Glasgow coma scale and APACHE-II scores affect the liver transplantation outcomes in patients with acute liver failure

WOS: 000328005900004PubMed ID: 24322743BACKGROUND: The timing and selection of patients for liver transplantation in acute liver failure are great challenges. This study aimed to investigate the effect of Glasgow coma scale (GCS) and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure. METHOD: A total of 25 patients with acute liver failure were retrospectively analyzed according to age, etiology, time to transplantation, coma scores, complications and mortality. RESULTS: Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants. The mean duration of follow-up after liver transplantation was 39.86 +/- 40.23 months. Seven patients died within the perioperative period and the 1-, 3-, 5-year survival rates of the patients were 72%, 72% and 60%, respectively. The parameters evaluated for the perioperative deaths versus alive were as follows: the mean age of the patients was 33.71 vs 28 years, MELD score was 40 vs 32.66, GCS was 5.57 vs 10.16, APACHE-II score was 23 vs 18.11, serum sodium level was 138.57 vs 138.44 mmol/L, mean waiting time before the operation was 12 vs 5.16 days. Low GCS, high APACHE-II score and longer waiting time before the operation (P<0.01) were found as statistically significant factors for perioperative mortality. CONCLUSION: Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation

Is There A Role For MELD In Adult Living Donor Liver Transplantation?

64th Annual Meeting and Postgraduate Course of the American-Association-for-the-Study-of-Liver-Diseases -- NOV 01-05, 2013 -- Washington, DCWOS: 000330252203339…Amer Assoc Study Liver Di

Living Donor Liver Transplantation for Small (< 2 cm) Hepatocellular Carcinoma: A Class of Its Own.

18th Annual International Congress on ILTS -- MAY 16-19, 2012 -- San Francisco, CAWOS: 000303043200595…ILT

PET/CT Positivity Has Lower Survival in Adult Living Donor Liver Transplantation for Hepatocellular Carcinoma

65th Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases -- NOV 07-11, 2014 -- Boston, MAWOS: 000344483802145…Amer Assoc Study Liver Di

Right Lobe Grafts with Triple Biliary Orifices: Think Thrice

21st Annual International Congress of the International-Liver-Transplant-Society (ILTS) -- JUL 08-11, 2015 -- Chicago, ILWOS: 000368626500077…Int Liver Transplant So

Biliary complications after right lobe living donor liver transplantation: a single-centre experience

WOS: 000297800400008PubMed ID: 22151451Background: Biliary complications that developed after right lobe liver transplantation from living donors were studied in a single centre. Methods: From 2004 to 2010, 200 consecutive living donor right lobe liver transplantations were performed. The database was evaluated retrospectively. Biliary complications were diagnosed according to clinical, biochemical and radiological tests. The number of biliary ducts in the transplanted graft, the surgical techniques used for anastomosis, biliary strictures and bile leakage rates were analysed. Results: Of a total of 200 grafts, 117 invloved a single bile duct, 77 had two bile ducts and in six grafts there were three bile ducts. In 166 transplants, the anastomosis was performed as a single duct to duct, in 21 transplants double duct to ducts, in one transplant, three duct to ducts and in 12 transplants as a Roux-en-Y reconstruction. In all, 40 bile leakages (20%) and 17 biliary strictures (8.5%) were observed in 49 patients resulting in a total of 57 biliary complications (28.5%). Seventeen patients were re-operated (12 as a result of bile leakages and five owing to biliary strictures). Conclusion: Identification of more than one biliary orifice in the graft resulted in an increase in the complication rates. In grafts containing multiple orifices, performing multiple duct-to-duct (DD) or Roux-en-Y anastomoses led to a lower number of complications

Anatomical variations of donor portal vein in right lobe living donor liver transplantation: the safe use of variant portal veins

WOS: 000330176700007PubMed ID: 24252057In right lobe (RL) living donor liver transplantation (LDLT), portal vein (PV) variations are of immense clinical significance. In this study, we describe in detail our PV reconstruction techniques in RL grafts with variant PV anatomy and evaluate the impact of accompanying biliary variations on the recipient outcomes. In a total of 386 RL LDLTs performed between July 2004 and July 2012, the clinical data on 52 (13%) transplants using RL grafts with variant PV anatomy were retrospectively analyzed. Portal vein anatomy was classified as type 2 in 20 patients, type 3 in 24 patients, and type 4 in eight patients. The PV reconstruction techniques utilized included back-wall plasty (n = 21), back-wall plasty with saphenous vein graft interposition (n = 6), saphenous vein graft interposition (n = 5), cryopreserved iliac vein Y-graft interposition (n = 6), and quiltplasty (n = 3). There was no donor mortality. In a median follow-up of 29 months, none of the recipients had vascular complications. Anomalous PV anatomy was associated with a high (54%) incidence of biliary variations; however, these variations did not result in increased biliary complication rate. Overall, the 1- and 3-year patient survival rates of recipients were 91% and 81%, respectively. Vascular and biliary variations in RL grafts render LDLT technically more challenging. By employing appropriate reconstruction techniques, it is possible to successfully use RL grafts with PV variations without endangering recipient and donor safety

A new technique for the reconstruction of complex portal vein anomalies in right lobe living liver donors

WOS: 000307210300015PubMed ID: 22893474Living donor liver right lobe transplantation using donors with variation of the right sectorial portal vein is considered a challenging procedure in terms of the donor's safety and the complexity of reconstruction in the recipient. We describe an innovative technique to reconstruct double portal vein orifices via a deceased donor iliac vein graft. The postoperative course of the recipient was uneventful. Doppler ultrasound on the fourth postoperative month revealed equivalent flow in both portal vein branches. Reconstruction of double right portal vein branches using a cryopreserved iliac vein is a valuable technique for utilizing right lobe grafts with challenging portal vein anatomy