Two-Stage Liver Transplantation with Temporary Porto-Middle Hepatic Vein Shunt

Two-stage liver transplantation (LT) has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC), followed by the creation of a temporary end-to-side porto-caval shunt (TPCS). The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV) was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS

Successful Kidney Transplantation after COVID-19

COVID-19, the ongoing pandemic caused by SARS-CoV-2, has had a dramatic impact on transplant systems in the most affected countries, namely Italy. Preliminary data indicates that patients on hemodialysis therapy as well kidney transplant (KTx) recipients appear to be particularly susceptible to COVID-19 illness due to immunosuppression and coexisting conditions. Currently, there is a lack of data concerning the biologic behavior, recurrence and long-term morbidity of COVID-19 and there are no experiences of transplants in patients who have previously had COVID-19. We report what is likely to be the first case of a KTx performed after a recent COVID-19 illness

Fatal Donor-Derived Carbapenem-Resistant Klebsiella pneumoniae Infection in a Combined Kidney-Pancreas Transplantation

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in solid organ transplant recipients are associated with high morbidity and mortality. We report a case of a fatal donor-derived CR-KP infection in a combined kidney-pancreas transplant. Given the short interval of time between donor hospitalization and organ procurement, information concerning the donor CR-KP positivity arrived only 72 hours after transplant. Based on this experience, we believe that knowledge of the donor’s CR-KP status should be mandatory before procurement and, if positive, pancreas donation should be contraindicated

Prognostic evaluation of the new American joint committee on cancer/international union against cancer staging system for hepatocellular carcinoma: Analysis of 112 cirrhotic patients resected for hepatocellular carcinoma

Background: In 2002, the American Joint Committee on Cancer and the International Union Against Cancer redefined the T-classification for hepatocellular carcinoma, shifting the cutoff value for tumor size from 2 to 5 cm and giving more emphasis to vascular invasion. Methods: A retrospective cohort study was conducted on 223 consecutive patients with hepatocellular carcinoma observed between 1990 and 2002. One hundred twelve were resected and considered for retrospective analysis. Univariate and multivariate analyses were performed on several clinicopathologic variables. After classification according to each staging system, the long-term survival of different stages was compared. The prognostic value of each staging system was further evaluated by entering each stage, in turn, into the Cox regression model with other clinicopathologic variables. The median follow-up was 19 months. Results: On multivariate analysis, the viral etiology of cirrhosis and the presence of multiple nodules were independent prognostic factors. When the new staging system was entered into the multivariate analysis, it was the only independent factor (P = .02). When stratified according to the old tumor-node-metastasis system, there were no significant differences in the survival between stage I and II (P = .14) or between stage IIIA and IVA (P = .33); only the survival of stage II and IIIA was different (P < .01). When stratified according to the new tumor-node-metastasis system, there were significant differences between stage I and II (71.7% vs. 54.7%; P = .02). Conclusions: The new staging system is a more reliable and objective method for T classification. It is easy to use in clinical practice and is better at stratifying curatively resected patients with respect to prognosis. © 2005 The Society of Surgical Oncology, Inc