693 research outputs found
Reply: Viability assessment and transplantation of fatty liver grafts using end-ischemic normothermic machine perfusion
No full textTransplantation bench surgery of the abdominal organs
No full textLiver bench surgery: carefully dissect the donor inferior vena cava, especially in the suprahepatic region, where the adventitia is firmly adherent to the surrounding diaphragm, and on the posterior side to avoid uncontrollable posterior bleeding during implantation. Recognize hepatic artery variations (Michel’s classification) when examining the superior mesenteric artery. Dissect the hepatic artery from the aortic patch to the level of bifurcation of the gastroduodenal artery, cleaning off the celiac plexus and fibrofatty tissue enveloping the vessels. Do not ligate the small collaterals too near to the vascular ostia, especially in atheromasic arteries.
Kidney bench surgery: carefully remove the perinephric fat without skeletonizing the ureters; avoid extensive opening and massive cleaning of perinephric fat in kidneys from older donors. Mark and subtend both the ureters with light mosquito forceps to avoid their accidental shortening and injury. Cut the left renal vein along the left margin of the vena cava. Choose the right renal vein elongation technique that is most appropriate according to the shape of the vein. Pay special attention to the inferior polar arteries, which often originate far from the main renal artery, from the inferior abdominal aorta, or from the iliac axis.
Pancreas bench surgery: manipulate the pancreas parenchyma very carefully to minimize edema, injuries, and bleeding, all factors which increase the risk of acute pancreatitis of the graft
Current surgical management of peri-hilar and intra-hepatic cholangiocarcinoma
No full textCholangiocarcinoma accounts for approximately 10% of all hepatobiliary tumors and represents 3% of all new-diagnosed malignancies worldwide. Intrahepatic cholangiocarcinoma (i-CCA) accounts for 10% of all cases, perihilar (h-CCA) cholangiocarcinoma represents two-thirds of the cases, while distal cholangiocarcinoma accounts for the remaining quarter. Originally described by Klatskin in 1965, h-CCA represents one of the most challenging tumors for hepatobiliary surgeons, mainly because of the anatomical vascular relationships of the biliary confluence at the hepatic hilum. Surgery is the only curative option, with the goal of a radical, margin-negative (R0) tumor resection. Continuous efforts have been made by hepatobiliary surgeons in order to achieve R0 resections, leading to the progressive development of aggressive approaches that include extended hepatectomies, associating liver partition, and portal vein ligation for staged hepatectomy, preoperative portal vein embolization, and vascular resections. i-CCA is an aggressive biliary cancer that arises from the biliary epithelium proximal to the second-degree bile ducts. The incidence of i-CCA is dramatically increasing worldwide, and surgical resection is the only potentially curative therapy. An aggressive surgical approach, including extended liver resection and vascular reconstruction, and a greater application of systemic therapy and locoregional treatments could lead to an increase in the resection rate and the overall survival in selected i-CCA patients. Improvements achieved over the last two decades and the encouraging results recently reported have led to liver transplantation now being considered an appropriate indication for CCA patients
Hyper-Urgent Liver Transplantation for Posttraumatic and Surgical Iatrogenic Acute Liver Failure
No full textPancreatico-duodenectomy and postoperative pancreatic fistula: Risk factors and technical considerations in a specialized HPB center
No full textThe long-term follow-up of the living liver donors
No full textLiving donor liver transplantation (LDLT) has been proposed in many countries to reduce organ shortage. While the early postoperative outcomes have been well investigated, little is known about the long-term follow-up of the living donors. We, therefore, designed a systematic review of the literature to explore long-term complications and quality of life among living donors. We searched MEDLINE and EMBASE registries for studies published since 2013 that specifically addressed long-term follow-up following living-donor liver donation, concerning both physical and psychological aspects. Publications with a follow-up shorter than 1 year or that did not clearly state the timing of outcomes were excluded. A total of 2505 papers were initially identified. After a thorough selection, 17 articles were identified as meeting the eligibility criteria. The selected articles were mostly from North America and Eastern countries. Follow-up periods ranged from 1 to 11.5 years. The most common complications were incision site discomfort (13.2–38.8%) and psychiatric disorders (1–22%). Biliary strictures occurred in 1–14% of cases. Minimally invasive donor hepatectomy could improve quality of life, but long-term data are limited. About 30 years after the first reported LDLT, little has been published about the long-term follow-up of the living donors. Different factors may contribute to this gap, including the fact that, as healthy individuals, living donors are frequently lost during mid-term follow-up. Although the reported studies seem to confirm long-term donor safety, further research is needed to address the real-life long-term impact of this procedure. Graphical abstract: (Figure presented.
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