Recurrence of Hepatocellular Carcinoma After Liver Transplantation: A Single-Center Experience.

BACKGROUND There is a worldwide increase in use of liver transplantation (LT) for treatment of hepatocellular carcinoma (HCC). We analyzed our experience with LT for HCC to determine long-term and recurrence-free survival, accuracy of imaging diagnosis of HCC compared to the explant pathology, recurrence rate of HCC, and predictors of recurrence. MATERIAL AND METHODS The whole explant was examined by the same pathologist and compared with the baseline diagnosis established according to clinical, laboratory, and radiological data. A group of patients with pathologically confirmed HCC was characterized, with special attention to etiology, survival, recurrence, and diagnostic accuracy of imaging techniques. RESULTS Among 718 patients transplanted from 2000 to 2018 in our center, HCC was found in 166 explanted livers. In 42 cases the clinical diagnosis of HCC was not accurate, being either false positive or negative; however, the specificity and sensitivity of CT/MRI in HCC recognition was 97.87% and 88.24%, respectively. Five- and 10-year survival was 81.27% and 66.57%, respectively, and it was inferior to the overall survival. The recurrence rate was 9.6% with a median time to recurrence of 14 months and a median survival time of 9 months. Poor differentiation of HCC and HCV etiology of the baseline disease, but not previous DAA treatment, were the risk factors of HCC recurrence. CONCLUSIONS Adherence to strictly defined selection criteria for LT in HCC patients guarantees the success of LT in HCC treatment.

Cavoportal hemitransposition for unrecognized spontaneous mesocaval shunt after liver transplantation: a case report.

Spontaneous portosystemic shunts can steal the blood away from the portal system. This may result in graft dysfunction or even loss following liver transplantation and can be sorted by shunt occlusion based on intraoperative flow measurements. Herein, we present an alternative technique with cavoportal hemitransposition performed for unrecognized spontaneous mesocaval shunt with 'portal steal' syndrome and primary graft nonfunction diagnosed first day following the transplant. This was chosen as a rescue strategy because an attempt to locate the shunt during relaparotomy was unsuccessful. As there was no improvement, emergency liver retransplantation with preservation of the cavoportal hemitransposition was performed on the fourth day after the primary transplant with good long-term outcome. We conclude that cavoportal hemitransposition during or after liver transplantation can be used to provide an adequate inflow into the donor portal vein if the shunting vessels responsible for the steal cannot be located and dealt with at surgery.

The arterial anastomosis in liver transplantation: complications, treatment and outcome.

BACKGROUND/AIMS: Arterial complications continue to be a major source of morbidity, graft loss and mortality after liver transplantation (OLT). In this study we analyzed the incidence, treatment and outcome of arterial complications in patients who underwent OLT in our center. METHODOLOGY: Between February 2002 and May 2009, 210 whole-organ OLTs were performed in 199 adults. Analyzed patients were divided into group I (the first 100 OLTs) and group II (subsequent 110 OLTs). Factors that could contribute to the development of arterial complications were analyzed. RESULTS: Fourteen (6.5%) arterial complications occurred in 13 patients resulting in graft loss in 4 (31%) and mortality in 5 (38%) cases. There were two (1%) serious intraoperative bleedings requiring major arterial reconstruction. The most frequent arterial complication was hepatic artery thrombosis (3.3%; 7/210), requiring re-OLT in 5 cases and resulting in death in 4 patients. Hepatic artery kinking was found in 3 (1.4%) patients while the splenic artery steal syndrome and hepatic artery stenosis coexistent with portal vein stenosis occurred in one patient each. The incidence of arterial complications (9% vs. 4.6%; p=NS), related graft loss (3% vs. 0.9%; p=NS) and mortality (4% vs. 0.9%; p=NS) were comparable in both groups. CONCLUSIONS: Arterial complications remain a major source of graft loss and mortality after OLT. Their occurrence and related graft loss and mortality were not associated with a significant learning curve in our series. Hepatic artery thrombosis although rare, is a devastating complication requiring re-OLT in majority of cases. Early diagnosis and prompt therapy are crucial to improve outcome.

[Benign solid tumors of the liver--review of current knowledge]. / Lagodne lite guzy watroby--aktualny stan wiedzy.

Benign solid tumors of the liver may be one of the great diagnostic difficulties among the hepatic problems. The most common of them are: haemangiomas, adenomas, nodular regenerative hyperplasia (NRH) and focal nodular hyperplasia (FNH). There are several useful ways of imaging for those lesions (USG, CT, MR), which are helpful in decision-making and further management. This article presents a summary of the main information on benign solid tumors of the liver based on internet database MEDLINE. Also, it contains some proceedings of treatment and control for patients with those lesions, which can help to differentiate benign and malignant hepatic tumors.

Biliary complications following adult liver transplantation with routine use of external biliary drainage.

OBJECTIVES: Biliary complications are still common and often related to the use of biliary drains in liver transplant setting. We analyzed the incidence, treatment and outcome of biliary complications following adult orthotopic liver transplantation (OLTx) performed between February 2002 and October 2004. METHODS: Overall there were 46 OLTx performed in 44 patients. Two cases of primary graft-non-function (one re-graft) and 2 early postoperative deaths were excluded from the study resulting in 42 OLTx performed in 41 patients included in the final analysis. Biliary reconstruction was by duct-to-duct choledochocholedochostomy (DD, n = 37) and Roux-en-Y hepaticojejunostomy (RYHJ, n = 5) performed over an external Levin type biliary drain in all cases. RESULTS: The overall incidence of biliary complications was 28.6% (12/42). Bile leak was the commonest and occurred in 16.6% (7/42) of transplants, whereas biliary strictures were found in 3 (7.2%) patients. Eight (19%) patients required surgical treatment and one patient died due to a biliary complication (2.4% mortality rate). Majority (7/12) of complications were bile drain related and all of these occurred in patients with DD anastomosis. CONCLUSION: Biliary complications continue to cause significant morbidity after OLTx but rarely result in mortality if early diagnosis and prompt therapy is applied. Majority of biliary complications following DD anastomosis have been related to the use of biliary drains. In view of this and endoscopic expertise available, duct to duct anastomosis without a biliary drain may reduce complication rates and improve outcome.