associated with male gender (P=0.005) and higher BMI (P=0.029). Moreover, the Chi- square test showed that there were significant relationships between major complications and male gender (P=0.010,Z2=6.614, df=l) and BMI 〉25 kg/m2 (P=-0.031, Z2=8.562, df-1). Of the 96 male donors with BMI 〉25 kg/m2, 14 (14.6%) with major complications had significantly smaller mean remnant liver volume than those (82, 85.4%) without major complications (32.50%± 4.45% vs 34.63%±3.11%, P=0.029).CONCLUSION: Male donors with BMI 〉25 kg/m2 and a remnant liver volume 〈32.50% had a significantly increased risk for major complications. 展开更多
关键词 living donor right lobe liver donor major complications risk factors
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Evaluation outcomes of donors in living dono liver transplantation: a single-center analysis of 132 donors 被引量:1
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作者 Ding Yuan, Yong-Gang Wei, Bo Li, Lu-Nan Yan, Tian-Fu Wen, Ji-Chun Zhao, Yong Zeng and Ke-Fei Chen Department of Liver and Vascular Surgery, Liver Transplantation Center Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2011年第5期480-488,共9页
BACKGROUND: Donor safety has always been a major concern and potential risk to the donor must be balanced against recipient benefit. However, lack of a standardized and uniform evaluation of perioperative complication... BACKGROUND: Donor safety has always been a major concern and potential risk to the donor must be balanced against recipient benefit. However, lack of a standardized and uniform evaluation of perioperative complications is a serious limitation of the evaluation of donor morbidity. This study was designed to evaluate the outcomes of donors in adult living donor liver transplantation (LDLT) using the newer Clavien classification system in a single center in China. METHODS: We prospectively analyzed the outcomes of 132 consecutive living liver donors from 2005 to 2008 using the newer Clavien classification system. The preoperative, intraoperative and postoperative data of the donors were collected and analyzed Ordinal regression was used to analyze the ordered grades of complications. RESULTS: Ninety-four (71.2%) of the donors developed postoperative complications of grade I (n=45, 34.1%), grade II (n=39, 29.5%) and grade III (n=10, 7.6%). There was no death or grade IV morbidity. Hepatic functional impairment and pleural effusion were the most frequent morbidities for living donors. Fifty-three donors (40.1%) developed hepatic functional impairment of grade I (n=40, 31.1%) and grade II (n=13, 10.0%). The ICU stay (7.8±1.8 days) and length of hospital stay (17.7±4.6 days) were significantly longer in donors with grade III than others. Furthermore, ordinal logistic regression revealed that donor’s older age (>40 years) and right hepatectomy were associated with morbidity. In addition, only preoperative total bilirubin (within the normal range) and postoperative nadir serum phosphorus were independently associated with hepatic functional impairment. The receiveroperator characteristic curve revealed that preoperative total bilirubin >18.0 μmol/L and postoperative nadir of serum phosphorus <1 mg/dL may lead to more severe hepatic functional impairment. CONCLUSIONS: Despite the fact that donors are relatively safe to undergo hepatectomy, many living donors still experience postoperative morbidity. Meticulous technical and preoperative donor evaluation and treatment are sure to reduce the incidence of complications. 展开更多
关键词 liver transplantation living donor risk factors SAFETY
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Health-related quality of life in living liver donors after transplantation 被引量:1
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作者 Pei-Xian Chen and Lu-Nan Yan Division of Liver Transplantation,West China Hospital,Sichuan University,Chengdu 610041,China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2011年第4期356-361,共6页
BACKGROUND:Living donor liver transplantation (LDLT) has recently emerged as an effective therapeutic alternative for patients with end-stage liver disease.In the meantime,the health-related quality of life (HRQoL) of... BACKGROUND:Living donor liver transplantation (LDLT) has recently emerged as an effective therapeutic alternative for patients with end-stage liver disease.In the meantime,the health-related quality of life (HRQoL) of the donors is becoming better appreciated.Here we aimed to review the current literature and summarize the effects of liver donation on the long-term HRQoL of living donors.DATA SOURCES:A literature search of PubMed using 'donors','living donor liver transplantation','health-related quality of life',and 'donation' was performed,and all the information was collected.RESULTS:The varied postoperative outcomes of liver donors are attributive to the different evaluation instruments used.On the whole,donors experienced good long-term physical and mental well-being with a few complaining of compromised quality of life due to mild symptoms or psychiatric problems.The psychosocial dimension has received increasing attention with the vocational,interpersonal and financial impact of liver donation on donors mostly studied.CONCLUSIONS:Generally,donors have a good HRQoL after LDLT.Nevertheless,to achieve an ideal donor outcome,further work is necessary to minimize the negative effects as well as to incorporate recent progress in regenerative medicine. 展开更多
关键词 living donor liver transplantation DONATION health-related quality of life
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A new technique for the reconstruction of complex portal vein anomalies in right lobe living liver donors
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作者 Onur Yaprak Necdet Guler +5 位作者 N Cem Balci Murat Dayangac Tolga Demirbas Refik Killi Yaman Tokat Yildiray Yuzer 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2012年第4期438-441,共4页
Living donor liver right lobe transplantation using donors with variation of the right sectorial portal vein is considered a challenging procedure in terms of the donor’s safety and the complexity of reconstruction i... Living donor liver right lobe transplantation using donors with variation of the right sectorial portal vein is considered a challenging procedure in terms of the donor’s safety and the complexity of reconstruction in the recipient.We describe an innovative technique to reconstruct double portal vein orifices via a deceased donor iliac vein graft.The postoperative course of the recipient was uneventful.Doppler ultrasound on the fourth postoperative month revealed equivalent flow in both portal vein branches.Reconstruction of double right portal vein branches using a cryopreserved iliac vein is a valuable technique for utilizing right lobe grafts with challenging portal vein anatomy. 展开更多
关键词 liver transplantation living donor portal vein variations venous plasty
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Platelet count reduction and outcomes in living liver donors
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作者 Jian-Yong Lei Wen-Tao Wang 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2014年第1期25-31,共7页
BACKGROUND: Platelet count reduction in living donors after graft harvesting is very common. The mechanisms and the subsequent adverse consequences are not clear. The present study was to explore the mechanisms and th... BACKGROUND: Platelet count reduction in living donors after graft harvesting is very common. The mechanisms and the subsequent adverse consequences are not clear. The present study was to explore the mechanisms and the consequences of platelet count reduction in living donors. METHODS: We collected data from 231 living liver donor patients who donated at our transplant center between July 2002 and August 2009. Baseline and post-operative platelet counts were collected and analyzed. Multivariate logistic regression analysis was used to compare the risk factors for the persistent decrease in platelet counts. Complications and other postoperative recovery were compared between the donors. RESULTS: Platelet count decreased differently at each of the follow-up intervals, and the average reduction from baseline evaluation to year 3 was 18.2%. A concomitant decrease in white blood cells was observed with platelet count reduction. All of the splenic volumes at the post-operative follow-up time points were significantly higher than those at baseline(P【0.01). Multivariate logistic regression analysis indicated that the graft-to-donor weight ratio was a risk factor for low postoperative platelet counts in living donors at the three followup time points: one week(P=0.047), one month(P=0.034), and three months(P=0.047). At the one week follow-up time, 77 donor platelet counts were higher(group 1) and 151 donor platelet counts were lower(group 2) than baseline levels. Two hemorrhage events(1.3%) were observed in group 2, while three hemorrhage events(3.9%) were observed in group 1(P=0.211). The overall complication rate was comparable between the two groups(P=0.972). CONCLUSION: An increase in harvesting graft may decrease platelet counts, but this reduction does not produce short- or long-term damage in living liver donors. 展开更多
关键词 living donor liver transplantation platelet count reduction OUTCOMES
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Outcome of split liver transplantation vs living donor liver transplantation:A systematic review and meta-analysis
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作者 Ibrahim Umar Garzali Sami Akbulut +2 位作者 Ali Aloun Motaz Naffa Fuat Aksoy 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第7期1522-1531,共10页
BACKGROUND The outcomes of liver transplantation(LT)from different grafts have been studied individually and in combination,but the reports were conflicting with some researchers finding no difference in both short-te... BACKGROUND The outcomes of liver transplantation(LT)from different grafts have been studied individually and in combination,but the reports were conflicting with some researchers finding no difference in both short-term and long-term outcomes between the deceased donor split LT(DD-SLT)and living donor LT(LDLT).AIM To compare the outcomes of DD-SLT and LDLT we performed this systematic review and meta-analysis.METHODS This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.The following databases were searched for articles comparing outcomes of DD-SLT and LDLT:PubMed;Google Scholar;Embase;Cochrane Central Register of Controlled Trials;the Cochrane Database of Systematic Reviews;and Reference Citation Analysis(https://www.referencecitationanalysis.com/).The search terms used were:“liver transplantation;”“liver transplant;”“split liver transplant;”“living donor liver transplant;”“partial liver transplant;”“partial liver graft;”“ex vivo splitting;”and“in vivo splitting.”RESULTS Ten studies were included for the data synthesis and meta-analysis.There were a total of 4836 patients.The overall survival rate at 1 year,3 years and 5 years was superior in patients that received LDLT compared to DD-SLT.At 1 year,the hazard ratios was 1.44(95%confidence interval:1.16-1.78;P=0.001).The graft survival rate at 3 years and 5 years was superior in the LDLT group(3 year hazard ratio:1.28;95%confidence interval:1.01-1.63;P=0.04).CONCLUSION This meta-analysis showed that LDLT has better graft survival and overall survival when compared to DD-SLT. 展开更多
关键词 Deceased donor liver transplantation Living donor liver transplantation Split liver transplantation Overall survival Graft survival Acute rejection
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Reasons and effects of the decline of willing related potential living kidney donors
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作者 Rabea Ahmed Gadelkareem Amr Mostafa Abdelgawad +5 位作者 Nasreldin Mohammed Ahmed Reda Nashwa Mostafa Azoz Mohammed Ali Zarzour Hisham Mokhtar Hammouda Mahmoud Khalil 《World Journal of Transplantation》 2023年第5期276-289,共14页
BACKGROUND Although the availability of related living donors(LDs)provides a better chance for receiving kidney transplantation(KT),the evaluation protocols for LD selection remain a safeguard for the LD’s safety.The... BACKGROUND Although the availability of related living donors(LDs)provides a better chance for receiving kidney transplantation(KT),the evaluation protocols for LD selection remain a safeguard for the LD’s safety.These protocols are variable from one center to another,resulting in variable rates of decline of the potential LDs(PLDs).The decline of willing PLDs may occur at any stage of evaluation,starting from the initial contact and counseling to the day of operation.AIM To identify the causes of the decline of PLDs,the predictors of PLD candidacy,and the effect on achieving LDKT.METHODS A retrospective study was performed on the willing PLDs who attended our outpatient clinic for kidney donation to their related potential recipients between October 2015 and December 2022.The variables influencing their candidacy rate and the fate of their potential recipients were studied.Two groups of PLDs were compared:Candidate PLDs after a completed evaluation vs non-candidate PLDs with a complete or incomplete evaluation.A multivariate logistic regression was performed to assess the factors contributing to the achievement of PLD candidacy.RESULTS Of 321 willing PLDs,257 PLDs(80.1%)accessed the evaluation to variable extents for 212 potential recipients,with a mean age(range)of 40.5±10.4(18-65)years,including 169 females(65.8%).The remaining 64 PLDs(19.9%)did not access the evaluation.Only 58 PLDs(18.1%)succeeded in donating,but 199 PDLs(62.0%)were declined;exclusion occurred in 144 PLDs(56.0%)for immunological causes(37.5%),medical causes(54.9%),combined causes(9.7%),and financial causes(2.1%).Regression and release occurred in 55 PLDs(17.1%).The potential recipients with candidate PLDs were not significantly different from those with non-candidate PLDs,except in age(P=0.041),rates of completed evaluation,and exclusion of PLDs(P<0.001).There were no factors that independently influenced the rate of PLD candidacy.Most patients who failed to have KT after the decline of their PLDs remained on hemodialysis for 6 mo to 6 years.CONCLUSION The rate of decline of willing related PLDs was high due to medical or immunological contraindications,release,or regression of PLDs.It reduced the chances of high percentages of potential recipients in LDKT. 展开更多
关键词 Donor decline Donor evaluation Donor exclusion Kidney transplantation Living kidney donors Related living donors
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Renal allograft procurement from living unrelated donors in Iran: What falls under the eclipse
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作者 Saeed Taheri 《World Journal of Transplantation》 2023年第5期250-253,共4页
Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a signifi... Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a significant increase in the number of patients on transplant waiting lists globally.Societies worldwide have employed different methods to address this,each with specific ethical concerns surrounding them.Over three decades ago,a governmentally regulated program of kidney transplantation from living unrelated donors was introduced in Iran and since practiced which has been the subject of hot debate in the literature.Nevertheless,despite all these extensive discussions and publications,several key aspects of the program have still not been properly elucidated and addressed.In this article,the author aims to illuminate some dark corners related to this issue that have largely escaped the notice of ethicists. 展开更多
关键词 Allograft procurement Renal transplantation Living unrelated donor Organ market Iran
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COVID-19 in liver transplant patients: Impact and considerations
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作者 Shrouq Khazaaleh Mohammad Alomari +3 位作者 Sanskriti Sharma Nikhil Kapila Xaralambos Bobby Zervos Adalberto Jose Gonzalez 《World Journal of Transplantation》 2023年第1期1-9,共9页
The coronavirus disease 2019 pandemic has significantly impacted liver transplantation worldwide,leading to major effects on the transplant process,including the pretransplant,perioperative,and post-transplant periods... The coronavirus disease 2019 pandemic has significantly impacted liver transplantation worldwide,leading to major effects on the transplant process,including the pretransplant,perioperative,and post-transplant periods.It is believed that patients with chronic liver disease,especially those with cirrhosis,have a higher risk of complications from coronavirus disease 2019 infection compared to the general population.However,evaluation of coronavirus disease 2019 effects on liver transplant patients has not uniformly demonstrated worse outcomes.Nonetheless,the pandemic created significant challenges and restrictions on transplant policies and organ allocation. 展开更多
关键词 COVID-19 liver transplantation IMMUNOSUPPRESSION Living donor MORTALITY
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Retroperitoneal Laparoscopic Live Donor Nephrectomy:Report of 105 Cases 被引量:3
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作者 董隽 卢锦山 +5 位作者 祖强 杨素霞 郭刚 马鑫 李宏召 张旭 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 2011年第1期100-102,共3页
Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitone... Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitoneal complications.Herein we presented our experience performing retroperitoneal laparoscopic live donor nephrectomy in 105 donors.All donor nephrectomy was successful.There were no donor deaths and no conversion to open surgery.Mean operation time was 112 min(range,70-200 min).Intraoperative blood loss was 10-150 mL with an average of 30 mL.Warm ischemia time was 1.3 to 6 min with an average of 3.1 min.Postoperative retroperitoneal hematoma occurred in only one case and there were no other surgical complications.Donors were discharged from the hospital 5 to 10 days postoperation.Average postoperative hospital stay was 6.4 days.One graft was removed due to acute rejection.Delayed graft function occurred in two recipients but renal function returned to normal within four weeks.The other recipients had normal renal function in two weeks except three recipients in four weeks.We believe that retroperitoneal laparoscopic live donor nephrectomy is safe,reliable,and less invasive. 展开更多
关键词 LAPAROSCOPY kidney transplantation live donors
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Small-for-size syndrome in liver transplantation:Definition,pathophysiology and management 被引量:17
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作者 Yuichi Masuda Kazuki Yoshizawa +3 位作者 Yasunari Ohno Atsuyoshi Mita Akira Shimizu Yuji Soejima 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2020年第4期334-341,共8页
Background:Since the first success in an adult patient,living donor liver transplantation(LDLT)has become an universally used procedure.Small-for-size syndrome(SFSS)is a well-known complication after partial LT,especi... Background:Since the first success in an adult patient,living donor liver transplantation(LDLT)has become an universally used procedure.Small-for-size syndrome(SFSS)is a well-known complication after partial LT,especially in cases of adult-to-adult LDLT.The definition of SFSS slightly varies among transplant physicians.The use of a partial liver graft has risks of SFSS development.Persistent portal vein(PV)hypertension and PV hyper-perfusion after LT were identified as the main factors.Hence,various approaches were explored to modulate PV flow and decrease PV pressure in order to alleviate this syndrome.Herein,the definition,clinical symptoms,pathophysiology,basic research,as well as preventive and treatment strategies for SFSS are reviewed based on an extensive review of the literature and on our own experiences.Data sources:The articles were collected through PubMed using search terms“liver transplantation”,“living donor liver transplantation”,“living liver donation”,“partial graft”,“small-for-size graft”,“small-forsize syndrome”,“graft volume”,“remnant liver”,“standard liver volume”,“graft to recipient body weight ratio”,“sarcopenia”,“porcine”,“swine”,and“rat”.English publications published before March 31,2020 were included in this review.Results:Many transplant surgeons performed PV flow modulation,including portocaval shunt,splenic artery ligation and splenectomy.With these techniques,patient outcome has been improved even when using a"small"graft.Other factors,such as preoperative recipients’nutritional and skeletal muscle status,graft congestion,and donor factors,were also identified as risk factors which all have been addressed using various strategies.Conclusions:The surgical approach controlling PV flow and pressure could help to prevent SFSS especially in severely ill recipients.In the absence of efficacious medications to resolve SFSS,conservative treatments,including aggressive fluid balance correction for massive ascites,anti-microbiological therapy to prevent or control sepsis and intensive nutritional therapy,are all required if SFSS could not be prevented. 展开更多
关键词 liver transplantation Living donor liver transplantation Small-for-size graft Small-for-size syndrome
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Microsurgical reconstruction of hepatic artery in living donor liver transplantation:experiences and lessons 被引量:10
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作者 Yan, Sheng Zhang, Qi-Yi +7 位作者 Yu, Yu-Sheng He, Jiang-Juan Wang, Wei-Lin Zhang, Min Shen, Yan Wu, Jian Xu, Xiao Zheng, Shu-Sen 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2009年第6期575-580,共6页
BACKGROUND: Hepatic artery (HA) reconstruction is one of the key steps for living donor liver transplantation (LDLT). The incidence of HA thrombosis has been reduced by the introduction of nucrosurgical techniques und... BACKGROUND: Hepatic artery (HA) reconstruction is one of the key steps for living donor liver transplantation (LDLT). The incidence of HA thrombosis has been reduced by the introduction of nucrosurgical techniques under a high resolution microscope or loupe. METHODS: We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-undamp and posterior-wall-first technique. The reconstructions were completed by either a plastic surgeon or a transplant surgeon. RESULTS: The rate of HA thrombosis was 2% (2/101). The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon. For a graft with duplicate arteries, we considered no branches should be discarded even with a positive clamping test. CONCLUSIONS: HA reconstruction without clamping the graft artery is a feasible and simplified technique, which can be mastered by transplant surgeons with considerable microsurgical training. 展开更多
关键词 living donor liver transplantation MICROSURGERY ANASTOMOSIS hepatic artery
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Management of the middle hepatic vein and its tributaries in right lobe living donor liver transplantation 被引量:11
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作者 Yu, Peng-Fei Wu, Jian Zheng, Shu-Sen 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2007年第4期358-363,共6页
BACKGROUND: Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency, living donor liver transplantation (LDLT) using the... BACKGROUND: Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency, living donor liver transplantation (LDLT) using the right lobe has become a standard method for adult patients. As the drainage of the median sector (segments V, VIII and IV) is mainly by the middle hepatic vein (MHV), the issue of whether the MHV should or should not be taken with the graft or whether the MHV tributaries (V5, V8) should be reconstructed in the recipient remains to be settled. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1985-2006) on right lobe living donor liver transplantation, middle hepatic vein, vein graft, hepatic venoplasty and other related subjects. RESULTS: Some institutions had proposed their policy for the management of the MHV and its tributaries. Dominancy of the hepatic vein, graft-to-recipient weight ratio, and remnant liver volume as well as the donor-to-recipient body weight ratio, the volume of the donor's right lobe to the recipient's standard liver volume and the size of MHV tributaries are the major elements for the criteria of inclusion of the MHV, while for the policy of MHV tributaries reconstruction, the proportion of congestive area and the diameter of the tributaries are the critical elements. Optimal vein grafts such as recipient's portal vein and hepatic venoplasty technique have been used to obviate hepatic congestion and venous drainage disturbance. CONCLUSIONS: Taking right liver grafts with the MHV trunk (extended right lobe grafts) or performing the MHV tributaries reconstruction in modified right lobe grafts, according to the criteria proposed by the institutions with rich experience, can solve the congestion problem of the right paramedian sector and help to improve the outcomes of the patients. The additional use of optimal vein grafts and hepatic venoplasty also can guarantee excellent venous drainage. 展开更多
关键词 right lobe living donor liver transplantation middle hepatic vein vein graft hepatic venoplasty
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Efficacy of middle hepatic vein reconstruction in adult right-lobe living donor liver transplantation 被引量:7
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作者 Peng, Ci-Jun Wang, Xiao-Fei +6 位作者 Li, Bo Wei, Yong-Gang Yan, Lu-Nan Wen, Tian-Fu Yang, Jia-Yin Wang, Wen-Tao Zhao, Ji-Chun 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2010年第2期135-138,共4页
BACKGROUND: Congestion of the right anterior segment may lead to graft dysfunction in right-lobe living donor liver transplantation (LDLT) without a middle hepatic vein (MHV) trunk. Selective reconstruction of MHV tri... BACKGROUND: Congestion of the right anterior segment may lead to graft dysfunction in right-lobe living donor liver transplantation (LDLT) without a middle hepatic vein (MHV) trunk. Selective reconstruction of MHV tributaries with the interposition of vascular grafts has been introduced to overcome this problem. However, there is still no consensus on the definite criteria of MHV reconstruction. METHODS: LDLT patients were reviewed to evaluate the effects of MHV reconstruction. From March 2005 to September 2008 in our transplantation center, 120 consecutive LDLTs were performed using a right-lobe graft without a MHV. Excluding 11 patients, among the remainder, 73 (67%) had reconstructed MHV tributaries, and the others 36 (33%) did not. The values of liver functional index and liver graft regeneration ratio were compared between the two groups. RESULTS: There was a prolonged period of liver functional recovery in patients with small-for-size grafts and a graft-recipient weight ratio (GRWR) <1.0%, and without MHV reconstruction. The ratio of liver regeneration 1 month postoperatively in reconstruction cases was 81%, versus 78% in patients without reconstruction (P=0.352), but among small-for-size grafts, there was a significant difference between the two groups (95% vs. 80%). CONCLUSION: Our study shows that reconstruction of MHV tributaries is not necessary in all patients, but is beneficial for patients with GRWR <1.0%. (Hepatobiliary Pancrent Dis Int 2010; 9: 135-138) 展开更多
关键词 middle hepatic vein RECONSTRUCTION living donor liver transplantation interposition vascular conduits
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Graft-to-recipient weight ratio lower to 0.7% is safe without portal pressure modulation in right-lobe living donor liver transplantation with favorable conditions 被引量:8
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作者 Seung Duk Lee Seong Hoon Kim +2 位作者 Young-Kyu Kim Soon-Ae Lee Sang-Jae Park 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2014年第1期18-24,共7页
BACKGROUND: The low graft-to-recipient weight ratio(GRWR) in adult-to-adult living donor liver transplantation(LDLT) is one of the major risk factors affecting graft survival. The goal of this study was to evaluate wh... BACKGROUND: The low graft-to-recipient weight ratio(GRWR) in adult-to-adult living donor liver transplantation(LDLT) is one of the major risk factors affecting graft survival. The goal of this study was to evaluate whether the lower limit of the GRWR can be safely reduced without portal pressure modulation in right-lobe LDLT. METHODS: From 2005 to 2011, 317 consecutive patients from a single institute underwent LDLT with right-lobe grafts without portal pressure modulation. Of these, 23 had a GRWR of less than 0.7%(group A), 27 had a GRWR of ≥0.7%, 【0.8%(group B), and 267 had a GRWR of more than and equal to 0.8%(group C). Medical records, including recipient, donor, operation factors, laboratory findings and complications were reviewed retrospectively. RESULTS: The baseline demographics showed low model for end-stage liver disease score(mean 16.3±8.9) and high percentage of hepatocellular carcinoma(231 patients, 72.9%). Three groups by GRWR demonstrated similar characteristics except recipient body mass index and donor gender. For smallforsize syndrome, there were 3(13.0%) in group A, 1(3.7%) in group B, and 2 patients(0.7%) in group C(P【0.001). Hepatic artery thrombosis was more frequently observed in group A than in groups B and C(8.7% vs 3.7% vs 1.9%, P=0.047). However, among the three groups, graft survival rates at 1 year(100% vs 96.3% vs 93.6%) and 3 years(91.7% vs 73.2% vs 88.1%) were not different(P=0.539). In laboratory measurements,there was no group difference in total bilirubin and albumin. However, prothrombin time was longer in group A within postoperative 1 week and platelet count was lower in groups A and B within postoperative 1 month. CONCLUSION: A GRWR lower to 0.7% is safe and does not need to modulate portal pressure in adult-to-adult LDLT using the right-lobe in favorable conditions including low model for end-stage liver disease score. 展开更多
关键词 graft-to-recipient weight ratio living donor liver transplantation small-for-size graft small-for-size syndrome
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Outcomes in children with biliary atresia following liver transplantation 被引量:8
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作者 Li-Ying Sun Yun-Sheng Yang +15 位作者 Zhi-Jun Zhu Wei Gao Lin Wei Xiao-Ye Sun Wei Qu Wei Rao Zhi-Gui Zeng Chong Dong Jin-Peng Tu Jian Wang Yi-He Liu Yuan Liu Li-Xin Yu Yu Wang Jing Li Zhong-Yang Shen 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2013年第2期143-148,共6页
BACKGROUND: Congenital biliary atresia is a rare condition characterized by idiopathic dysgenesis of the bile ducts. If untreated, congenital biliary atresia leads to liver cirrhosis, liver failure and premature death... BACKGROUND: Congenital biliary atresia is a rare condition characterized by idiopathic dysgenesis of the bile ducts. If untreated, congenital biliary atresia leads to liver cirrhosis, liver failure and premature death. The present study aimed to evaluate the outcomes of orthotopic liver transplantation in children with biliary atresia. METHOD: We retrospectively analyzed 45 patients with biliary atresia who had undergone orthotopic liver transplantation from September 2006 to August 2012. RESULTS: The median age of the patients was 11.0 months (5-102). Of the 45 patients, 41 were younger than 3 years old. Their median weight was 9.0 kg (4.5-29.0), 34 of the 45 patients were less than 10 kg. Thirty-one patients had undergone Kasai portoenterostomy prior to orthotopic liver transplantation. We performed 30 living donor liver transplants and 15 split liver transplants. Six patients died during a follow-up. The median follow-up time of surviving patients was 11.4 months (1.4-73.7). The overall 1-, 2- and 3-year survival rates were 88.9%, 84.4% and 84.4%, respectively. CONCLUSION: With advances in surgical techniques and management, children with biliary atresia after liver transplantation can achieve satisfactory survival in China, although there remains a high risk of complications in the early postoperative period. 展开更多
关键词 liver transplantation biliary atresia CHILDREN living donor
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Modified techniques for adult-to-adult living donor liver transplantation 被引量:6
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作者 Lu-Nan Yan, Bo Li, Yong Zeng, Tian-Fu Wen, Ji-Chun Zhao, Wen-Tao Wang, Jia-Yin Yang, Ming-Qing Xu,Yu-Kui Ma, Zhe-Yu Chen, Jiang-Wen Liu and Hong Wu Liver Transplantation Division, Department of Surgery, West China Hospital, Sichuan University, Chengdu 610041 , China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2006年第2期173-179,共7页
BACKGROUND: Because of critical organ shortage, transplant professionals have utilized living donor liver transplantation (LDLT) in recent years. We summarized our experience in adult-to-adult LDLT with grafts of righ... BACKGROUND: Because of critical organ shortage, transplant professionals have utilized living donor liver transplantation (LDLT) in recent years. We summarized our experience in adult-to-adult LDLT with grafts of right liver lobe by a modified technique. METHODS: From January 2002 to August 2005, 24 adult patients underwent living donor liver transplantation with grafts of the right liver lobe at West China Hospital, Sichuan University, China. Twenty-two patients underwent modi-Bed procedures designed to improve the reconstruction of the right hepatic vein and the tributaries of the middle hepatic vein by interposing a great saphenous vein ( GSV) graft and the anastomosis of the hepatic arteries and bile ducts. RESULTS: No severe complications and death occurred in all donors. In the first 2 patients, (patients 1 and 2), operative procedure was not modified. One patient suffered from 'small-for-size syndrome' and the other died of sepsis with progressive deterioration of graft function. In the rest 22 patients (patients 3 to 24), however, the procedure of venous reconstruction was modified, and better results were obtained. Complications occurred in 7 recipients including acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left sub-phrenic abscess (1), and pulmonary infection (1). One patient with pulmonary infection died of multiple organ failure (MOF). The 22 patients underwent direct anastomosis of the right hepatic vein to the inferior vena cava (IVC), 9 direct anastomosis plus the reconstruction of the right inferior hepatic vein, and 10 direct anastomosis plus the reconstruction of the tributaries of the middle hepatic vein by in-terpos-ing a GSV graft to provide sufficient venous outflow. Trifurcation of the portal vein was met in 3 patients. Venoplasty or separate anastomosis was performed. The ratio of graft to recipient body weight ranged from 0.72% to 1.17%. Among these patients, 19 had the ratio <1.0% and 4 <0.8%, and the ratio of graft weight to recipient standard liver volume was between 31.86% and 62.48%. Among these patients, 10 had the ratio <50% and 2 <40%. No 'small-for-size syndrome' occurred in the 22 recipients who were subjected to modified procedures. CONCLUSIONS: With the modified surgical techniques for the reconstruction of the hepatic vein to obtain an adequate outflow and provide a sufficient functioning liver mass, living donor liver graft in adults using the right lobe can be safe to prevent the 'small-for-size syndrome'. 展开更多
关键词 living donor liver transplantation adult-to-adult right lobe graft surgical technique reconstruction of hepatic vein small-for-size syndrome
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