Donor Hepatectomy For Liver Transplantation Research Articles

Surgical experience of hepatectomy in a live donor with absent celiac trunk - a case report

BackgroundCeliac trunk agenesis is the recent and the rarest vascular variation reported. Reported cases in literature were identified either incidentally on imaging or while cadaveric dissections. This is a unique experience of hepatectomy in a patient without celiac artery ever reported.Case presentationThis is a case of a patient who was scheduled to undergo donor hepatectomy. He was found to have a rare anatomical variation of agenesis of the celiac trunk during preoperative imaging done as a routine transplant surgery workup. He underwent live donor hepatectomy with no intra-operative or post-operative complications. This is the first case to be reported in the literature of a donor hepatectomy for liver transplantation in a patient with this rarest vascular variation of the celiac axis.ConclusionPre-operative imaging to determine hepatic vascular anatomy improves the understanding of the surgeon intraoperatively while dissection and decreases the chance of any iatrogenic damage.

Duodenal Ulcer as a Postoperative Complication in the Donor in Living-Donor Liver Transplantation

IntroductionDonor safety is one of the most important factors in living-donor liver transplantation. Duodenal ulcer (DU) is a common postoperative complication. Here we aimed to reveal the risk factors associated with postoperative DU in the donors. MethodsBetween April 2007 and March 2017, 318 cases underwent donor hepatectomy for liver transplantation at Kumamoto University Hospital. We classified the donors into two groups: a DU group and a non-DU group. DU was defined as mucosal break with unequivocal depth requiring an endoscopic procedure. The characteristics and clinical factors of the donors were retrospectively analyzed. ResultsPostoperative DU occurred in 17 donors during the study period. The mean interval after donor hepatectomy to occurrence of DU was 124.8 ± 185.4 days. The two groups were comparable in terms of age at time of the donor hepatectomy (P = .45). The male-to-female ratio (P = .03) was significantly different between the two groups and left-side hepatectomy was performed more often in the DU group (P = .003). Multivariable logistic regression revealed that left-side hepatectomy was independently associated with postoperative DU in the donors. ConclusionsThese findings indicated that left-side hepatectomy is a risk factor for postoperative DU in the donors.

Surgery for primary liver malignancies – innovations and limitations

Primary liver malignancies mainly arise from hepatocytes or bile duct cells. They become clinically evident as hepatocellular carcinomas (HCCs) and intrahepatic or hilar cholangiocarcinoma (CC). The treatment of these tumours is based on an interdisciplinary, multimodal approach, in which surgery has a major role. As techniques have improved, more patients can undergo safe operations, including extended resections and vascular reconstructions. In the case of an expected critical liver remnant after surgery, techniques before or during surgery can be used to induce liver hypertrophy, which reduces postoperative liver failure. There is ongoing discussion about whether resection or transplantation in cirrhotic livers is preferred in patients with HCCs. Patients with cholangiocarcinomas should undergo transplantation only within clinical trials. A neoadjuvant treatment protocol (Mayo Clinic protocol) that improves surgical outcome in patients with hilar CCs has been established. Nevertheless, criteria to predict good outcome of liver transplantation in patients HCCs and CCs exist and should be respected. Recent innovations in liver surgery are minimally invasive procedures. The innovative approach of robotic-assisted operations is a technical upgrade to conventional laparoscopy. These methods enable experienced surgeons to perform nearly all types of surgery, including living donor hepatectomy for liver transplantation. The oncological outcomes after minimally invasive liver resection are comparable to those of open procedures. For most patients surgery remains the only chance for complete cure and therefore it is still the most commonly performed procedure for primary liver tumour treatment. New innovative techniques will support the impact of surgery in the future.

Quality of Life After Living Donor Hepatectomy for Liver Transplantation.

Living donor liver transplantation (LDLT) involves healthy individuals undergoing voluntary major hepatic resection. LDLT program only started in 2012 in Pakistan and its impact on donor's quality of life (QOL) post resection is not known. The objective of this study was to determine health-related QOL in donors who underwent hepatectomy in country's first liver transplant program. A total of 60 donors who underwent hepatectomy between 2012 and 2014 with a minimum follow-up of 6 months were included in the study. Short form (SF-36) and Profile of mood states (POMS-65) was used to assess QOL. In addition scores were compared between patients who did and did not develop complications. Mean time duration between hepatectomy and administration of questionnaire was 15 ± 5.1 months. Median age was 28 (19-45) years. Mean BMI was 24.4 ± 3.7. A total of 7 (11.6%) Grade 3 and above complications were observed in donors. Donors exceeded a score of 90 in 6 out of 8 evaluated categories on SF-36. The highest mean score was recorded for emotional role limitation 95.5 ± 17.1 and lowest for energy 84.8 ± 17.5. The mean score for anger was 6.6 ± 7.5. Donors also did well on the POMS vigor score with a mean of 22.7 ± 5. No significant difference in scores was observed between donors with and without complications for any of the categories except tension. Donors who developed complications post-operatively had a significantly low mean tension score of 1.5 versus 3.8 for donors without complications. Acceptable post donation QOL was achieved and surgical complications did not adversely affect SF-36 and POMS scores.

Delayed gastric emptying after living donor hepatectomy for liver transplantation.

Delayed gastric emptying is a significant postoperative complication of living donor hepatectomy for liver transplantation and may require endoscopic or surgical intervention in severe cases. Although the mechanism of posthepatectomy delayed gastric emptying remains unknown, vagal nerve injury during intraoperative dissection and adhesion formation postoperatively between the stomach and cut liver surface are possible explanations. Here, we present the first reported case of delayed gastric emptying following fully laparoscopic hepatectomy for living donor liver transplantation. Additionally, we also present a case in which symptoms developed after open right hepatectomy, but for which dissection for left hepatectomy was first performed. Through our experience and these two specific cases, we favor a neurovascular etiology for delayed gastric emptying after hepatectomy.

Low-dose Heparin Therapy During Living Donor Right Hepatectomy Is Associated With Few Side Effects and Does Not Increase Vascular Thrombosis in Liver Transplantation

BackgroundAt many centers, various heparin doses have been administrated systemically during living donor partial hepatectomy in an effort to minimize the potential for graft vascular thrombosis, which could lead to delayed graft function. However, there is no consensus regarding the advisability of heparin administration during living donor hepatectomy for liver transplantation. MethodsWe prospectively enrolled 270 donors between 2005 and 2011 to investigate donor and recipient outcomes between a low dose (25 IU/kg) and a conventional dose of heparin (50 IU/kg). ResultsThe low-dose heparin group did not show an increased incidence of vascular thrombosis: the rates of hepatic artery and portal vein thromboses were not significantly different between the two groups (P = .935 and P = .158, respectively). In addition, injection of low-dose heparin reduced donor complications with significant differences in postoperative hospital stay (P < .001), donor operative time (P < .001), hemoglobin/hematocrit decrease (P = .05/P = .02) and hemorrhagic complications (P = .004). ConclusionsAdministration of low-dose heparin during living donor hepatectomy can be used without worsening vascular thrombosis or donor complications.

Live donor hepatectomy for liver transplantation in Egypt: Lessons learned

Purpose:To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011.Methods:After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed.Results:One hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of (50.1%). The most frequent complication was infection (21.1%) (intraabdominal collections), followed by biliary leak (18.2%). Two donors had major complications: one had portal vein thrombosis (PVT) treated with vascular stent. This patient recovered fully. The other donor had serious intraoperative bleeding and developed postoperative PVT and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely (n=90) with no epidural hematoma despite significantly elevated prothrombin time (PT) and international normalization ratio (INR) postoperatively, reaching the maximum on Day 1 (16.9±2.5 s and 1.4±0.2, P<0.05 when compared with baseline). Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05±0.18 mg/dL on Day 1 and 2.3±0.83 mg/dL on Day 3 postoperatively.Conclusions:Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. PT and INR monitoring postoperatively is still necessary for best timing of epidural catheter removal. Live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. Donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting.

Laparoscopic living donor hepatectomy for liver transplantation in children

Because cadaveric organ donors are in short supply, living donors are increasingly being used in transplantations. We have developed a safe and reproducible method for laparoscopic liver resection. Left hepatic lobectomy (resection of segments 2 and 3) was done by laparoscopy in one woman aged 27 years and one man aged 31 years. The grafts were prepared under laparoscopy, without any vascular clamping, and were externalised through a suprapubic Pfannenstiel incision. Both grafts were transplanted conventionally to the patients' respective sons, who were both aged 1 year and had biliary atresia. Donor operations lasted 7 h for the woman and 6 h for the man, and warm ischaemia times were 4 and 10 min, respectively. Blood loss was 150 and 450 mL, respectively, and no transfusions were required. Neither patient had complications during or after surgery; and hospital stay was 7 and 5 days, respectively. Both recipients are alive and have excellent graft function. We have shown the feasibility of laparoscopic living donor hepatectomy from parent to child. If the safety and feasibility of this procedure can be shown in larger series, laparoscopic donor left lobectomy could become a new option for paediatric living donor liver transplantation.