Asunto(s)
Supervivencia de Injerto/fisiología , Hepatectomía/métodos , Trasplante de Hígado/fisiología , Donadores Vivos , Recolección de Tejidos y Órganos/métodos , Adolescente , Adulto , Femenino , Humanos , Trasplante de Hígado/métodos , Masculino , Persona de Mediana Edad , Núcleo Familiar , Estudios RetrospectivosRESUMEN
BACKGROUND AND OBJECTIVE: Evaluation of a new pig liver transplantation technique for survival and hypertrophy of a small-sized graft by providing adapted and controlled venous portal flow. MATERIAL AND METHODS: [corrected] Twenty Large-White pigs underwent heterotopic liver transplantation after a mesocaval shunt and ligation of the superior mesenteric vein downstream from the shunt. The donor-to-recipient weight ratio was below 30%. Furthermore, recipient's biliary duct and portal vein into the hilum were tied. In a control group, no mesocaval shunt was performed and the graft received the entire splanchnic venous flow. RESULTS: The mesocaval shunt provided diversion of 60% of the splanchnic blood flow. The median survival of study pigs was 39 days (range: 8-98). Median serum bilirubin levels at 1 week were 12 micromol/L (range: 4-59). At autopsy, graft weight was increased to 2.7 times the initial weight and histological findings were normal. In the control group, all pigs died quickly from acute splanchnic congestion. CONCLUSION: In a model of heterotopic liver transplantation using small-sized grafts, complete diversion of mesenteric blood flow through a mesocaval shunt resulted in hemodynamic tolerance and hypertrophy of a graft corresponding to less than 30% of the ideal mass.
Asunto(s)
Hemodinámica , Trasplante de Hígado/métodos , Hígado/patología , Anastomosis Quirúrgica , Animales , Conductos Biliares , Bilirrubina/sangre , Constricción , Hipertrofia , Ligadura , Venas Mesentéricas/cirugía , Modelos Animales , Tamaño de los Órganos , Vena Porta/cirugía , Circulación Esplácnica , Porcinos , Trasplante HeterotópicoRESUMEN
BACKGROUND: The order of revascularization in human liver grafts is still discussed. This study tries to answer this question in terms of hemodynamic data. STUDY DESIGN: Fifty-nine patients were randomized in this study to compare hemodynamic data just before and 15 minutes after revascularization of liver grafts in relation to first hepatic artery (n = 29) or first portal vein (n = 30) revascularization procedure. RESULTS: Hemodynamic variations were significantly greater in the portal vein group than in the hepatic artery group in terms of mean arterial pressure, cardiac index, central venous pressure, pulmonary capillary pressure, and systemic vascular resistance. The latter decreased from 741.8 +/- 390.3 to 659.9 +/- 411.1 dynes/ cm5 (NS) in the hepatic artery group versus 807.7 +/-336.7 to 439.7 +/- 215 dynes/cm5 (p < 0.05) in the portal vein group. Clinical results and postoperative complications, graft characteristics, patient survival, and graft survival were not significantly different between the groups. CONCLUSIONS: Initial arterial revascularization of the liver graft leads to a more stable hemodynamic profile during revascularization of the liver graft after vascular unclamping. This technique is always feasible and has become our reference procedure.
Asunto(s)
Hemodinámica/fisiología , Circulación Hepática/fisiología , Trasplante de Hígado/métodos , Hígado/irrigación sanguínea , Anastomosis Quirúrgica/métodos , Femenino , Arteria Hepática/cirugía , Humanos , Masculino , Persona de Mediana Edad , Vena Porta/cirugía , Estudios ProspectivosRESUMEN
STUDY AIM: In children, living donor liver transplantation has been shown to be efficient in treating end-stage liver diseases when the left lateral segment is harvested. In adults, more liver mass is needed to provide adequate hepatic function. The aim of this study is to report 2 successful cases of living donor liver transplantation using a right hepatic lobe from adult. PATIENTS AND METHODS: In 2 sons, the right hepatic lobe was harvested without the middle hepatic vein for transplantation in their fathers who were suffering from end-stage liver cirrhosis. Hepatectomy was done without vascular inflow occlusion after dissection of vascular and biliary structures, itself strictly restricted to the right side. In recipients, the graft was implanted orthotopically with preservation of the native inferior vena cava and after temporary porto-caval shunt. RESULTS: The duration of donors procedures was 7 h and 11 h 45 min; intra-operative transfusions comprised of 700 mL from cell-saver in the first case, and 1300 mL plus 1 autologous red blood cell unit in the second case. Graft weights were 770 g and 1100 g. None of the donors experienced liver failure and both were able to leave the hospital 9 days after the operation. In recipients, initial graft function was excellent in the first case and correct in the second case, despite the necessity to redo intra-operatively the hepatic vein anastomosis secondary to a twisting. Patients were discharged 20 and 40 days respectively following transplantation. CONCLUSION: Adult living donor liver transplantation using a right hepatic lobe is efficient and safe. This option could contribute to reducing the mortality of patients on the waiting list.
Asunto(s)
Trasplante de Hígado/métodos , Donadores Vivos , Adolescente , Adulto , Anastomosis Quirúrgica , Transfusión de Sangre Autóloga , Hepatectomía/métodos , Arteria Hepática/cirugía , Humanos , Cuidados Intraoperatorios , Tiempo de Internación , Cirrosis Hepática/cirugía , Fallo Hepático/cirugía , Trasplante de Hígado/patología , Masculino , Persona de Mediana Edad , Seguridad , Factores de Tiempo , Vena Cava Inferior/cirugíaRESUMEN
BACKGROUND & AIMS: Hepatic involvement in hereditary hemorrhagic telangiectasia is common but often asymptomatic. However, in some cases, the vascular lesions that involve the liver may lead to high-output cardiac failure and pulmonary hypertension that is predominant over hepatobiliary manifestations. Liver transplantation and treatment of these complications are described and discussed in this article. METHODS: Three patients with hereditary hemorrhagic telangiectasia and hepatic involvement received transplants. They had pulmonary hypertension and chronic right-sided heart failure caused by disseminated intrahepatic telangiectasias with shunts between the hepatic artery and hepatic veins or portal vein. Left-to-right intrahepatic shunt output was estimated to range between 51% and 57.5% of cardiac output. RESULTS: Hyperdynamic circulation disappeared after liver transplantation in all patients. Results of computed tomography and right-sided heart catheterization performed 6 months later were normal. Follow-up periods currently are 65, 53, and 29 months, and each patient continues to be asymptomatic. CONCLUSIONS: This report suggests that liver transplantation can be considered as an alternative and successful curative treatment that may prevent the irreversible evolution of cardiopulmonary disease.
Asunto(s)
Circulación Hepática , Trasplante de Hígado , Telangiectasia Hemorrágica Hereditaria/fisiopatología , Telangiectasia Hemorrágica Hereditaria/cirugía , Adulto , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/prevención & control , Hemodinámica/fisiología , Humanos , Hipertensión Pulmonar/complicaciones , Pruebas de Función Hepática , Persona de Mediana Edad , Pruebas de Función Respiratoria , Telangiectasia Hemorrágica Hereditaria/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: In this pilot study, we present the results of treatment of early (3 months after liver transplantation) acute rejection episodes by increasing only the tacrolimus doses. METHODS: Ten patients who received tacrolimus as primary treatment experienced acute mild (one case), moderate (four cases), or severe (five cases) rejection episodes. Tacrolimus dosing was increased 1-2 mg every 1 or 2 days until hepatic enzymes started to improve. Steroid basic daily doses were kept unchanged. RESULTS: With the daily dose of tacrolimus increased by a median 1.89-fold (range: 1.2-5), alanine aminotransferase, bilirubin, and gamma-glutamyltranspeptidase levels rapidly reached normal values within the first month. During a median follow-up time of 19.5 months (range: 14-24), none of the 10 patients died or lost their graft. Control liver biopsies were done 13.5 months (range: 7-19) after rejection episode in all patients, and none demonstrated evidence of rejection or sequela. CONCLUSION: This pilot study suggests that increasing tacrolimus dosage could be considered as treatment against early acute rejection episodes including the severe grade.
Asunto(s)
Rechazo de Injerto/prevención & control , Inmunosupresores/administración & dosificación , Trasplante de Hígado/inmunología , Tacrolimus/administración & dosificación , Enfermedad Aguda , Alanina Transaminasa/sangre , Bilirrubina/sangre , Biopsia , Relación Dosis-Respuesta a Droga , Rechazo de Injerto/patología , Humanos , Hígado/patología , Proyectos Piloto , gamma-Glutamiltransferasa/sangreRESUMEN
We used laparoscopy to treat a case of primary retroperitoneal mucinous cystadenoma. This tumours is rarely encountered and has been reported in 22 cases in the literature. The histogenesis is uncertain. Diagnosis is never made preoperatively since primary retroperitoneal mucinous cystadenomas are usually mistaken for cystic lymphangiomas of the retroperitoneum. Surgery is the only treatment. Laparoscopic surgery can be used only if the cystadenocarcinomatous nature of the tumour is ruled out.