Experience Of Liver Transplantation Research Articles

Certification Training and Liver Transplant Experience Improves Liver Procurement Outcomes: The Dutch Approach.

This study investigates the impact of certification training and liver transplant experience on procurement outcomes of deceased donor liver procurement in the Netherlands. Three groups (trainee, certified, and master) were formed, with further subdivision based on liver transplant experience. Three key outcomes-surgical injury, graft discard after injury, and donor hepatectomy duration-were analyzed. There were no significant differences in surgical graft injury in the three groups (trainee, 16.9%; certified, 14.8%; master, 18.2%; P = 0.357; 2011 to 2018). The only predictor for surgical graft injury was donation after cardiac death (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.10-2.02). Of the three groups, the master group had the highest discard rate after surgical injury (trainee, 0%; certified, 1.3%; master, 2.8%; P = 0.013). Master group without liver transplant experience (OR, 3.16; 95% CI, 1.21-8.27) and male donor sex (OR, 3.58; 95% CI, 1.32-9.73) were independent risk factors for discarding livers after surgical injury. Independent predictors for shorter hepatectomy durations included donors older than 50 years (coefficient [Coeff], -7.04; 95% CI, -8.03 to -3.29; P < 0.001), and master group (Coeff, -9.84; 95% CI, -14.37 to -5.31; P < 0.001) and certified group with liver transplant experience (Coeff, -6.54; 95% CI, -10.83 to -2.26; P = 0.003). On the other hand, master group without liver transplant experience (Coeff, 5.00; 95% CI, 1.03-8.96; P = 0.014) and donation after cardiac death (Coeff, 10.81; 95% CI, 8.32-13.3; P < 0.001) were associated with longer hepatectomy durations. Training and certification in abdominal organ procurement surgery were associated with a reduced discard rate for surgical injured livers and shorter hepatectomy times. The contrast between master group with and without liver transplant experience underscores the need for specialized training in this field.

Experience of adult liver transplantation with the severe portal vein cavernous transformation

Experience of adult liver transplantation with the severe portal vein cavernous transformation

Management strategies on acute fatty liver in pregnancy: the Malaysian experience of liver transplantation in an obstetric emergency

Management strategies on acute fatty liver in pregnancy: the Malaysian experience of liver transplantation in an obstetric emergency

Liver transplantation in Budd–Chiari patients with history of portacaval shunt surgery

The paper presents the experience of successful treating a patient with diuretic-resistant ascites associated with Budd– Chiari syndrome. The authors provide a clinical observation of deceased donor liver transplantation to a patient with Budd–Chiari syndrome type 1, total hepatic vein occlusion, and diuretic-resistant ascites after portacaval shunt surgery. The post-transplantation period is observed as stable, with no signs of liver failure; ascites is reduced. The first experience of surgical treatment of a patient with Budd–Chiari syndrome, as well as the first experience of liver transplantation after portacaval shunting is appeared to be successful.

First experience of liver transplantation after liver trauma: a case report

First experience of liver transplantation after liver trauma: a case report

Experience of liver transplantation in National Scientific Center for Surgery Named after A.N. Syzganov

Experience of liver transplantation in National Scientific Center for Surgery Named after A.N. Syzganov

A small-volume center experience of liver transplantation for the patients with hepatocellular carcinoma

A small-volume center experience of liver transplantation for the patients with hepatocellular carcinoma

Layered Methodologies: Innovating Multimodal Qualitative Research in Liver Transplantation

BackgroundThere is a growing interest in qualitative methodologies for understanding complexities in the lived experience of liver transplantation. Frequently, such studies explore quality of life and offer insights for integrating patient-oriented outcomes into conventional research strategies. The scope of qualitative research in liver transplantation tends to be limited, however, with respect to engagement with critical theories, leaving certain aspects of lived experience unexamined. MethodsThe authors describe the process of layering multiple modes of critical qualitative research in liver transplantation, exploring how experiences in liver transplantation are structured discursively and what aspects of recipients’ stories are not easily spoken or shared. This study pairs a critical discourse analysis of patient manuals from a Canadian liver transplant program with digital storytelling with liver transplant recipients. ResultsA homogenous narrative emerges from patient manuals that does not adequately capture the complexity of lived experience of liver transplant survivors. Digital storytelling opens new narrative possibilities by layering sensory aspects of the transplant experience, which are often difficult to articulate through words. This complicates common ideas of survivorship, who is considered a “good” patient, and the cultural scripts that transplant stories frequently engage. ConclusionCritical qualitative research offers opportunities for understanding structures of power embedded within biomedical transplant narratives. Layering qualitative and arts-based methodologies within a framework of co-creation can shift knowledge/power relations while also intervening through material-discursive practices to offer novel insights and opportunities for critical reflection on transplant experiences for recipients, families, and healthcare providers.

Extended criteria liver donation after circulatory death with prolonged warm ischemia: a pilot experience of normothermic regional perfusion and no subsequent ex-situ machine perfusion

BackgroundLivers from controlled donation after circulatory death (cDCD) with very prolonged warm ischemic time (WIT) are regularly transplanted after abdominal normothermic regional perfusion (aNRP) plus ex-situ machine perfusion (MP). Considering aNRP as in-situ MP, we investigated whether the results of a pilot experience of extended criteria cDCD liver transplantation (LT) with prolonged WIT, with aNRP alone, were comparable to the best possible outcomes in low-risk cDCD LT. MethodsProspectively collected data on 24 cDCD LT, with aNRP alone, were analyzed. ResultsThe median total and asystolic WIT were 51 and 25 min. Measures within benchmark cut-offs were: median duration of surgery (5.9 h); median intraoperative transfusions (3 units of red blood cells); need for renal replacement therapy (2/24 patients); median intensive care stay (3 days); key complications; overall morbidity, graft loss, and retransplantation up to 12 months; 12-month mortality (2/21 patients). The median hospital stay (33 days, due to logistics) and mortality up to 6 months (2/24 patients, due to graft-unrelated causes) exceeded benchmark thresholds. ConclusionsThis pilot experience suggests that livers from cDCD with very prolonged WIT that appear viable during adequate quality aNRP may be safely transplanted, with no need for ex-situ MP, with considerable resource savings.

Long-term outcomes after normothermic machine perfusion in liver transplantation—Experience at a single North American center

Normothermic machine perfusion (NMP) has emerged as a valuable tool in the preservation of liver allografts before transplantation. Randomized trials have shown that replacing static cold storage (SCS) with NMP reduces allograft injury and improves graft utilization. The University of Alberta’s liver transplant program was one of the early adopters of NMP in North America. Herein, we describe our 7-year experience applying NMP to extend preservation time in liver transplantation using a “back-to-base” approach. From 2015 to 2021, 79 livers were transplanted following NMP, compared with 386 after SCS only. NMP livers were preserved for a median time of minutes compared with minutes in the SCS cohort (P < .0001). Despite this, we observed significantly improved 30-day graft survival (P = .030), although there were no differences in long-term patient survival, major complications, or biliary or vascular complications. We also found that although SCS time was strongly associated with increased graft failure at 1 year in the SCS cohort (P = .006), there was no such association among NMP livers (P = .171). Our experience suggests that NMP can safely extend the total preservation time of liver allografts without increasing complications.

A “return to normalcy” or establishing a “new normal”: The patient experience of liver transplantation

BackgroundThe experience of liver transplantation is incompletely understood from the patient perspective. The purpose of this investigation was to characterize patient experiences central to the process of liver transplantation from the time of diagnosis through the first year after liver transplantation. MethodsSemi-structured interviews were conducted at a liver transplant center from January 2021-August 2021 with liver transplant recipients one year following liver transplantation. ResultsTwenty patients and eight caregivers participated in the study. Participants described diverse experiences recognizing and accepting their illness. Motivations for pursuing transplantation were varied as was severity of illness, the perioperative course itself, and the process of recovery after transplant. The establishment of a “new normal” was a consistent theme across participants. Interestingly, we found a tension between the motivations described by many patients and the reality of the outcome many of them faced after transplantation. While, the motivation for many patients was to return to a previous level of physical and mental function they had before their liver disease they often were faced with a new improved status as opposed to a return to their previous full function. This new normal describes tension between restoration of physical function, acceptance of new limitations and a progression toward a new sense of values created by the transplant experience itself. ConclusionsMany recognize that liver transplantation restores physical wellbeing, but few recognize that transplant often fundamentally recreates personhood. Sensitivity, to these changes should be recognized to maximize the success of liver transplantation patients.

Experience of liver transplantation in national scientific center for surgery named after A.N. Syzganov

Experience of liver transplantation in national scientific center for surgery named after A.N. Syzganov

First experience of liver transplantation for HIV-positive patients in Russia

The article presents the results of liver transplantation in five HIV-infected recipients with irreversible liver damage. It is shown that four of them survived in the long-term period and are observed in a stable condition, and the only death in the recipient was not related to the HIV infection. The experience in the treatment of these patients was summarized. Analysis of the first results of liver transplantation in HIV-infection in Russia shows its validity and clinical efficacy. The only lethal case is connected with the initial extremely grave condition of the recipient and his age. Two cases of surgical traumatism, lack of consistent vaccination in the preoperative period, as well as lack of patients with hepatocellular cancer, small number of observations are obvious drawbacks of our first experience and should be corrected in the future. The success of a complex and multidisciplinary program of organ transplantation in HIV infection is impossible without participation of HIV-infectionists in the transplantation team.

Experience of split liver transplantation from deceased marginal donor: eight adult recipients from four deceased donors

Experience of split liver transplantation from deceased marginal donor: eight adult recipients from four deceased donors

Four-year experience of liver transplantation in National Cancer Center of Mongolia

Four-year experience of liver transplantation in National Cancer Center of Mongolia

Early experiences of liver transplantation in new opened hospital

Early experiences of liver transplantation in new opened hospital

Long-term outcomes of retransplantation after live donor liver transplantation: A Western experience

BackgroundDespite most liver transplants in North America being from deceased donors, the number of living donor liver transplants has increased over the last decade. Although outcomes of liver retransplantation after deceased donor liver transplantation have been widely published, outcomes of retransplant after living donor liver transplant need to be further elucidated. MethodWe aimed to compare waitlist outcomes and survival post-retransplant in recipients of initial living or deceased donor grafts. Adult liver recipients relisted at University Health Network between April 2000 and October 2020 were retrospectively identified and grouped according to their initial graft: living donor liver transplants or deceased donor liver transplant. A competing risk multivariable model evaluated the association between graft type at first transplant and outcomes after relisting. Survival after retransplant waitlisting (intention-to-treat) and after retransplant (per protocol) were also assessed. Multivariable Cox regression evaluated the effect of initial graft type on survival after retransplant. ResultsA total of 201 recipients were relisted (living donor liver transplants, n = 67; donor liver transplants, n = 134) and 114 underwent retransplant (living donor liver transplants, n = 48; deceased donor liver transplants, n = 66). The waitlist mortality with an initial living donor liver transplant was not significantly different (hazard ratio = 0.51; 95% confidence interval, 0.23–1.10; P = .08). Both unadjusted and adjusted graft loss risks were similar post-retransplant. The risk-adjusted overall intention-to-treat survival after relisting (hazard ratio = 0.76; 95% confidence interval, 0.44–1.32; P = .30) and per protocol survival after retransplant (hazard ratio:1.51; 95% confidence interval, 0.54–4.19; P = .40) were equivalent in those who initially received a living donor liver transplant. ConclusionPatients requiring relisting and retransplant after either living donor liver transplants or deceased donor liver transplantation experience similar waitlist and survival outcomes.

Experience of liver transplantation in the regional clinical hospital

The purpose of the study is to summarize the first experience of liver transplants. Material and methods. Liver transplantation was performed at the Regional Clinical Hospital. 5 liver transplants from a posthumous donor were performed. Based on the available data, the analysis was carried out according to the following criteria: gender, age, MELD- Na index, cause of liver cirrhosis, method of liver transplantation, duration of surgery, postoperative complications, average bed-day, outcome. Results. In total, 5 liver transplants were performed from a posthumous donor. Among the patients there was 1 man and 4 women. The age of men is 41 years, women are 55.4 ± 9.2 years on average. The MELD- Na index is from 15 to 28, on average 17.8 ± 5.1. When transplanting a cadaveric liver, the method of classical orthotopic liver transplantation was used in 4 cases, in one the piggyback technique was used. The duration of surgical intervention in minutes averaged 394 ± 17.4. Postoperative complications on the Clavien-Dindo scale ranged from I to IIIb. The average bed-day of the patient’s stay in the hospital is 20.2 ± 8.9, including 6.2 ± 1.7 days in the intensive care unit. In all 5 cases, the outcome of liver transplantation is satisfactory. Conclusion. The first results of liver transplantation on the basis of the Regional Clinical Hospital showed that performing such a level of operations is possible in a multidisciplinary medical institution.

Anaesthesia for Liver Transplantation

Abstract Since the first liver transplantation at the Kaunas Clinic of the Hospital of Lithuanian University of Health Sciences (LUHS), in 2000, many changes have been implemented and an increasing number of cases led to the development of expertise. The aim of this article was to summarise 12-years out of liver transplantation experience. Data was obtained retrospectively from inpatient medical records at the Hospital of LUHS, Kaunas Clinic. All cases of liver transplantations from November 2009 to September 2021 were included (n = 96). The median age of transplant recipients was 50 years (IQR 46–56). Two-thirds of recipients were male (n = 66, 69%). The mean Model for End-Stage Liver Disease (MELD) score was 23 (SD 6). The most common indication for liver transplantation was hepatitis C virus-related end-stage liver disease (n = 24, 25%). Immediate extubation was performed with a median of 63% of cases (IQR 14.3–75.7%). We further compared data between the early (November 2009 – December 2015) and late phases (January 2016 – September 2021) of experience: the number of liver transplantation cases increased by 66% from 36 to 60), MELD scores stayed similar (an average of 22 vs 24, p = 0.282), and mean intraoperative time did not change significantly (543 minutes vs 496 minutes, p = 0.078). Liver transplantation has been gaining momentum in Lithuania. Increasing experience enables our centre to meet an increasing demand for liver transplantations.

Early experiences of liver transplantation in new opened hospital

Early experiences of liver transplantation in new opened hospital