상단 PDF Duct-to-Duct Biliary Reconstructions and Complications in 100 Living Donor Liver Transplantation

The effect of intraductal transanastomotic stent in reducing biliary complication after duct-to-duct biliary reconstruction in living donor liver transplantation: Single center experience

The effect of intraductal transanastomotic stent in reducing biliary complication after duct-to-duct biliary reconstruction in living donor liver transplantation: Single center experience

duct-to-duct biliary reconstruction in living donor liver transplantation: Single center experience Changho SEO, Ho Joong CHOI*, Sung Eun PARK, Joseph AHN, Tae Ho HONG, Young Kyoung YOU Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

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How to reduce biliary complication in living donor liver transplantation?

How to reduce biliary complication in living donor liver transplantation?

Eun-Kyoung JWA*, Joo Dong KIM, Dong Lak CHOI Division of Hepatobiliary Pancreas Surgery and Liver Transplantation, Daegu Catholic University School of Medicine, Daegu, Korea EP-58 Introduction: Biliary complication is Achilles in LDLT. Many studies have studied risk factors associated with biliary tract complica- tions. We review our two year LDLT data and find ways to reduce the biliary complications.

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Eversion technique: A safe anastomosis method of bile duct in living donor liver transplantation without internal or external biliary stent

Eversion technique: A safe anastomosis method of bile duct in living donor liver transplantation without internal or external biliary stent

Introduction: Biliary stricture (BS) is still a major concern after bile duct anastomosis in living donor liver transplantation (LDLT), even after the technical refinements using a microscope. This study aims to describe our eversion technique without stent insertion of biliary anastomosis and its effects on the incidence of biliary complications. Methods: This was a single-center retrospective study of 52 adult LDLT recipients between December 2011 and June 2020. Group 1 consisted of the first 20 patients for whom the standard technique of biliary anastomosis (minimal hilar dissection during donor duct division, high hilar division of the recipient bile duct, and preservation of the recipient duct periductal tissue) was used. Group 2 con- sisted of 32 patients for whom biliary anastomosis was done with the addition of corner-sparing sutures and mucosal eversion of the recipient duct to the standard technique. Primary outcome measures included biliary complications (biliary leaks and strictures).
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Cystic duct anastomosis can be a viable option for biliary reconstruction in case of multiple ducts in right lobe living-donor liver transplantation

Cystic duct anastomosis can be a viable option for biliary reconstruction in case of multiple ducts in right lobe living-donor liver transplantation

Hepaticojejunostomies were found to have more bile leaks, which contributed to significant morbidity and mortality in the early postoperative period. There was a significant delay in the initiation of enteral nutrition in patients who underwent HJ in our study. On the other hand, biliary strictures were commonly encountered with duct-to-duct anastomoses, with a more delayed presentation frequently amenable to endoscopic or percutaneous curative therapy [6]. It is currently unclear which technique is superior to the other. Nevertheless, duct-to- duct anastomosis is the preferred technique of biliary recon- struction in adult right lobe LDLT currently. Its merits include less operative time, less number of anastomoses, reduced post- operative ileus, preservation of physiological continuity of the tract, reduced enteric contamination of biliary tract due to in- tact Sphincter of Oddi and most importantly, and maintained
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Impact of extended living donor criteria focusing on donor safety in living donor liver transplantation

Impact of extended living donor criteria focusing on donor safety in living donor liver transplantation

Results: Posthepatectomy liver failure (PHLF) occurred in 48 donors (10.6%) and most cases were grade A except one case with con- ventional criteria. PHLF and major complications were not more frequent in extended donor group . In multivariate analysis, the only the event for major complications was associated with PHLF but neither extended criteria nor RLV ratio was related to PHLF. Conclusions: LDRH under our extended criteria could be performed to expand donor pools without adverse effects on donor safety and could be performed safely in donors with RLV ratio < 30% under our strict criteria when no other donors are available.
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Feasibility of external biliary drainage in living donor liver transplantation: Lessons learned from initial experiences in single center

Feasibility of external biliary drainage in living donor liver transplantation: Lessons learned from initial experiences in single center

EP-86 Introduction: Biliary complication is the most common and unmanageable complication of living donor liver transplantation (LDLT). External biliary drainage (EBD) is one of the strategies to decrease the incidence of biliary complication. Herein, we examined the LDLT cases with EBD application and evaluated the outcome of patients to assess whether EBD is a practicable surgical method to re- duce biliary problem.

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Outcomes of living donor liver transplantation using elderly donors

Outcomes of living donor liver transplantation using elderly donors

postoperative treatment protocol. Doppler ultrasonography was routinely performed to evaluate vascular structure patency and confirm bile duct dilatation on the first, third, and fifth postoperative days. On the 7th and 20th day after surgery, follow-up abdominal CT scans were performed to evaluate intra-abdominal statuses of vascular patency, liver regeneration status and the other intra-abdominal condition. On the 20th postoperative day, MRCP was performed to examine the status of the biliary system. CT scans with volumetry were performed regularly after discharge. If abnormal findings were suspected, then angiography, endoscopic retrograde cholangiopancreatography, or percutaneous transhepatic cholangiography was also performed, and an immediate interventional procedure was performed if indicated.
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Donor safety in living donor liver transplantation: The Korean organ transplantation registry study.

Donor safety in living donor liver transplantation: The Korean organ transplantation registry study.

and 7 bile leakages [43.8%]). Among the 832 donors, the mean aspartate transaminase, alanine aminotransferase, and total bilirubin levels were 23.9 6 8.1 IU/L, 20.9 6 11.3 IU/L, and 0.8 6 0.4 mg/dL, respectively, 6 months after liver donation. In conclusion, bil- iary complications were the most common types of major morbidity in living liver donors. Donor hepatectomy can be performed successfully with minimal and easily controlled complications. Our study shows that prospective, nationwide cohort data provide an important means of investigating the safety in living liver donation.
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Neutrophil-to-lymphocyte ratio predicts early acute cellular rejection in living donor liver transplantation

Neutrophil-to-lymphocyte ratio predicts early acute cellular rejection in living donor liver transplantation

Protocol biopsies can identify subclinical degrees of ACR and detect the tissue change of the liver graft early [27]. For these reasons, our center performed a protocol liver biopsy on a postoperative day 7. It is helpful to detect the patient without the sign of graft dysfunction. The benefits of treatment of subclinical rejection and the clinical utility of protocol liver biopsy are controversial [28]. In our study, during follow-up, 2 patients (13.3%) developed chronic rejection without proper management because they were not shown any sign of graft dysfunction. Therefore, it is important to detect subclinical rejection using an easy tool. For these reasons, monitoring of noninvasive tools such as NLR can reduce the possibility of liver biopsy related complications and early detection for subclinical ACR.
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Cystic duct patch closure of remnant bile duct in living donor hepatectomy when primary closure is difficult: An easy solution

Cystic duct patch closure of remnant bile duct in living donor hepatectomy when primary closure is difficult: An easy solution

and “probe-and-clamp technique” 12 have been suggested to avoid this biliary complication. Our technique of bile duct division starts with slight lowering of the hilar plate, after dissecting the hepatic artery and portal vein and marking the ischemic line. We mark the proposed site of duct transection with a large ligaclip and confirm its posi- tion on the intraoperative cholangiogram. After com- pletion of the parenchymal transection, we encircle the duct along with the hilar plate with a right-angled dissect- ing forceps. A second cholangiogram is obtained to con- firm the site of transection of the right duct and the duct is divided. After harvesting the graft liver, a completion cholangiogram is performed to check the integrity of the bile duct closure.
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Tumor response to transcatheter arterial chemoembolization in recurrent hepatocellular carcinoma after living donor liver transplantation

Tumor response to transcatheter arterial chemoembolization in recurrent hepatocellular carcinoma after living donor liver transplantation

Overall, the TACE procedure was well tolerated by all patients, and no major complications developed during follow-up period. Five patients (17.9%) experienced some immediate side effects after TACE, including transient nausea, vomiting, diarrhea, hypertension, tachycardia, and right upper quadrant pain, but these effects resolved within a few days of the procedure.

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Comparison of liver regeneration in laparoscopic versus open righthemihepatectomy for adult living donor liver transplantation

Comparison of liver regeneration in laparoscopic versus open righthemihepatectomy for adult living donor liver transplantation

licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Annals of Hepato-Biliary-Pancreatic Surgery ∙ pISSN: 2508-5778ㆍeISSN: 2508-5859 INTRODUCTION Liver transplantation is the most definitive treatment for patients with end-stage liver disease. However, compared to the number of patients who require liver transplan- tation, the number of livers from deceased patients are limited. For this reason, living donor liver transplantation (LDLT) has emerged as an alternative. 1 Since the first successful LDLT was performed with pediatric recipients in 1989, 2 LDLT has developed rapidly. 3
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Caudal middle hepatic vein trunk preserved right lobe graft in living donor liver transplantation

Caudal middle hepatic vein trunk preserved right lobe graft in living donor liver transplantation

The clinical data from the donors and recipients were analyzed retrospectively. Parameters compared between group A donors and group B donors included operation time, bench work time, number and diameter of V5, remnant liver volume, length of hospital stay, length of intensive care unit (ICU) stay, major complications, and laboratory findings on postoperative days (POD) 1, 3, and 5. Those were also investigated in group B1 compared with group B2 to evaluate the impact of the absence of dominant drainage vein of S4. And, we reviewed postoperative course of the recipients in groups A and B, which included liver function test, volume of the ascites on POD 7, MHV stent insertion rate and patency rate of V5 at one month and 3 months after LDLT. The chi-square test was used for comparisons of discrete variables and Mann-Whitney U test was used for comparison of continuous variables. P < 0.05
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Sclerosing encapsulating peritonitis after living-donor liver  transplantation: A case series, Kyoto experience

Sclerosing encapsulating peritonitis after living-donor liver transplantation: A case series, Kyoto experience

All the patients presented with obstructive gastro- intestinal symptoms. Initially, contrast studies were per- formed in all the four cases and delayed transit time for the contrast material to pass through the small intestine was observed for all patients. On abdominal CT, abdomi- nal cocoon findings were detected. The third patient ex- hibited extremely poor liver function at the time of SEP diagnosis to perform surgery. Unfortunately, the patient was lost due to deteriorated liver failure and SEP complications. The other three patients were successfully operated upon (mortality rate was 25%). Until now, all the 3 patients are doing well, without SEP recurrence.
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Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation

Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation

Copyright Ⓒ 2016 by The Korean Association of Hepato-Biliary-Pancreatic Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Korean Journal of Hepato-Biliary-Pancreatic Surgery ∙ pISSN: 1738-6349ㆍeISSN: 2288-9213

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Diaphragmatic herniation following donor hepatectomy for living donor liver transplantation: a serious complication not given due recognition

Diaphragmatic herniation following donor hepatectomy for living donor liver transplantation: a serious complication not given due recognition

deaths had occurred in India. 8 A further death was re- ported later that year. 9 According to a worldwide survey, the average donor morbidity rate is 24%, with 5 donors (0.04%) requiring transplantation. 2 Donor mortality rate is 0.2% (23/11,553), with majority of deaths occurring within 60 days after donation surgery. All but four deaths were related to the donation surgery. Incidences of near-miss for donor death events and aborted hepatectomies were reported to be 1.1% and 1.2%, respectively. 2 This report emphasized the significance of near-miss events, including hemorrhaging requiring surgical intervention, thrombotic events, biliary reconstruction procedures, life-threatening sepsis, and ia- trogenic injury to the bowel or vasculature. Amongst these near-miss events, two reoperations for diaphragmatic her- nia were reported from two centers. In addition, there were two cases of gastric volvulus. What is important is that nearly half of these near-miss events are not directly related to the liver. These near-miss events could have easily resulted in donor mortality, given the extremely se- rious nature of these complications.
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Use of right lobe graft with type IV portal vein accompanied by type IV biliary tree in living donor liver transplantation: report of a case

Use of right lobe graft with type IV portal vein accompanied by type IV biliary tree in living donor liver transplantation: report of a case

CASE REPORT We recently experienced a case of a 35-year-old male who underwent primary LDLT with right lobe graft for single hepatocellular carcinoma, 2.5 cm in diameter, on top of liver cirrhosis due to hepatitis B virus and hepatitis C virus. On routine preoperative imaging study of the only available live donor, including three-dimensional reconstruction computed tomography with volumetric analysis and magnetic resonance cholangiography, he had right lobe with type IV PV (anterior sectoral branching from the umbilical portion of the left PV) associated with type IV BD (right posterior sectoral duct drains into left duct at its umbilical portion) and dual arterial inflows;
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JKSSJKSSJKSSJournal of the Korean Surgical Society pISSN 2233-7903ㆍ

The effect of a positive T-lymphocytotoxic crossmatch on clinical outcomes in adult-to-adult living donor liver transplantation

Suh et al. [24] have shown that pretransplant positive TLC is an independent risk factor causing early death after adult-to-adult LDLT using small-for-size grafts. They stat- ed that all 4 patients died of multiorgan failure after early acute rejection episodes. It was difficult to determine whe- ther the causes of graft loss were truly related with the acute rejection episodes. They also mentioned that a small- for-size graft is related to detrimental outcomes. Three of the 4 patients had nonimmunologic disorder complica- tions , such as hepatic venous stenosis, bleeding and sig- moid volvulus in the early postoperative period. Surgical repair was required for the complications before liver fail- ure developed. In our study, 4 of the 8 patients underwent LDLT using a small liver graft (graft recipient weight ratio
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Dextroplantation of a reduced left lateral section graft in an infant undergoing living donor liver transplantation

Dextroplantation of a reduced left lateral section graft in an infant undergoing living donor liver transplantation

1 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, 2 Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Case Report Graft size matching is essential for successful liver transplantation in infant recipients. We present our technique of graft dextroplan- tation used in an infant who underwent living donor liver transplantation (LDLT) using a reduced left lateral section (LLS) graft. The patient was an 11-month-old female infant weighing 7.8 kg with hepatoblastoma. She was partially responsive to systemic chemother- apy. Thus, LDLT was performed to treat the tumor. The living donor was a 34-year-old mother of the patient. After non-anatomical size reduction, the weight of the reduced LLS graft was 235 g, with a graft-to-recipient weight ratio of 3.0%. Recipient hepatectomy was performed according to the standard procedures of pediatric LDLT. At the beginning of graft implantation, the graft was temporarily placed at the abdomen to determine the implantation location. The graft portal vein was anastomosed with an interposed external iliac vein homograft. As the liver graft was not too large and it was partially accommodated in the right subphrenic fossa, thus the ab- dominal wall wound was primarily closed. The patient recovered uneventfully. An imaging study revealed deep accommodation of the graft within the right subphrenic fossa. The patient has been doing well for six months without any vascular complications. This case suggests that dextroplantation of a reduced LLS graft can be a useful technical option for LDLT in infant patients.
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Dextroplantation of a reduced left lateral section graft in an infant undergoing living donor liver transplantation

Dextroplantation of a reduced left lateral section graft in an infant undergoing living donor liver transplantation

Introduction: Graft size matching is essential for successful liver transplantation in infant recipients. Methods: We present our technique of graft dextroplantation used in an infant who underwent living donor liver transplantation (LDLT) using a reduced left lateral section (LLS) graft. Results: The patient was an 11-month-old 7.8 kg-weighing female infant with hepatoblastoma. She was partially responsive to sys- temic chemotherapy, thus LDLT was performed to treat the tumor. The living donor was a 34-year-old mother of the patient. After non-anatomical size reduction, the weight of the reduced LLS graft was 235 g, which was 3.0% of the graft-recipient weight ratio. Re- cipient hepatectomy was performed according to the standard procedures of pediatric LDLT. At the beginning of graft implantation, the graft was temporarily placed at the abdomen to determine the implantation location. The graft portal vein was anastomosed with an interposed external iliac vein homograft. As the liver graft was not too large and it was partially accommodated in the right sub- phrenic fossa, the abdominal wall wound was primarily closed. The patient recovered uneventfully. An imaging study revealed deep accommodation of the graft within the right subphrenic fossa. The patient has been doing well for 3 months without any vascular complications.
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