Portal vein grafts in hepatic transplantation

Confirmation of patency of the portal vein by either ultrasound or angiography is a routine part of the evaluation of patients being considered for hepatic transplantation. Complete thrombosis of the portal vein usually has been viewed as precluding successful orthotopic hepatic replacement. In addition, some pediatric patients present with extremely small portal veins which, although patent, have proved to be thick walled and sclerotic. Our recent experience has shown that, in both of these situations, successful and complete revascularization of hepatic allografts is quite feasible by using a vein graft to ensure adequate portal venous flow

Investigation for Daily Profile of Blood Glucose by the Administration of Canagliflozin and Xultophy (IdegLira)

Background: American Diabetes Association (ADA) presented 2022 guideline, and indicated the benefit of sodium-glucose transporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonist (GLP-1RA). Xultophy is a combined agent of insulin degludec/liraglutide (IDegLira), which is recently clinically useful. Patient and Method: The case is 72-year-old man with type 2 diabetes mellitus (T2DM). He has been treated by some oral hypoglycemic agents (OHAs) with unstable HbA1c levels. Results: When HbA1c was 9.9% in 2018, his daily profile of blood glucose three times a day ranged 208-289 mg/dL. By starting canagliflozin, blood glucose decreased for 145-194 mg/dL. As HbA1c increased to 8.8% in 2021, blood glucose ranged 179-192 mg/dL. By starting Xultophy 12 doses per day, it decreased to normal level for 73-155 mg/dL. HbA1c was reduced to 6.7% half year later. Changes in eGFR showed the decrease from 80 to 51 mL/min/1.73 m2 during unstable HbA1c period in 2018-2019, and stable 50-60 mL/min/1.73 m2 during stable HbA1c period in 2020-2021 with Xultophy therapy. Discussion: SGLT2i, GLP-1RA and Xultophy seem to be beneficial for cardiovascular and renal function. Furthermore, these agents seem to be adequate for diabetic patients with chronic kidney disease (CKD) and/or diabetic kidney disease (DKD)

Accuracy of computerized tomography in determining hepatic tumor size in patients receiving liver transplantation or resection

Computerized tomography (CT) of liver is used in oncologic practice for staging tumors, evaluating response to treatment, and screening patients for hepatic resection. Because of the impact of CT liver scan on major treatment decisions, it is important to assess its accuracy. Patients undergoing liver transplantation or resection provide a unique opportunity to test the accuracy of hepatic-imaging techniques by comparison of finding of preoperative CT scan with those at gross pathologic examination of resected specimens. Forty-one patients who had partial hepatic resection (34 patients) or liver transplantation (eight patients) for malignant (30 patients) or benign (11 patients) tumors were evaluable. Eight (47%) of 17 patients with primary malignant liver tumors, four (31%) of 13 patients with metastatic liver tumors, and two (20%) of 10 patients with benign liver tumors had tumor nodules in resected specimens that were not apparent on preoperative CT studies. These nodules varied in size from 0.1 to 1.6 cm. While 11 of 14 of these nodules were 1.0 cm. These results suggest that conventional CT alone may be insufficient to accurately determine the presence or absence of liver metastases, extent of liver involvement, or response of hepatic metastases to treatment

Pancreatic complications following orthotopic liver transplantation

During fiscal year 1986, 40 out of 196 patients (21%) developed hyperamylasemia following orthotopic liver transplantation. The placement of a retropancreatic aortohepatic arterial interposition graft was associated with hyperamylasemia (p < 0.025). Eight patients (20%) developed clinically significant acute pancreatitis and its sequelae; abscesses and pseudocysts each in 2. Pancreatitis was attributable to the retropancreatic arterial graft in 4, viral infection in 2 and obstruction of the pancreatic duct in 1 patient. All 4 patients with arterial graft-related pancreatitis exhibited poor graft function immediately postoperatively, of whom 2 required retransplantation - both of which failed to function. Five patients died (63%); 2 from primary graft non-function, 2 due to sepsis and 1 from systemic cytomegalovirus infection. We conclude that acute pancreatitis after liver transplantation is a life-threatening complication which is often associated with graft non-function

Liver transplantation: an unfinished product.

Liver transplantation has become an extraordinarily valuable and useful operation, but one that is not perfect and that has not been exploited to anything like its full potential. Better immunosuppression may become available soon as exemplified by developments with the Japanese drug, FK506. Improved preservation with the UW solution is already here. With these advantages, liver transplantation is certain to become far more widely used than at any time in the past. Examples were cited of innovative approaches using liver transplantation for the treatment of hepatic malignancies

Analysis of surgical complications after 397 hepatic transplantations

The results of 397 consecutive orthotopic hepatic transplantations in 333 recipients were reviewed. One or more surgical complications developed in 172 of 323 patients (55 per cent), excluding ten intraoperative deaths. The six month mortality rate among the patients with surgical complications (55 of 172; 32 per cent) was statistically higher than that among patients without such complications (16 of 151; 11 per cent) (p < 0.001; chi-square, 58.36). Surgical complications including exploratory laparotomy for bleeding or infection in 74 (22 per cent), reconstruction of the bile duct for biliary obstruction or leakage in 55 (17 per cent), external biliary drainage for biliary leakage in four (1 per cent), tracheostomy in 80 (24 per cent), thoracotomy in 12 (4 per cent) and splenectomy in seven (2 per cent). The incidence of biliary obstruction (16 per cent mortality rate) and leakage (48 per cent mortality rate) was 18 per cent (34 of 193) and 2 per cent (four of 193) each after choledochocholedochostomy, which was 3 per cent (five of 187) and 9 per cent (17 of 187) each choledochojejunostomy. Biliary obstruction (16 per cent mortality rate) was more common after choledochocholedochostomy (p < 0.005; chi-square, 23.01), whereas the incidence of more serious biliary leakage (48 per cent mortality rate) was higher after choledochojejunostomy (p < 0.005; chi-square, 8.97). It is concluded that orthotopic hepatic transplantation remains an unforgiving extensive surgical procedure, in which choledochocholedochostomy remains the first-choice reconstruction of the biliary tract because of its lower mortality

Amelioration of normothermic canine liver ischemia with prostacyclin.

A model of hepatic ischemia was developed in dogs using a pump-driven splanchnic-to-jugular vein bypass during crossclamping of the portal triad. An LD50 was established with three hours of ischemia. PGI2 given for one hour before the ischemic insult ameliorated the ischemic injury and increased survival

Improved HbA1c value by combined treatment of Dulaglutide and Imeglimin for patient with type 2 diabetes mellitus (T2DM)

Background: As a novel oral hypoglycemic agent (OHA), imeglimin has been recently applied for patients with type 2 diabetes mellitus (T2DM) as Twymeeg. It has beneficial twin mechanisms associated with increasing insulin secretion, and decreasing insulin resistance. It has a triazine ring and become the first OHA for tetrahydrotriazine-containing agent in the category of the glimins. Case presentation: The case is 84-year-old female with T2DM and mild cognitive impairment (MCI). Her HbA1c was 9.3% a year ago. Results: She was begun to receive Dulaglutide 0.75mg/week and showed 1.3% HbA1c reduction for 6 months. However, HbA1c was elevated again to 8.5%, and then she was provided Twymeeg 2000mg/day. HbA1c decreased from 8.5% to 7.5% in 3 months. [Discussion and conclusion] From combined treatments of imeglimin and other agents in the previous study, mean HbA1c reduction showed single imiglimin -0.46%, DPP-4i -0.92% and GLP-1RA -0.12%. Possible reason for the difference between the latter two suggests that multiple action mechanisms of imeglimin may be present including the enhancement of glucose-stimulated insulin secretion (GSIS). In contrast, she showed satisfactory HbA1c reduction by the combination of imeglimin and GLP-1RA. The pathophysiology is not clear, and future follow up the clinical progress will be required

Influence of Diabetes Mellitus on Chronic Periodontitis from Recent Studies

Diabetes mellitus (DM) and chronic periodontitis have been medical and social crucial problem. The standard guideline on DM and periodontitis is from European Federation of periodontology (EFP) and International Diabetes Federation (IDF). Compared with DM without periodontitis, DM with periodontitis showed higher clinical risks. Odds ratio (OR) were neuropathy 3.2-6.6, retinopathy 2.8-8.7, nephropathy 1.9-8.5, cardiovascular complications 1.3-17.7 and mortality 2.3-8.5. By proper treatment of periodontitis, estimated HbA1c decrease would be 0.27-0.48% for a few months. As to educational, protective and treatment strategies, authors propose the use of soft interdental brush for DM patients by medical professionals such as nurses