Neo-Suprahepatic cava: A case report of a modified technique for domino liver transplantation

Domino liver transplantation, introduced in 1997, originally consisted of a graft from a patient with familial amyloidotic polyneuropathy used as a donor for a compatible recipient, thus increasing the pool of hepatic grafts for liver transplantation. The aim of this report was to present a modification on the technique for outflow reconstruction in domino liver transplantation first proposed by Liu et al and Cescon et al. In this description we proposed a new technique that differs from the one mentioned above by performing a neo-suprahepatic cava, constructed using only an iliac vein graft, facilitating the anastomosis as if it was a regular cadaveric liver transplant.Fil: Padín, J. M.. Fundación Favaloro; ArgentinaFil: Pfaffen, G.. Fundación Favaloro; ArgentinaFil: Pérez Fernández, I.. Fundación Favaloro; ArgentinaFil: Sandi, M.. Fundación Favaloro; ArgentinaFil: Ramisch, D.. Fundación Favaloro; ArgentinaFil: Barros Schelotto, P.. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome

Abstract Background. Portal vein thrombosis (PVT) is a well recognized complication of patients with end-stage cirrhosis and its incidence ranges from 2 to 26%. The aim of this study was to analyze the results and long-term follow-up of a consecutive series of liver transplants performed in patients with PVT and compare them with patients transplanted without PVT. Patients and methods. Between July 1995 and June 2006, 26 liver transplants were performed in patients with PVT (8.7%). Risk factors and variables associated with the transplant and the post-transplant period were analyzed. A comparative analysis with 273 patients transplanted without PVT was performed. Results. The patients comprised 53.8% males, average age 40, 7 years. PVTwas detected during surgery in 65%. Indications for transplantation were: post-necrotic cirrhosis 73%, cholestatic liver diseases 23%, and congenital liver fibrosis 4%. Child-Pugh C: 61.5%. Techniques were trombectomy in 21 patients with PVT grades I, II, IV, and extra-anatomical mesenteric graft in 5 with grade III. Morbidity was 57.7%, recurrence of PVTwas 7.7%, and in-hospital mortality was 26.9%. Greater operative time, transfusion requirements, and re-operations were found in PVT patients. One-year survival was 59.6%: 75.2% for grade 1 and 44.8% for grades 2, 3, and 4. Discussion. The study demonstrated a PVT prevalence of 8.7%, a higher incidence of partial thrombosis (grade 1), and successful management of PVT grade 4 with thrombectomy. Liver transplant in PVT patients was associated with an increased operative time, transfusion requirements, re-interventions, and lower survival rate according to PVT extension

Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome

Background. Portal vein thrombosis (PVT) is a well recognized complication of patients with end-stage cirrhosis and its incidence ranges from 2 to 26%. The aim of this study was to analyze the results and long-term follow-up of a consecutive series of liver transplants performed in patients with PVT and compare them with patients transplanted without PVT. Patients and methods. Between July 1995 and June 2006, 26 liver transplants were performed in patients with PVT (8.7%). Risk factors and variables associated with the transplant and the post-transplant period were analyzed. A comparative analysis with 273 patients transplanted without PVT was performed. Results. The patients comprised 53.8% males, average age 40, 7 years. PVT was detected during surgery in 65%. Indications for transplantation were: post-necrotic cirrhosis 73%, cholestatic liver diseases 23%, and congenital liver fibrosis 4%. Child-Pugh C: 61.5%. Techniques were trombectomy in 21 patients with PVT grades I, II, IV, and extra-anatomical mesenteric graft in 5 with grade III. Morbidity was 57.7%, recurrence of PVT was 7.7%, and in-hospital mortality was 26.9%. Greater operative time, transfusion requirements, and re-operations were found in PVT patients. One-year survival was 59.6%: 75.2% for grade 1 and 44.8% for grades 2, 3, and 4. Discussion. The study demonstrated a PVT prevalence of 8.7%, a higher incidence of partial thrombosis (grade 1), and successful management of PVT grade 4 with thrombectomy. Liver transplant in PVT patients was associated with an increased operative time, transfusion requirements, re-interventions, and lower survival rate according to PVT extension

Right Extended Split Liver Transplantation Compared With Whole Liver Transplantation: Lessons Learned at a Single Center in Latin America—Results From a Match Case-Control Study

Background Despite the progressively increasing gap between patients waiting for liver transplant under the Model for End-stage Liver Disease MELD system and the availability of deceased donor organs, the use of right extended split liver grafts (RESLG) has not been accepted by all centers. In this study, we compared the results obtained using RESLG vs a group of matched whole liver graft (WLG) recipients at a single center in Latin America. Methods A single-center retrospective review performed between August 2009 and December 2015. Results Fifteen RESLGs were implanted to recipients between 13 and 70 years of age; 80% were performed ex situ. The “biological MELD” score for the RESLG group was 17.5 ± 5.6, and it was 12.8 ± 4.5 for the WLG group (P =.01). Cold ischemia times were significantly longer in RESLG recipients compared with WLG recipients (528 minutes vs 420 minutes; P <.01). No significant differences were found in biliary (leak or strictures P =.40) and arterial complications (hepatic artery thrombosis, P =.06). RESLG patients benefited from a considerable reduction on their waiting time in list. The 1-, 3-, and 5-year patient survival rates were 93%, 93%, and 93% respectively, for RESLG recipients vs 100%, 95.7%, and 86.1%, respectively, for WLG recipients. The 1-, 3-, and 5-year graft survival rates were 79.4%, 79.4%, and 79.4% for RESLG recipients and 89.7%, 89.7%, and 89.7% for WLG recipients, respectively. No statistical differences were observed. Conclusion RESLG allows expeditious transplantation for low MELD recipients. Its use should be expanded in Latin America and worldwide as a valid alternative to increase the donor pool as it has been used in other regions.Fil: Gambaro, Sabrina Eliana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Favaloro; ArgentinaFil: Romero, P.. Fundación Favaloro; ArgentinaFil: Pedraza, N.. Fundación Favaloro; ArgentinaFil: Moulin, L.. Fundación Favaloro; ArgentinaFil: Yantorno, S.. Fundación Favaloro; ArgentinaFil: Ramisch, D.. Fundación Favaloro; ArgentinaFil: Rumbo, Carolina. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Descalzi, Ricardo Luis. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; Argentina. Fundación Favaloro; Argentin

Impact of prior portosystemic shunt procedures on outcome of liver transplantation

Background. Cirrhotic patients may require portosystemic shunts as treatment for complications of portal hypertension. The aim of this study was to asses how these procedures may influence the orthotopic liver transplantation procedure and its outcome. Methods. Forty-five patients with a previous portosystemic shunt were divided into 3 groups (group 1, 19 with a portocaval shunt; group 2, 4 with a mesocaval shunt and 5 with a distal splenorenal shunts; group 3, 17 with a transjugular intrahepatic portosystemic shunt). Forty-five patients without a shunt, matched for age, gender, pretransplant liver status, and year of transplantation, were selected as controls. Surgical time, transfusional requirement, intensive care unit and total hospital duration of stay, complications, retransplantation rate, and short- and long-term mortality were analyzed. Results. Group 1 showed a significantly longer surgical time, higher red blood cell transfusional requirements, longer intensive care unit and hospital stay, and greater short and long-term mortality than the controls. No significant differences were observed between groups 2 and 3 and the controls. Conclusions. In cirrhotic patients, surgically created portosystemic shunts involving the hepatic hilum have a negative impact on liver transplantation. This operation should be avoided in potential liver transplant candidates; surgical shunts that do not compromise the hepatic hilum or transjugular intrahepatic portosystemic shunts are preferred

Pancreas Transplantation at a Single Latin-American Center; Overall Results with Type 1 and Type 2 Diabetes Mellitus

Background: Simultaneous pancreas-kidney transplantation (SPK) has become the treatment of choice for type 1 diabetes mellitus (T1DM) patients with chronic renal failure. Type 2 diabetes mellitus (T2DM), was once considered to be a contraindication for pancreas transplantation; however, it has been accepted as a new indication, under strict criteria. Although favorable results have increase the indication for T2DM in developed countries, there have been no reports of long-term results for this indication from Latin American centers. Methods: From April 2008 to March 2016, patients receiving SPK or pancreas transplant alone (PTA) for T2DM were included and compared with T1DM recipients. Variables were compared between groups with the use of χ2 and t tests; Kaplan-Meier with log rank was used for patient and graft survivals; P <.05 was considered to be significant. Results: A total of 45 SPK and 1 PTA were performed, 35 (76.1%) for T1DM and 11 (24.5%) for T2DM. Mean pre-transplantation C-peptide was significantly higher in the T2DM group (P =.01); HbA1c was higher in the T1DM group (P =.03). No differences were found in weight, body mass index, and pre-transplantation glycemia. Patient survivals for T1DM recipients were 88.2% and 84.8% at 1 and 5 years, respetively, versus 100% and 74.1% for T2DM recipients (P =.87). Conclusions: Our initial prospective experience in a single Latin American center showed that medium- and long-term outcomes for T1DM and T2DM individuals receiving pancreas transplants are similar, under strict selection criteria.Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaFil: Aguirre, N. F.. Fundación Favaloro; ArgentinaFil: Ramisch, D. A.. Fundación Favaloro; ArgentinaFil: Mos, F. A.. Fundación Favaloro; ArgentinaFil: Pedraza, N. F.. Fundación Favaloro; ArgentinaFil: Fortunato, M. R.. Fundación Favaloro; ArgentinaFil: Gutiérrez, L. M.. Fundación Favaloro; ArgentinaFil: Fraguas, H.. Fundación Favaloro; ArgentinaFil: Marrugat, R.. Fundación Favaloro; ArgentinaFil: Rabin, G. E.. Fundación Favaloro; ArgentinaFil: Musso, C.. Fundación Favaloro; ArgentinaFil: Farinelli, P. A.. Fundación Favaloro; ArgentinaFil: Barros Schelotto, P. H. L.. Fundación Favaloro; ArgentinaFil: Raffaele, P. M.. Fundación Favaloro; Argentin