Lessons Learned From Review of a Single Center Experience With 500 Consecutive Liver Transplants in a Region With Insufficient Deceased-Donor Support.

OBJECTIVES: We present here the outcomes of our first 500 liver transplants and discuss the lessons learned during this time. MATERIALS AND METHODS: We retrospectively analyzed the first 500 consecutive transplants within the listing criteria of the United Network for Organ Sharing, with recipients and donors with minimum 1-year follow-up. Patient survival and donor complications were analyzed for 31 liver transplant recipients with hepatocellular carcinoma beyond the Milan criteria who had transplant performed during the same time. RESULTS: Between August 2006 and March 2013, there were 519 liver transplants performed in 500 patients (365 adult, 135 pediatric). There were 394 living-donor and 125 deceased-donor liver transplants. In addition, 31 adult liver transplants were performed in patients with hepatocellular carcinoma beyond Milan criteria (22 living-donor and 9 deceased-donor transplants). The main cause of chronic liver failure was biliary atresia in pediatric patients (30.4%) and chronic hepatitis B infection in adults (35.6%). The complication rate for primary nonfunction was 3.8%, overall biliary complications 24.0% (significantly higher after adult living-donor liver transplant, 30.3%), hepatic artery thrombosis 1.6%, portal vein thrombosis 3.0%, retransplant 3.8%, acute cellular rejection 29.6%, and bacterial infection 39.4%. Overall 1-, 3-, and 5-year patient survival rates in the first 500 consecutive transplants performed on recipients within United Network for Organ Sharing listing criteria were 87.8%, 85.0%, and 78.6%; for hepatocellular carcinoma patients beyond the Milan criteria, survival rates were 71.9%, 52.5%, and 38.2%. CONCLUSIONS: In regions without a sufficient number of deceased donors, living-donor liver transplant, with its associated problems, is the only alternative to deceased-donor liver transplant. Liver transplant requires teamwork, with all players working well together for a successful outcome. The important keys to success in liver transplant include decision-making, timing, surgical skills, experience, and close follow-up.

Polyunsaturated phosphatidylcholine protects against wound contraction in experimental skin burn injury.

Polyunsaturated phosphatidylcholine (PP) is a soybean lecithin, whose oral supplementation prevents fibrosis and strictures in animal models. The purpose of the present study was to investigate the effect of PP on wound contraction using a model of skin burn injury. Thirty male Sprague-Dawley rats were randomly divided into three groups: control (C), just burn (JB), and burn treated with PP (BPP). Burns were induced on the dorsum of the rats by a metal plate with a 4-cm(2) contact surface. Ten percent emulsion of PP was given orally for 21 days in BPP group. The effects of PP on burns were evaluated histologically on day 21, and wound contraction was measured by planimetry weekly. Microscopic evaluation included the amount and density of myofibroblasts and collgen type III, the existence of mature collagen fibers in the regenerated dermis, and thickness measurements of the regenerated tissue. There was a significant decrease in mean wound size index in group JB when compared to BPP on days 14 and 21 (p <.05 and p <.01, respectively). After 3 weeks, the granulation tissue was more cell dense, containing high numbers of myofibroblasts in group JB when compared to BPP (p <.05). The wounds had more mature collagen bundles, but less collagen type III in group BPP when compared to JB. Thus, polyunsaturated phospatidylcholine protected against wound contraction and modulated wound healing in the rat model of skin burn injury.