Living donor liver transplant in Romania – 116 cases experience

Centrul de Chirurgie Generală și Transplant Hepatic “Dan Setlacec”, Institutul Clinic Fundeni, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Cererea pentru transplantul hepatic în Romania este în continuă creștere în timp ce penuria de donatori de organe persistă. Timpul lung de așteptare pentru un transplant de ficat şi disfuncţia hepatică progresivă aferentă așteptării a motivat multe familii să ia în considerare donarea de organe. Material și metode: În anul 2000 a fost realizat primul transplant hepatic ortotopic cu ficat întreg de către echipa I.Popescu et al. la Institutul Clinic Fundeni din Bucureşti, urmat de transplantul de ficat de la donator viu (LDLT) mai târziu în acelaşi an, ajungând în aprilie 2015 la un total de 116 de transplanturi cu ficat de la donator viu. LDLT a fost realizată cu hemificat drept la 78 pacienți, secțiune laterală stânga – la 26 pacienți, hemificat stâng – la 7 pacienți, hemificat stâng în bloc cu segmentul 1 – la 3 pacienți, şi dual graft – la 2 pacienți. Rezultate: Rata de morbidități majore a fost de 53,4% (62 pacienți), rata generală de retransplant a fost de 11,3% (13 pacienți). Rata de supraviețuire generală la 1-, 3-, şi 5 ani a fost de 88,8%, 82,5%, respectiv, 79,2%. Concluzii: Scopul nostru a fost de a reduce rata mortalității pe lista de așteptare prin scurtarea timpului de aşteptare pentru TH prin asigurarea grefelor necesare. Avantajele LDLT includ posibilitatea de a fi efectuate în regim programat şi cu un timp de aşteptare scurt pentru primitor, în timp ce indicaţiile de transplant pot fi extinse (ex: HCC în afara criteriilor Milano).Introduction: The request for Liver Transplant (LT) in Romania continues to increase while the donor pool size remains inadequate. The long waiting time for a liver transplant and the progressive liver dysfunction that occurs in this time has motivated many families to consider living donation. Material and methods: In 2000, the first successful LT (with whole graft) was carried out by I.Popescu et al. at Fundeni Clinical Institute in Bucharest, followed by the first living donor liver transplantation (LDLT) (successful) later the same year, reaching 116 living donors liver transplants by April 2015. LDLT was performed with right hemiliver in 78 pts, left lateral section in 26 pts, left hemiliver in 7 pts, left hemiliver with segment 1 in 3 pts, and dual graft LDLT in 2 pts: one received a right hemiliver and a left lateral section (17), and one received a left hemiliver and a left lateral section. Results: Major morbidity rates were 53.4% (62 pts) Overall retransplantation rate was 11.3% (13 pts). Long-term overall 1-, 3-, and 5- year estimated survival rates were 88.8%, 82.5%, and 79.2%, respective. Conclusions: Our main goal was to continuously reduce the drop-out rate on waiting list (due to mortality and morbidity) by shortening the waiting time for LT insured by providing the necessary grafts. Advantages of LDLT include the ability to be performed on an elective basis, with optimal timing and no waiting time for the recipient, while the indications for transplantation may be extended (i.e. HCC beyond Milan criteria)

15 years of Romanian national program of liver transplant – a retrospective analysis of 648 patients operated

Centrul de Chirurgie Generală şi Transplant Hepatic “Dan Setlacec”, Institutul Clinic Fundeni, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Transplantul hepatic (TH) a devenit metoda de elecție în tratamentul bolilor hepatice în stadiu terminal, cu peste 20.000 de proceduri anuale la nivel mondial. Scopul acestui studiu este de a analiza rezultatele programului de transplant hepatic românesc după 15 ani de activitate. Material și metode: Între aprilie 2000 și aprilie 2015, 648 de pacienți au fost transplantați cu ficat în România. Raportul pe sexe a fost 382 (m) / 266 (f), în timp ce raportul adulți/copii a fost de 588/60, cu o vârstă medie de 45 de ani. Indicațiile principale pentru TH au fost: ciroza de etiologie VHB (176 pct; 27,1%), HCC (128 pct; 19,7%), și ciroza de etiologie VHC (118 pct; 18,2%). Transplantul hepatic de la donator cadaveric a fost efectuat la 532 pacienți (82,1%): 512 pct cu ficat întreg, 16 pct – cu ficat split, 2 pct – cu ficat redus, transplant-domino – la 2 pct. Transplantul de ficat de la donator viu a fost efectuat la 116 pct (17,9%). Rezultate: Mortalitatea perioperatorie a fost de 7,9% (51 pct). Rata de retransplant a fost de 4,6% (30 pct). Supraviețuirea la 1, 3 și 5 ani pe termen lung a fost estimată la 88,8%, 82,5% și respectiv 79,2%. Timpul de așteptare pentru TH a scăzut semnificativ în timp. Mortalitatea pe un an pe lista de așteptare a scăzut semnificativ, de la 31,4% la 11,8%. Concluzii: Programul de transplant hepatic în România se adresează atât cauzelor de insuficiență hepatică acută și cronică, cât și tumorilor hepatice la adulți și copii, fiind folosite toate tehnicile chirurgicale. Amploarea programului a crescut constant în timp, ceea ce a adus la scurtarea timpului și a ratelor de mortalitate pe lista de așteptare.Background: Liver transplantation (LT) is the treatment of choice for end-stage liver diseases, with more than 20.000 procedures yearly worldwide. The aim of this study was to analyze the results of Romanian National Program of LT after 15 years of activity. Methods: Between April 2000 and April 2015, 648 patients received 678 LTs in Romania. Male/female ratio was 382/266, while adult/pediatric ratio was 588/60, with a mean age range 7 months – 68 yr. Main LT indications in the adult population were HBVrelated cirrhosis (176 pts; 27.1%), hepatocellular carcinoma (128 pts; 19.7%), and HCV-related cirrhosis (118 pts; 18.2%). DDLT (death donor liver transplant) was performed in 532 pts (82.1%): whole LT in 512 pts, split LT in 16 pts, reduced LT in 2 pts, and domino LT in 2 pts. LDLT (living donor liver transplant) was performed in 116 pts (17.9%). Results: Perioperative mortality was 7.9% (51 pts). Retransplantation rate was 4.6% (30 pts). Long-term overall 1-, 3-, and 5- year estimated survival rates were 88.8%, 82.5%, and 79.2%, respectively. Median waiting time for LT decreased significantly over time. One-year overall mortality on waiting list also decreased significantly over time from 31.4% to 11.8%. Conclusions: The liver transplantation program in Romania addresses all causes of acute and chronic liver failure or liver tumors in adults and children, using all surgical techniques. The program constantly increased over time, leading to less time and lower mortality rate on the waiting list with the results similar to those of other centers

Anatomical resection of segment 8 by means of ultrasound-guided vessel compression

BACKGROUND: Anatomical resection is the gold standard for liver resection in patients with hepatocellular carcinoma (HCC). Bimanual hepatic vessel compression has been already described, although segmental and subsegmental resection of segment 8 (S8) remain challenging by this technique. We demonstrate how to obtain a S8 demarcation by means of ultrasound-guided vessel compression. METHODS: Two patients with HCC with hepatitis C virus-related cirrhosis partially or fully located in S8 without portal thrombosis underwent liver resection. In the first patient with a HCC fed by subsegmental glissonian pedicles to S4 superior (P4sup) and S8 ventral (P8v), the resection area was disclosed by direct compression of the aforementioned feeding pedicles. A second patient had a HCC located in S8 ventral with a satellite in S8 dorsal; the patient had a pedicle to the right anterior sector originating from the left portal vein. The resection area was obtained by means of direct compression of the P8d and countercompression of the left portal vein (peripherally to the origin of the pedicle to the anterior sector), and P5. Countercompression was needed because of the peculiar trajectory of P8v passing across the middle hepatic vein. RESULTS: In neither case was there a congested area. In the first patient, hepatic veins were not exposed because it was a resection conducted in a subsegmental fashion. There was no morbidity, and no blood transfusions were needed. Patients were both discharged on day 8 after surgery. CONCLUSIONS: Disclosure of subsegmental portions of S8 by means of intraoperative ultrasound-guided compression technique is feasible and confirms the reliability of this approach

Pediatric liver transplant in Romania – 60 cases experience

Centrul de Chirurgie Generală şi Transplant Hepatic “Dan Setlacec”, Institutul Clinic Fundeni, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: În ultimele două decenii transplantul hepatic pediatric a devenit o soluţie viabilă pentru copiii cu boală hepatică în stadiu terminal. Deşi cazurile pediatrice reprezintă aproximativ 11% din totalul pacienţilor de pe lista de aşteptare din România, utilizarea grefelor de la donator în viață, a grefelor split și a celor reduse a oferit posibilitatea transplantării mai multor pacienţi pediatrici şi adolescenţi, reducând astfel numărul de pacienţi de pe lista de aşteptare şi demonstrând rezultate similare în comparaţie cu transplantul de ficat la adult. Material și metode: Între martie 2004 şi aprilie 2015 un numar de 60 de pacienți pediatrici au fost transplantați hepatic de echipa I.Popescu et al. la Institutul Clinic Fundeni din Bucureşti. Principalele indicaţii pentru transplantul pediatric au fost anomaliile biliare congenitale (atrezie biliară, ductopenie) (12 pacienți; 20%), boala Wilson (11 pacienți; 18,3%), glicogenoză (8 pacienți; 13,3%), şi fibrozele hepatice congenitale (7 pacienți; 11,7%). Rezultate: La copii şi adolescenţi ratele de supraviețuire pe termen lung la 1, 3, şi 5 ani au fost de 91,9%, 88,5%, respectiv 88,5% (0-17 ani). Concluzie: Transplantul de ficat pentru bolile hepatice în stadiul terminal la copii a devenit o soluţie viabilă, donatorul viu fiind principala sursă de grefe hepatice. Avantajele transplantului hepatic de la donator în viață includ posibilitatea de a fi efectuate în regim programat într-un cadru optim şi timp de aşteptare scăzut pentru primitor.Introduction: In the last two decades pediatric liver transplantation became a viable solution for children with End stage liver disease. Although pediatric cases represent about 11% of the total patients on the waiting list in Romania, the utilization of living-related donors livers, cut down “reduced” and split liver grafts has provided more liver grafts for pediatric patients thus reducing the number of the patients on the waiting list and had shown results similar in comparison with adult liver transplant. Material and methods: Between March 2004 and April 2015, 60 children pts were liver transplanted by I.Popescu et al. at Fundeni Clinical Institute in Bucharest. The main indication for transplantation were congenital biliary anomalies (biliary atresia, hypoplasia or ductopenia) (12 pts; 20%), Wilson’s disease (11 pts; 18.3%), glycogenosis (8 pts; 13.3%), and congenital liver fibrosis (7 pts; 11.7%). Results: In pediatric patients, long-term 1-, 3-, and 5-year estimated survival rates were 91.9%, 88.5%, and 88.5% (0-17 yrs). Conclusion: Liver transplant for end stage liver disease in children has became a viable curative solution, living donor liver transplant being the main source of liver grafts

A comparative study of navigation meshes

International audienceA navigation mesh is a representation of a 2D or 3D virtual environment that enables path planning and crowd simulation for walking characters. Various state-of-the-art navigation meshes exist, but there is no standardized way of evaluating or comparing them. Each implementation is in a different state of maturity, has been tested on different hardware, uses different example environments, and may have been designed with a different application in mind. In this paper, we conduct the first comparative study of navigation meshes. First, we give general definitions of 2D and 3D environments and navigation meshes. Second, we propose theoretical properties by which navigation meshes can be classified. Third, we introduce metrics by which the quality of a navigation mesh implementation can be measured objectively. Finally, we use these metrics to compare various state-of-the-art navigation meshes in a range of 2D and 3D environments. We expect that this work will set a new standard for the evaluation of navigation meshes, that it will help developers choose an appropriate navigation mesh for their application, and that it will steer future research on navigation meshes in interesting directions

Reports on the 2015 AAAI Workshop Program

Knowledge, Skill, and Behavior Transfer in Autonomous Robots: report on p. 9

Managing travels with PETRA: The Rome use case

The aim of the PETRA project is to provide the basis for a city-wide transportation system that supports policies catering for both individual preferences of users and city-wide travel patterns. The PETRA platform will be initially deployed in the partner city of Rome, and later in Venice, and Tel-Aviv