Liver metastasis from colorectal cancer 12 years after liver transplantation.

Liver transplantation is an effective treatment for many liver diseases, with a 5-year survival of about 70 %. However, development of de novo malignancies in these immunocompromised patients is becoming a frequent complication medium term. The annual risk of developing a malignant tumor after a solid organ transplant is 2% . We report the case of a liver transplant patient who developed colorectal neoplasia at 12 years after transplantation , and then a metachronous metastases in the liver transplanted.

Indication for Liver Transplantation After Direct-Acting Agents in the Treatment of Patients With Hepatitis C.

BACKGROUND: The development of new direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment has reduced the indications for liver transplantation (LT). We analyzed the indications, characteristics, and evolution of patients with HCV infection who were treated with DAA-based therapies and who underwent LT. MATERIAL AND METHODS: A retrospective single-center study was performed. Data were collected of patients undergoing LT owing to HCV infection between January 2016 and August 2020. Overall characteristics of the patients were analyzed and divided into 2 groups according to the indication for LT: hepatocellular carcinoma (HCC) or decompensated cirrhosis (DC). Differences between biliary and vascular complications after surgery and survival time were compared. RESULTS: Of 156 LTs, 33 (22%) were performed in patients with HCV infection in this period, which shows a decrease of nearly 16% when comparing this period with the interferon/ribavirin era. Indications for LT were 56.7% in patients with HCC and 43.3% in patients with DC. After DAA treatment, all patients developed a sustained viral response. Mean age of the global series, HCC group, and DC group were 56.9, 58.71, and 54.4 years, respectively (P = .041); 53.8% of the HCV-DC group initiated DAA treatment by the time to be included at the waiting list, compared with 17.6% of HCV-HCC group (P = .045). There were no statistically significant differences in terms of survival or biliary and vascular complications after LT. CONCLUSION: Patients with HCV are still part of the waiting list, mainly because of HCC. No statistical differences were shown in terms of postoperative complications or survival. Studies with a higher number of patients are needed.

Renal Function in Receptors With Simultaneous Liver-Kidney Transplant From the Same Donor.

Controversy surrounds the suitability of simultaneous liver-kidney transplant (SLKT) when compared with sequential transplant. Pretransplant renal failure is a post-transplant mortality predictor, and studies demonstrate worse functioning and lower survival of the renal graft when compared with kidney transplant alone (KTA). BACKGROUND: This study compares renal function in patients with SLKT and those who received the contralateral kidney from the same donor. MATERIAL AND METHODS: From June 2017 to February 2021, 5 SLKTs were performed in our hospital, and contralateral kidney grafts took place in other Andalusian Modification on Diet in Renal Disease-4 hospitals. Renal function was assessed according to glomerular filtration (GF) by the formula (that uses 4 variables: creatinine, age, sex, and race) during different periods of time; and the average increase of GF during 6 months in both groups was compared. Other factors from donors and receptors were also compared. RESULTS: No statistically significant differences between average GF in both groups were found; however, there were statistically significant differences when we compared the GF increase 6 months after the transplant in both groups of patients, being that increase higher in patients with KTA. CONCLUSIONS: Despite our small sample size, our study found that patients with SLKT have worse functioning of the kidney graft than those with KTA.

Eight Years of Extracorporeal Membrane Oxygenation in Liver Transplantation: Our Experience.

Liver grafts from donors after cardiac death (DCD) involve a risk of failure owing to warm ischemia, among other factors. To minimize this important issue, new systems like normothermic regional perfusion have arisen. We report an observational and unicentric study focused on the results of liver transplantation after DCD, performing normothermic regional perfusion using extracorporeal membrane oxygenation. In the period between 2011 and 2018, 33 recipients underwent the procedure, 9 from Maastricht II DCD donor liver transplantation (LT) and 24 from Maastricht III DCD donors. The median recipient survival rose to 67 ± 9 months and 41 ± 7 months, respectively. Only 1 patient suffered from ischemic cholangiopathy needing retransplantation. Therefore, according to our experience, liver grafts from DCD using extracorporeal membrane oxygenation are suitable for LT.

Cholangiocarcinoma, 10-Year Survival After Liver Transplantation: A Case Report.

Cholangiocarcinoma is the second most common neoplasm in the liver, with a very poor, short-term prognosis. Today, surgery associated with or without an adjuvant is the only curative treatment. Liver transplantation (LT) is the best treatment for hepatocellular carcinoma tumor. In recent years, treatment of hilar cholangiocarcinoma by LT associated with neoadjuvant therapy has been studied under a criterion. But could it be possible to apply LT like the curative treatment of intrahepatic cholangiocarcinoma (iCC)? Initially the answer is no, but there are different studies about incidental LT in patients with iCC that demonstrate survival over 40% to 50%. In our center, we conducted a review of 468 transplants completed between 2002 and 2018, and we identified 1 case of incidental LT in a patient with iCC with an overall survival of 10 years. Because there is currently an increase in donors owing to the expansion of the criteria, a study to consider extending the criteria of LT to include iCC would be beneficial.

Retroperitoneoscopy to extract dropped gallstones after laparoscopic cholecystectomy.

Complications resulting from gallstones left in the peritoneal cavity are most often reported after laparoscopic treatment of cholelitiasis. Gallstones are frequently dropped in the posterior subhepatic space, which can lead to the development of abscesses that usually require laparotomy for extraction of the stones. We present a novel technique for treating collections associated with dropped gallstones, using retroperitoneoscopy with two 10-mm ports after ultrasound localization of the abscess. We carried out this procedure in two patients and successfully extracted the gallstones without postoperative complications or recurrences. We consider this approach to be technically feasible, safe, and effective. It avoids the usual inefficacy of simple percutaneous drainage of these collections and the complications associated with the drainage of intra-abdominal abscesses by laparotomy.