Patients Undergoing Liver Transplantation Research Articles

Reassessment After Locoregional Treatment of Hepatocellular Carcinoma Previous Liver Transplantation: Is MRI Necessary for All Patients?

The tumor response of cirrhotic patients with hepatocellular carcinoma (HCC) undergoing locoregional treatment (TLR) before liver transplantation can be evaluated using different imaging tests. The aim of this study was to compare the correlation of radiological response evaluated by magnetic resonance imaging (MRI) vs computed tomography (CT) vs ultrasound with histopathological findings. A retrospective single-center study was performed. Data of patients undergoing Liver transplantation due to HCC between January 2010 and December were collected, selecting patients who underwent TLR. Four hundred and four patients were transplanted, of whom 103 (25.5%) had HCC. Ninety-seven patients (93.2%) received TLR. Eighty-eight of these patients (90.7%) underwent a reevaluation imaging test: 8 (8.2%) underwent ultrasound, 68 (70.1%) underwent MRI, and 12 (12.4%) underwent CT. Of the 88 patients, 59% were classified as nonviable LR-TR (Liver Imaging Reporting and Data System Treatment Response), 32.5% as viable LR-TR, and the rest (8.5%) as equivocal LR-TR. Regarding the correlation of the degree of radiological response according to each imaging test, ultrasound categorized 62.5% as nonviable LR-TR vs 60.6% by MRI vs 44.4% by CT, with these differences not being significant (P=.779). Regarding the correlation of patients classified as nonviable LR-TR by each test and total tumor necrosis in histopathology, both MRI and ultrasound correctly classified 60% of complete necrosis as nonviable LR-TR, and in the case of CT, it was 50%, with these differences not being significant (P=1). Ultrasound and CT have obtained similar results as reevaluation tests to MRI, which could replace it in case of unavailability of the latter.

Impact of Ischemia and Preservation Times on Survival in Transplant Recipients From After Circulatory Death Donors

The limitation of ischemia times, which damages the organs and impacts transplant outcomes, is a drawback of controlled donation after circulatory death. The aim of the study was to analyze the influence of preservation and ischemia times on overall survival and both censured graft survival and overall graft survival. This was an observational and retrospective study of patients undergoing liver transplantation with grafts from controlled donation after circulatory death between November 2013 and November 2022. Sixty-five patients were included in the study. Twenty percent (12 patients) developed early graft dysfunction according to Olthoff's classification, and 7 patients (11.6%) scored ≥7 points according to the Model for Early Allograft Function Scoring scale. Five patients (7.6%) met the criteria for primary graft failure. The retransplantation rate was 9.2% (6 cases). Fifty patients (76.9%) remained alive, and 15 patients (23.1%) died. When analyzing overall survival based on the main preservation and ischemia times, we observed that the best results occurred in the group with a functional warm ischemia time <12 minutes, with a survival rate at 1, 3, and 5 years of 95.8%, 87.1%, and 87.1%, respectively (P=.043). Regarding the analysis of censured graft survival based on the main preservation and ischemia times, we found that the worst results occurred in the group with a cold ischemia time ≥6 hours, with a survival rate of around 48% at 3 and 5 years (P=.047). High-risk patients have lower overall and graft survival in the short and long term in grafts from controlled donation after circulatory death.

Diabetes mellitus posterior a trasplante hepático y el impacto del antecedente familiar de diabetes en una cohorte mexicana

Introduction and aimsPosttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD). MethodsA retrospective single-center cohort study was conducted on patients undergoing liver transplantation. The primary outcome was time from liver transplantation to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM. ResultsA total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n=29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n=23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; P=.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), P=.005) and 3.48 (95% CI 1.35-9.01, P=.010), when further controlled for pretransplant prediabetes. ConclusionThe occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program.

MRI features for predicting the pathological grade of HCC in patients undergoing liver transplantation

BackgroundContrast-enhanced magnetic resonance imaging (MRI) plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC). This study aims to assess the performance of MRI features for evaluating hepatocellular carcinoma (HCC) aggressiveness in living liver transplantation in patients.Material and methodsThis retrospective study included patients who underwent liver transplantation in our hospital between 2015 and 2020. Abdominal contrast-enhanced MRIs of these patients were reviewed, and clinical, radiological, and histopathological findings of HCCs were recorded. The prognostic features of HCCs as determined by MRI were compared with Edmondson-Steiner (E-S) grades. Liver parenchyma fibrosis based on an apparent diffusion coefficient (ADC) map was correlated with histological subclassification of cirrhosis using the Laennec staging system.ResultsThe study subjects included 37 men and 8 women with a mean age of 59.56 ± 7.81 (range: 25–72). The mean tumour size was 37.33 ± 22.27 mm (range: 10–118 mm), and nine tumours (23.1%) involved portal vein tumour thrombosis. There was a significant correlation between tumour grade and size (p = 0.007) and intratumoral fat (p = 0.014) even though no significant correlations between grade and mean ADC value, capsule appearance, presence of satellite lesions, smooth margin, imaging of the tumour feeding artery, and corona enhancement of HCC (p > 0.05) were found. There was a statistically significant correlation between mild (stage 4A) and moderate (stage 4B) fibrosis of non-tumorous liver parenchyma and ADC value (p < 0.001).ConclusionOur study found that ADC values can be used to distinguish mild cirrhotic livers from moderate cirrhotic livers. Diffusion MRI might be used to diagnose the degree of liver fibrosis without histopathological analysis. According to our results, only intralesional fat and tumour size correlated with tumour grade, and as such, these parameters could be used as prognostic MRI biomarkers for HCC.

Osmotic Demyelination Syndrome after Correction of Hyponatremia

Osmotic demyelination syndrome is a rare neurological disease resulting in cerebral apoptosis and loss of myelin due to osmotic stress. Based on anatomical localization and pathological attributes, ODS can be categorized as Central Pontine Myelinolysis (CPM) and Extrapontine Myelinolysis (EPM). It has a biphasic course, with first phase reflecting electrolyte imbalance and the second with pontine dysfunction, impaired vigilance and movement disorders. In an autopsy-based study, a prevalence rate of 0.25–0.5% was seen in the general population and 10% in patients undergoing liver transplantation. Being a rare disease with variable, but preventable outcome, the present case was managed with Ayurvedic oral medication and Panchakarma therapy with an aim to improve the quality of life. In Ayurvedic perspective, Vata kshaya lakshanas occur during the phase of hyponatremia and further correction of this leads to disruption of osmolality (Kapha pitta accumulation) resulting in Avarana of Vata. This may be the reason for demyelination and localisation of Vata in Sira and Snayu leading to Sira snayu shoshana on both halves of the body resulting in Sarvangaroga (full body afflicted with Vata). Thus Avaranahara, Srotosodhana and Vatanulomana principles were adopted. An improvement in Barthel index and modified rankin scale were observed after a course of treatment for 30 days.

A clinical review of congenital hepatic fibrosis diagnosed in adulthood: presentation, complications, and outcomes

Introduction and ObjectivesCongenital hepatic fibrosis (CHF) is a rare condition characterized by biliary tract changes and a geographic pattern of liver fibrosis. Liver biopsy is essential to confirm its diagnosis. The absence of specific clinical indicators in adults often leads to delays in diagnosis and management, while the natural history has not been well described. We sought to define the presentation and outcomes of adults with biopsy-proven CHF. Materials and MethodsA retrospective chart review was conducted of patients diagnosed with CHF by liver biopsy. Continuous variables were summarized with the sample median and range. Categorical variables were summarized with number and percentage of patients. ResultsWe identified 24 patients evaluated over a 20-year period, with a median age of 51 years (range 22–72 years) at initial presentation; 14 were male. The most common imaging findings were renal cysts (91.3%), splenomegaly (69.6%), and a cirrhotic-appearing liver (60.9%). The most commonly treated liver-related complications were cholangitis (45.8%), varices (45.8%), and hepatic encephalopathy (25%). Two patients died with a median length of follow-up of 2.9 years (range: 0.0–20.0 years). Two patients underwent transjugular intrahepatic portosystemic shunt (TIPS) placement to manage bleeding esophageal varices. Eight patients underwent liver transplantation (LT), the most common indication being decompensated disease (50%). ConclusionsCHF should be considered when patients present with cholangitis and/or complications of portal hypertension and have a cirrhotic appearing liver and renal cysts on imaging. Depending upon the disease severity, interventions such as TIPS or LT may be required.

TCT-742 The Association of Incidentally Found Coronary Artery Disease and Empiric Revascularization on Postoperative Myocardial Infarction, Stroke, and Death in Patients Undergoing Liver Transplantation

TCT-742 The Association of Incidentally Found Coronary Artery Disease and Empiric Revascularization on Postoperative Myocardial Infarction, Stroke, and Death in Patients Undergoing Liver Transplantation

S1611 Treatment of Patients Undergoing Liver Transplant for Portopulmonary Hypertension with Oral Therapy

S1611 Treatment of Patients Undergoing Liver Transplant for Portopulmonary Hypertension with Oral Therapy

Impact of sarcopenia on the survival of patients undergoing liver transplantation for decompensated liver cirrhosis.

Patients with decompensated cirrhosis (DC) are prone to skeletal muscle loss, namely, sarcopenia, before liver transplantation (LT). While sarcopenia is reportedly associated with adverse outcomes after LT, these findings are limited owing to mixed diseases and retrospective data. We investigated the association between sarcopenia and 1-year overall survival (OS) in patients with DC after LT and established and validated a prediction model for postoperative OS based on sarcopenia. Overall, 222 consecutive patients who underwent LT at our centre were registered between September 2020 and June 2022. Third lumbar spine skeletal muscle mass index was measured using computed tomography. Patients were divided into sarcopenia and non-sarcopenia groups according to the skeletal muscle mass index, and baseline data and postoperative outcomes were collected, compared and analysed. The primary outcome was the 1-year OS after LT. We established a dynamic nomogram of the OS predictive model. We included 177DC patients [mean (standard deviation) age, 50.2±9.3years; 52 women (29.4%)]; 73 (41.2%) had sarcopenia. The mean (standard deviation) body mass index was 22.6±4.5kg/m2 , 28 (15.8%) patients had weight loss ≥5% within 6months before admission, and the mean (standard deviation) model for end-stage liver disease (MELD) score was 18.4±7.9. Patients with sarcopenia had a longer duration of intensive care unit stay (4.1±2.2 vs. 3.1±1.1days, P=0.008), higher rate of major complications (45.2% vs. 22.1%, P=0.001) and higher postoperative mortality (15.1% vs. 2.9%, P=0.003) than those without sarcopenia. The median 1-year OS after surgery was shorter in patients with sarcopenia than in those without (P<0.001). Sarcopenia [hazard ratio (HR), 2.54; 95% confidence interval (CI), 1.54-5.63; P=0.022], weight loss ≥5% (HR, 2.46; 95% CI, 1.39-5.09; P=0.015) and MELD score (HR, 1.05; 95% CI, 1.01-1.09; P=0.009) were independent risk factors associated with 1-year OS. The area under the curve of the established dynamic nomogram was 0.774, the calibration curve showed good consistency, and analysis of the decision curve showed more clinical benefits than the MELD score alone. High-risk patients (>102.9 points calculated using the nomogram) had a significantly reduced survival rate. Sarcopenia is associated with adverse outcomes after LT in patients with DC. High-risk patients should be classified by dynamic nomogram upon admission.

Role of NRF2 and reactive aldehydes in acute cellular rejection in liver transplant recipients

ObjectiveTo evaluate the level of oxidative stress and antioxidative response in the transplanted liver and its role in acute cellular rejection (ACR). Particular attention was paid to ACR diagnosis in patients with hepatitis C (HCV), as histopathological features of ACR and viral disease recurrence overlap. MethodsThis retrospective study included 40 liver transplant patients who underwent liver transplantation with two consecutive liver biopsies performed during one hospitalization period: 1.) initial biopsy of the donor liver (before implantation) and 2.) indication biopsy (after suspected ACR). Based on the etiology, patients were divided into two groups: 22 patients with alcoholic liver cirrhosis (EtOH group) and 18 patients with hepatitis C cirrhosis (HCV group). We analyzed the presence of acrolein, HNE (4-hydroxynonenal), and the major antioxidant transcription factor NRF2 (nuclear factor erythroid 2-related factor 2) in both biopsies. ResultsThe presence of acrolein and HNE in both biopsies indicates increased oxidative stress, while the decrease in these aldehydes in the indication biopsies indicates a decrease in oxidative stress over time, reflecting liver graft recovery. The absence of NRF2 in both biopsies reflects significantly reduced antioxidant protection in patients undergoing liver transplantation. ConclusionThe results support the role of oxidative stress in the pathogenesis of ACR. The presence of acrolein and the absence of HNE in the indication biopsy in patients with ACR could contribute to the diagnosis of ACR in clinical practice when functional antibodies are tested in the clinical setting.

Post-COVID-19 cholangiopathy: Systematic review.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on global health, primarily characterized by severe respiratory illness. However, emerging evidence suggests that COVID-19 can also lead to secondary sclerosing cholangitis (SC), referred to as post-COVID-19 cholangiopathy. To synthesize currently reported cases to assess the current state of knowledge on post-COVID-19 cholangiopathy. Medical Subject Headings and Health Sciences Descriptors were used to retrieve relevant studies, which were combined using Boolean operators. Searches were conducted on electronic databases including Scopus, Web of Science, and MEDLINE (PubMed). Studies published in English, Spanish, or Portuguese were included, with no restrictions on the publication date. Additionally, the reference lists of retrieved studies were manually searched. Simple descriptive analyses were used to summarize the results. Then the data were extracted and assessed based on Reference Citation Analysis (https://www.referencecitationanalysis.com/). The initial search yielded a total of 192 articles. After screening, 85 articles were excluded due to duplication, leaving 107 articles for further review. Of these, 63 full-length articles met the inclusion criteria and were included in the analyses. Most of the patients were male and exhibited elevated liver function tests (93.8%). Magnetic resonance imaging revealed duct thickening with contrast enhancement (47.7%), as well as beading of the intrahepatic ducts (45.7%) with peribiliary contrast enhancement on diffusion (28.7%). Liver biopsy results confirmed SC in most cases (74.4%). Sixteen patients underwent liver transplantation, with three experiencing successful outcomes. Post-COVID-19 cholangiopathy is a serious condition that is expected to become increasingly concerning in the coming years, particularly considering long COVID syndromes. Although liver transplantation has been proposed as a potential treatment option, more research is necessary to establish its efficacy and explore other potential treatments.

Gammagrafía de perfusión miocárdica en la evaluación del riesgo cardiovascular en el trasplante hepático de adultos

IntroductionThe non-invasive diagnostic study of cardiovascular risk in patients who are going to undergo liver transplantation is not clear, especially in asymptomatic patients. Regarding myocardial perfusion scintigraphy (MPS), it has been thought that the impaired vasodilator reserve in these patients may reduce its performance. The objective is to assess the role of the MPS in the pre-surgical evaluation of patients who are going to undergo liver transplantation. Material and methodsRetrospective, descriptive and observational study was designed. All adult patients undergoing liver transplantation between 2017 and 2021 who had previous MPS were included. The findings of MPS were described and correlated with the findings of invasive angiography and with the appearance or not of peri- and post-transplant cardiovascular events. ResultsThere were a total of 188 transplanted patients (mean age: 57 years, SD: 12), 178 had previous myocardial perfusion, 82 (46%) patients had no cardiovascular risk factors, and 5 (2.8%) had a history of coronary disease.Of the MPS, 177 were with dipyridamole stress performed on average 10 months before transplantation. Only 17/178 (9.5%) studies were abnormal. The mean follow-up was 38 months (SD: 10). Of the patients with normal MPS, only 2 (1.2%) presented cardiovascular events, both with studies performed more than 2years before the procedure. There were no deaths of cardiovascular origin. ConclusionsMPS is a safe and reliable technique for cardiovascular assessment of patients who are candidates for liver transplantation, given the low rate of false negatives during follow-up.

Role of protein induced by vitamin-K absence-II in transplanted patients with HCC not producing alpha-fetoprotein.

Elevated Protein Induced by Vitamin-K Absence-II (PIVKA-II) has been shown to be an adverse prognostic factor in HCC patients undergoing liver transplantation (LT). No definitive data are available about the impact of PIVKA-II concerning post-LT recurrence in patients not secreting (≤ 20ng/mL) alpha-fetoprotein (AFP). An observational retrospective study of the East-West HCC-LT consortium is reported. Between 2000 and 2019, 639 HCC patients were enrolled in 5 collaborative European and Japanese centers. To minimize the initial selection bias, an inverse probability therapy weighting method was adopted to analyze the data. In the post-inverse probability therapy weighting population, PIVKA-II (HR = 2.00; 95% CI: 1.52-2.64; p < 0.001) and AFP (HR=1.82; 95% CI: 1.48-2.24; p < 0.001) were the most relevant independent risk factors for post-LT recurrence. A sub-analysis focusing only on patients who are AFP non-secreting confirmed the negative role of PIVKA-II (HR=2.06, 95% CI: 1.26-3.35; p =0.004). When categorizing the entire population into 4 groups according to the AFP levels (≤ or > 20ng/mL) and PIVKA (≤ or > 300mUA/mL) at the time of LT, the lowest recurrence rates were observed in the low AFP-PIVKA-II group (5-year recurrence rate = 8.0%). Conversely, the high AFP-PIVKA-II group had the worst outcome (5-year recurrence rate = 35.1%). PIVKA-II secretion is a relevant risk factor for post-LT HCC recurrence. The role of this marker is independent of the AFP status. Combining both tumor markers, especially in the setting of LT, should be of great relevance for adding information about predicting the post-LT risk of tumor recurrence and selecting these patients for transplantation.

Myocardial perfusion scintigraphy in the assessment of cardiovascular risk in adult liver transplantation

IntroductionThe non-invasive diagnostic study of cardiovascular risk in patients who are going to undergo liver transplantation is not clear, especially in asymptomatic patients. Regarding myocardial perfusion scintigraphy (MPS), it has been thought that the impaired vasodilator reserve in these patients may reduce its performance. The objective is to assess the role of the MPS in the pre-surgical evaluation of patients who are going to undergo liver transplantation. Material and methodsRetrospective, descriptive and observational study was designed. All adult patients undergoing liver transplantation between 2017 and 2021 who had previous MPS were included. The findings of MPS were described and correlated with the findings of invasive angiography and with the appearance or not of peri- and post-transplant cardiovascular events. ResultsThere were a total of 188 transplanted patients (mean age: 57 years, SD: 12), 178 had previous myocardial perfusion, 82 (46%) patients had no cardiovascular risk factors, and 5 (2.8%) had a history of coronary disease.Of the MPS, 177 were with dipyridamole stress performed on average 10 months before transplantation. Only 17/178 (9.5%) studies were abnormal. The mean follow-up was 38 months (SD: 10). Of the patients with normal MPS, only 2 (1.2%) presented cardiovascular events, both with studies performed more than 2 years before the procedure. There were no deaths of cardiovascular origin. ConclusionsMPS is a safe and reliable technique for cardiovascular assessment of patients who are candidates for liver transplantation, given the low rate of false negatives during follow-up.

The influence of muscle performance and fatigue on prognosis in patients with compensated liver disease

BackgroundPoor muscle function is associated with a negative prognosis in advanced liver disease but the impact in compensated chronic liver disease is unknown. Similar prognostic uncertainty applies to fatigue. We aimed to assess the prognostic value of muscle performance and fatigue in a cohort of patients with compensated chronic liver disease.MethodsWe followed 241 patients with compensated chronic liver disease included in a study between 2010 and 2014. Subjects were 52 ± 15 years (mean ± SD; 134 females). All subjects performed four muscle function tests: “Timed Up and Go” test, walking speed, handgrip strength, and standing heel-rises. Fatigue was evaluated by fatigue impact scale. Follow up data was acquired through hospital records and registries.ResultsDuring follow up of 6.75 ± 1.4 years, 13 patients died (5.5%) and 11 (4.5%) patients underwent liver transplantation. A timed up and go over 10 s was not significantly associated with a lower survival (Kaplan-Meier, log rank test p = 0.132), or with transplant free survival (p = 0.543), Fig. 3. It was also not specifically associated with liver related causes of death (p = 0.597). The other physical functioning tests and fatigue were not significantly associated with mortality or transplant-free survival (p > 0.05 for all) except for maximal walking speed (2.2 vs. 1.9 m/s, p = 0.007).ConclusionsOur study suggests that muscle function and fatigue are not key prognostic factors in compensated chronic liver disease. However, further confirmation in future studies is needed.

Tracing anti-cancer immunity in patients undergoing liver transplantation for HCC after downstaging with immunotherapy

Tracing anti-cancer immunity in patients undergoing liver transplantation for HCC after downstaging with immunotherapy

Prolonged Tracheal Intubation in the ICU as a Possible Risk Factor for Arytenoid Dislocation After Liver Transplant Surgery: A Retrospective Case-Control Study.

BACKGROUND Arytenoid dislocation (AD) is a rare complication of general anesthesia with tracheal intubation, with a published incidence of 0.009-0.097%. This retrospective case-control study aimed to identify risk factors associated with AD in patients who underwent liver transplantation. MATERIAL AND METHODS This study included 476 patients who underwent liver transplantation between January 2013 and December 2022. Patients with AD who underwent surgery were included in the AD group. For each case of AD, 4 patients matched by anesthesia type and anesthetist were randomly selected as the non-AD group. Data on patient characteristics, anesthetic factors, and surgical factors were collected and compared between patients with and without AD. Logistic regression analysis was performed to determine the risk factors for AD after liver transplantation. RESULTS Of the 476 patients who underwent liver transplantation, 17 (3.57%) had AD. AD occurred on the left side in 13 patients and on the right side in 4 patients. The 17 patients who experienced AD and 68 matched non-AD patients were enrolled. Patients in the AD group had a greater intubation depth (24 [23-24] vs 24 [24-24], P=0.043), a higher level of hemoglobin (134.5 [118-147.5] vs 112 [96.25-125], P=0.014), and prolonged tracheal intubation in the ICU (19.75 [15.87-31.87] vs 13 [10.62-15], P<0.001) compared to those in the non-dislocation group. Multivariate logistic regression analysis showed that prolonged tracheal intubation in the ICU was independently associated with the occurrence of AD in patients who underwent liver transplantation (P=0.013). CONCLUSIONS This study showed that the incidence of AD was 3.57% in patients undergoing liver transplant surgery and that prolonged tracheal intubation in the ICU was a possible risk factor for AD.

Living Donor-Initiated Domino Split-Liver Transplantation in Pediatric Setup: A Case Report With Literature Review

In patients undergoing liver transplantation for metabolic diseases, removing the patient's liver for transplantation to another recipient is called "domino liver transplantation." The extracted liver can be divided and transplanted into 2 recipients, which is called domino split-liver transplantation in the literature. However, in our study, the domino liver was obtained from a pediatric patient. A patient with maple syrup urine disease (MSUD) underwent a living donor liver transplant, and the explanted liver was divided in situ into right and left lobes and transplanted to 2 separate patients. Demographic data, surgical techniques, postoperative period, and patient follow-ups were evaluated. The father's left lobe liver graft was transplanted into a 12-year-old boy with MSUD. The removed liver was divided in situ into right and left lobes. The left lobe was transplanted to a 14-year-old male patient, whereas the right lobe was transplanted to a 67-year-old male patient. The donor and the first recipient were discharged on postoperative days 5 and 22. The second pediatric patient who underwent domino split-left lobe transplantation was discharged on postoperative day 23. The adult patient who underwent domino split-right lobe transplantation died on postoperative day 12 owing to massive esophageal variceal bleeding. Patients who underwent liver transplantation due to MSUD are among the best donor choices for domino liver transplantation. If the extracted liver has a sufficient volume and anatomic features for a split, it can be used in "selected cases."

High prevalence of postoperative arytenoid dislocation in patients undergoing liver transplantation: A case-control study.

Arytenoid dislocation (AD) is a rare complication of surgery under general anesthesia. The potential factors for AD remain poorly defined, and the identification of risk factors is beneficial for reducing its incidence. We found that patients undergoing liver transplantation appeared to be more susceptible to postoperative AD at our hospital. The present study was designed to clarify this issue. A retrospective hospital-based case-control study was conducted in patients undergoing surgery under general anesthesia between 2017 and 2021. Recorded data for all patients were age, sex, body weight, height, body mass index, position of patients during surgery, duration of surgery, emergency status of surgery, and liver transplantation. Logistic regression analysis was performed to determine risk factors for AD. Thirty thousand one hundred fifty-four patients who underwent general anesthesia between 2017 and 2021 were included. Sixteen (0.05%) patients were diagnosed with AD, including 10 (3.9%) patients among 259 patients who underwent liver transplantation and 6 patients had complications among the 29,895 patients who underwent other operations (P < .0001). Postoperative AD incidence was significantly elevated in patients undergoing liver transplantation. This finding should be clinically relevant and alarming for anesthesiologists and clinicians to help avoid arytenoid dislocation and improve patient outcomes. Further studies that incorporate detailed data are needed to determine risk factors for AD.

Evaluation of the efficacy of TIPS in 27 patients with hepatic sinus obstruction syndrome in the near and medium term

Objective: intrahepatic portocaval shunt (TIPS) in the treatment of hepatic sinusoidal obstruction syndrome (HSOS). Methods: A retrospective analysis was performed on 27 patients with HSOS who were treated with TIPS in our center from July 2018 to July 2020. The changes of portal vein pressure (PVP), portal vein pressure gradient (PPG) and liver function were observed, so as to evaluate the efficacy. Paired t test was adopted to evaluate the quantitative parameters, while χ (2) test was used to analyze qualitative parameters, with P < 0.05 as statistical difference. Results: PVP decreased from (4.41 ± 0.18) kPa before shunt to (2.69 ± 0.11) kPa after shunt (t = 82.41, P < 0.001), PPG decreased from (3.23 ± 0.18) kPa before shunt to (1.46 ± 0.23) kPa after shunt (t = 32.41, P < 0.001). The liver function improved significantly after operation. After 24 months of follow-up, 3 patients developed stent restenosis and recanalized after balloon dilation. Three patients developed hepatic encephalopathy, which was improved after drug treatment. One patient underwent liver transplantation due to liver failure. Conclusion: TIPS is effective in the treatment of HSOS in the short and medium term, and can provide time for liver transplantation patients to wait for liver source.