Effect of pre‐transplant sarcopenia on the estimation of standard liver volume in living‐donor liver transplant candidates: risk factor for post‐transplant small‐for‐size syndrome? A retrospective study

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Results of laparoscopic subtotal cholecystectomy by laparoscopic linear stapler in difficult cases with severe cholecystitis

Laparoscopic subtotal cholecystectomy (LSC) has been recognized as a safe and feasible alternative surgical procedure for a difficult laparoscopic cholecystectomy (LC) with severe inflammation in Calot’s triangle. We compared the surgical outcomesof cholecystectomy for acute cholecystitis between standard LC and LSC using laparoscopic linear stapler. 172 patients were diagnosed as acute cholecystitis, among them, 16 patients who underwent LSC and other 156 patients who underwent standardLC were enrolled in this study. The severity grading of acute cholecystitis in LSC group was significantly higher than LC group. Operation time was longer in the LSC group than LC group. LSC had significantly more intraoperative blood loss compared to LC. However, there was no significant difference in the postoperative complications between two groups. LSC using laparoscopic linear stapler contributes surgeons avoid common bile duct injury in difficult LC

Ameliorated healing of biliary anastomosis by autologous adipose-derived stem cell sheets

Introduction: Cell sheets consisting of adipose-derived stem cells (ADSCs) have been reported to be effective for wound healing. We conducted this study to clarify the efficacy of ADSC sheets in wound healing at the duct-to-duct biliary anastomotic site in pigs. Methods: Eleven female pigs (20?25 kg) were divided into two groups: biliary anastomosis with an ADSC sheet (n = 6) or without an ADSC sheet (n = 5). To follow the transplanted ADSCs, PKH26GL-labeled sheets were used in one of the ADSC pigs. Two weeks prior to laparotomy, ADSCs were isolated from the lower abdominal subcutaneous adipose tissue. After three passages, ADSCs were seeded on temperature-responsive culture dishes and collected as cell sheets. ADSC sheets were gently transplanted on the anastomotic site. We evaluated specimens by PKH26GL labeling, macroscopic changes, infiltration of inflammatory cells, and collagen content. Results: Labeled ADSCs remained around the bile duct wall. In the no-ADSC group, more adhesion developed at the hepatic hilum as observed during relaparotomy. Histopathological examination showed that the diameter and cross-sectional area of the bile duct wall were decreased in the ADSC group. In the no-ADSC group, a large number of inflammatory cells and more collagen fibers were identified in the bile duct wall. Conclusions: The present study demonstrated that autologous ADSC sheet transplantation reduced hypertrophic changes in the bile duct wall at the anastomotic site. A long-term follow-up is required to evaluate the efficacy of this mechanism in prevention of biliary anastomotic strictures

Comparative study of the effect of neuromuscular electrical stimulation and oral administration of branched-chain amino acid on preventing sarcopenia in patients after living-donor liver transplantation: study protocol for an open-label randomized controlled trial

Background: Liver cirrhosis is the irreversible fibrosis of the liver and causes refractory ascites and hepatic encephalopathy, which might not respond to treatment. Living donor liver transplantation (LDLT) is an effective treatment for patients with cirrhosis. However, post-LDLT patients are prone to muscle atrophy and sarcopenia. Therefore, physiotherapy of post-LDLT patients is essential for preventing the progression of sarcopenia. Recently, rehabilitation using neuromuscular electrical stimulation (NMES) has been reported to be useful for preventing the progression of sarcopenia. Similarly, nutrition therapy is essential for post-LDLT patients because these patients frequently experience malnutrition. However, the effects of combined NMES and nutrition therapy on post-LDLT patients remain unknown. Methods/design: This open-label, randomized, parallel-group study will compare the effects of combined therapy with NMES and branched-chain amino acids (BCAA) with those of NMES alone in patients with decompensated cirrhosis after LDLT. After LDLT, 50 patients with decompensated cirrhosis will be randomly assigned to receive NMES with BCAA or NMES without BCAA. The duration of the intervention will be 3 months. To analyze the change in skeletal muscle mass, InBody 770 body composition and body water analysis and ultrasonography will be performed before LDLT and 4 weeks and 12 weeks post-LDLT. The primary endpoint is changes in the skeletal muscle mass from baseline to 3 months. Important secondary endpoints are the changes in the skeletal muscle mass from baseline to 1 month and changes in the quadriceps strength from baseline to 1 month. Discussion: The results of this study are expected to provide evidence regarding the effect of NMES combined with BCAA therapy on the skeletal muscle of post-LDLT patients. Trial registration: Japan Registry of Clinical Research jRCTs071190051. Registered on February 26, 2020

Predictive Factors for Local Recurrence after Intraoperative Microwave Ablation for Colorectal Liver Metastases

This study aimed to clarify local recurrence (LR) predictive factors following intraoperative microwave ablation (MWA) for colorectal liver metastases. The data from 195 patients with 1392 CRLM lesions, who were preoperatively diagnosed by gadolinium-enhanced MRI with diffusion-weighted imaging and dynamic CT and treated with intraoperative MWA (2450 MHz) with or without hepatectomy, from January 2005 to December 2019, were retrospectively reviewed and analyzed using logistic regression. In addition, the margins were measured on contrast-enhanced CT 6 weeks post-ablation. Overall, 1066 lesions were ablated. The LRs occurred in 44 lesions (4.1%) among 39 patients (20.0%). The multivariate analysis per patient showed that tumor size > 20 mm and ablation margin 15 mm, ablation margin 20 mm, and proximity to the Glisson were significant LR predictors. Finally, the outcome of this study may help determine indications for MWA

Understanding the pathogenic effect of frailty on the risk of acute cellular rejection in liver transplantation: are we already that far?

we have read with interest the study performed by Fozouni et al. on the association between pre-transplant frailty and increased risk of early acute cellular rejection (ACR) after liver transplantation (LT). Chronic systemic inflammation, which is frequently detected in frail patients, was suspected by the Authors as the underlying pathogenic mechanism. This result was somehow unexpected since frail patients are usually clinically perceived as immunocompromised. Moreover, liver cirrhosis itself is associated with a severe immune dysfunction which is characterized by immunodeficiency and systemic inflammation

The First Case of Deceased Donor Liver Transplantation for a Patient with End-Stage Liver Cirrhosis Due to Human Immunodeficiency Virus and Hepatitis C Virus Coinfection in Japan

We previously reported that progression of liver cirrhosis is quicker and survival is dismal in patients with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection, especially when acquired in childhood through contaminated blood products. Recently, we performed the first deceased donor liver transplantation (DDLT) for an HIV/HCV-coinfected hemophilic patient in Japan. A 40-year-old man was referred to our hospital for liver transplantation. Regular DDLT was performed using the piggyback technique with a full-sized liver graft. Cold ischemia time was 465 min, and the graft liver weighed 1,590 g. The antiretroviral therapy (ART) was switched from darunavir/ritonavir to raltegravir before the transplant for flexible usage of calcineurin inhibitors postoperatively; tenofovir was used as the baseline treatment. The postoperative course was uneventful, and the patient was discharged home on day 43. He started receiving anti-HCV treatment on day 110 with pegylated interferon, ribavirin, and simeprevir after the DDLT. Herein, we report the first case of DDLT in Japan. Meticulous management of ART and clotting factors could lead to the success of DDLT

Technical Refinement of Hepatic Vein Reconstruction in Living Donor Liver Transplantation Using Left Liver Graft

Background: In adult living donor liver transplantation (LDLT), left liver graft is generally safer for the donor. The aim of this study was to demonstrate a technical refinement for achieving sufficient outflow using left liver graft. Material/Methods: Forty-seven cases using left liver were divided into 2 groups according to the procedures of hepatic vein reconstruction: the side-clamp group (21 cases), and the cross-clamp group (26 cases), to sufficiently enlarge the diameter of the hepatic vein with excising the inferior vena cava (IVC). Results: The liver function tests at 7 days after LDLT were not significantly different between the 2 groups, but the median amount of ascites was significantly greater in the side-clamp group (1250 ml; range, 484?3690) than in the cross-clamp group (582 ml; 190?2785). When we selected the patients with the ratio of graft weight to recipient standard liver volume less than 30%, the 1-year patient survival after transplantation was significantly better in the cross-clamp group than in the side-clamp group (90% in cross-clamp group vs. 71% in side-clamp group, P>0.05). Conclusions: In conclusion, hepatic vein reconstruction with cross-clamping of the IVC can secure a sufficient outflow in LDLT using left liver graft

Postoperative delirium in liver resection patients: Usefulness of the abdominal wall fat index

Postoperative delirium is one of the most common and important complications in patients who have undergone surgery. Although the precise mechanism of postoperative delirium is unclear, several risk factors have been reported. Here we investigated candidate risk factors for postoperative delirium after liver resection. This retrospective analysis included 112 consecutive patients who underwent an elective liver resection. Preoperative and intraoperative parameters were analyzed for their potential as risk factors of postoperative delirium. Thirty-one patients (27.7%) developed postoperative delirium. A multivariate analysis showed that advanced age (odds ratio [OR] = 1.189, 95% confidence interval [95%CI] = 1.081–1.309, p<0.001), the abdominal wall fat index (AFI) (OR 14.904, 95%CI 3.072–72.319, p<0.001), and non-laparoscopic surgery (OR 5.496, 95%CI 1.237–24.413, p=0.025) were independent risk factors for postoperative delirium. The AFI had a high OR for postoperative delirium. The area under the receiver-operating characteristic (ROC) curve was 0.806 (95%CI, 0.713–0.896) with a calculated optimal cut-off value of 1.0. The AFI is thus the most useful predictor for postoperative delirium after liver resection. Elderly patients with a higher AFI (>1.0) and open liver resection are associated with an increased risk of postoperative delirium

Postoperative delirium in liver resection patients: Usefulness of the abdominal wall fat index

Postoperative delirium is one of the most common and important complications in patients who have undergone surgery. Although the precise mechanism of postoperative delirium is unclear, several risk factors have been reported. Here we investigated candidate risk factors for postoperative delirium after liver resection. This retrospective analysis included 112 consecutive patients who underwent an elective liver resection. Preoperative and intraoperative parameters were analyzed for their potential as risk factors of postoperative delirium. Thirty-one patients (27.7%) developed postoperative delirium. A multivariate analysis showed that advanced age (odds ratio [OR] = 1.189, 95% confidence interval [95%CI] = 1.081?1.309, p1.0) and open liver resection are associated with an increased risk of postoperative delirium