Evaluation of hepatic perfusion in the liver graft using fluorescence imaging with indocyanine green

Introduction: Portal vein thrombosis (PVT) after liver transplantation (LT) is one of serious complications and reportedly ranges from 2% to 13%. PVT impairs the blood perfusion to the grafts and causes the graft dysfunction. Presentation of case: A 60-year-old female underwent living-donor LT with the left liver graft for end-stage liver disease related to chronic hepatitis C. After reperfusion, Indocyanine green (ICG)-fluorescence imaging was performed to confirm the graft perfusion, which pointed out an insufficient perfusion on the surface of segment 4. Following intraoperative ultrasonography revealed thrombus in the portal vein of segment 4, which was successfully removed by heparinized saline flush. Discussion: The most of patients with PVT developed graft failure and resulted in retransplantation. This enhances the importance of the surveillance for PVT in the postoperative period as well as the intraoperative period. However, the modality to identify PVT during surgery is limited mainly to intraoperative ultrasound. ICG-fluorescence imaging can visualize regions with impaired hepatic perfusion due to PVT in real time during LT in addition to visualization of hepatic flows of reconstructed vessels and evaluation of regions with venous occlusion. Conclusion: ICG-fluorescence imaging can be simply performed with single ICG injection and is expected to have potential roles to enhance the safety of LT

Synthesis of Deuterium-Labeled Vitamin D Metabolites as Internal Standards for LC-MS Analysis

Blood levels of the vitamin D3 (D3) metabolites 25-hydroxyvitamin D3 (25(OH)D3), 24R,25-dihydroxyvitamin D3, and 1α,25-dihydroxyvitamin D3 (1,25(OH)2D3) are recognized indicators for the diagnosis of bone metabolism-related diseases, D3 deficiency-related diseases, and hypercalcemia, and are generally measured by liquid-chromatography tandem mass spectrometry (LC-MS/MS) using an isotope dilution method. However, other D3 metabolites, such as 20-hydroxyvitamin D3 and lactone D3, also show interesting biological activities and stable isotope-labeled derivatives are required for LC-MS/MS analysis of their concentrations in serum. Here, we describe a versatile synthesis of deuterium-labeled D3 metabolites using A-ring synthons containing three deuterium atoms. Deuterium-labeled 25(OH)D3 (2), 25(OH)D3-23,26-lactone (6), and 1,25(OH)2D3-23,26-lactone (7) were synthesized, and successfully applied as internal standards for the measurement of these compounds in pooled human serum. This is the first quantification of 1,25(OH)2D3-23,26-lactone (7) in human serum

Impact of Early Reoperation following Living-Donor Liver Transplantation on Graft Survival

<div><p>Background</p><p>The reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to <i>evaluate the impact of early reoperation following living-donor liver transplantation</i> (LDLT) on graft and recipient survival.</p><p>Methods</p><p>Recipients that underwent LDLT (n = 111) at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27) and a non-reoperation group (n = 84), and case-control study was conducted.</p><p>Results</p><p>Early reoperation was performed in 27 recipients (24.3%). Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6- month graft survival rates were 88.9% (95%confidential intervals [CI], 70.7–96.4), and 85.2% (95%CI, 66.5–94.3), respectively, in the reoperation group (n = 27), and 95.2% (95%CI, 88.0–98.2), and 92.9% (95%CI, 85.0–96.8), respectively, in the non-reoperation group (n = 84) (the log-rank test, p = 0.31). The 12- and 36- month overall survival rates were 96.3% (95%CI, 77.9–99.5), and 88.3% (95%CI, 69.3–96.2), respectively, in the reoperation group, and 89.3% (95%CI, 80.7–94.3) and 88.0% (95%CI, 79.2–93.4), respectively, in the non-reoperation group (the log-rank test, p = 0.59).</p><p>Conclusions</p><p>Observed graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of vigilant surveillance for postoperative complication and surgical rescue at an early postoperative stage in the LDLT setting.</p></div

Univariable and multivariable Cox proportional hazards model analysis to identify risk factors for early reoperation.

<p>Abbreviations: LDLT, living-donor liver transplantation; MELD, model for end-stage liver disease; PT-INR, international normalized ratio of prothrombin time; GV, graft volume; SLV, standard liver volume; RCC, red blood cell concentrate; FFP, fresh frozen plasma; PC, platelet concentration.</p><p>Univariable and multivariable Cox proportional hazards model analysis to identify risk factors for early reoperation.</p

Univariable and multivariable Cox proportional hazards model analysis for graft survival.

<p>Abbreviations: LDLT, living-donor liver transplantation; MELD, model for end-stage liver disease; PT-INR, international normalized ratio of prothrombin time; GV, graft volume; SLV, standard liver volume; RCC, red blood cell concentrate; FFP, fresh frozen plasma; PC, platelet concentration.</p><p>Univariable and multivariable Cox proportional hazards model analysis for graft survival.</p

Comparison of primary disease between reoperation and non-reoperation cases after LDLT.

<p>Abbreviations: HCV, hepatitis C virus; HBV, hepatitis B virus; PBC, primary biliary cirrhosis, PBC; PSC, Primary sclerosing cholangitis; LDLT, living-donor liver transplantation; N.A., not applicable. n (%).</p><p>Comparison of primary disease between reoperation and non-reoperation cases after LDLT.</p