Coagulation profile following liver resection: Does liver cirrhosis affect thromboelastography?

Background

Thromboelastography has called into question the coagulopathy seen following partial hepatectomy. However the coagulation profile in cirrhotic livers has not been studied. Our objective was to determine the coagulation profile following partial hepatectomy in normal and cirrhotic livers.

“Vanishing liver metastases”—A real challenge for liver surgeons

Expanded surgical intervention in colorectal liver metastasis (LM) and improved chemotherapy led to increasing problem of disappearing liver metastases (DLM). Treatment of those continues to evolve and poses a real challenge for HPB surgeons. This review discusses a clinical approach to DLM, emphasizing crucial steps in clinical algorithm. Particular issues such as imaging, intraoperative detection and surgical techniques are addressed. A step-by-step algorithm is suggested.     

The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection—a single-center experience

Purpose  

Postoperative liver failure (PLF) is a relatively frequent and life-threatening complication after extended liver resection. This study describes the economic burden of PLF from the hospitals' perspective and explores the role of liver function capacity.     

Simultaneous liver–pancreas transplantation for cystic fibrosis-related liver disease: A multicenter experience

BackgroundDiabetes is associated with increased morbidity and mortality in patients with cystic fibrosis (CF). While liver transplantation is well established for CF-related liver disease (CFLD), the role of simultaneous liver–pancreas transplantation is less understood.MethodsWe polled 81 pediatric transplantation centers to identify and characterize subjects who had undergone simultaneous liver–pancreas transplantation and obtain opinions about this procedure in CFLD.ResultsFifty (61.7%) polled transplant centers responded and 94% reported that they would consider simultaneous liver–pancreas transplantation for CFLD and diabetes. A total of 8 patients with simultaneous liver–pancreas transplantation were identified with median follow up of 38 months. All patients had pre-existing diabetes. Exocrine and endocrine pancreatic function was initially restored in all patients with later functional loss in one patient. Body mass index Z-score increased between one year pre-transplantation and one year post-transplantation (P = 0.029).ConclusionsPatients with CFLD undergoing initial assessment for liver transplantation may benefit from consideration of simultaneous liver–pancreas transplantation.     

Auxiliary liver transplantation for management of acute liver failure in children – Systematic review

IntroductionLiver transplantation (LT) remains the standard of care in the treatment of acute pediatric liver failure (PALF) for the replacement of a severely damaged native liver in patients who are unlikely to recover. However, this is burdened by the consequences of long-term immunosuppression.Auxiliary partial liver orthotopic transplantation (APOLT) has emerged as a possible improved approach, by providing a graft that assures liver function until the regeneration of the native liver occurs, and then allows for possible progression to immunosuppression withdrawal.No previous systematic review has assessed APOLT for PALF. The aim of this work is to provide information on survival, postoperative complications, and withdrawal of immunosuppression after APOLT for PALF.MethodsThe study was carried out according to the recommendations of the preferred report items for systematic reviews and meta-analyzes (PRISMA). We searched several electronic databases until October 31st, 2020, using the search terms “acute liver failure”, “auxiliary liver transplant” and the MESH term “liver failure, acute”. All types of clinical publications that presented results on APOLT for PALF, in English or Portuguese, and restricted to humans and for children under 18 years old were included. The following exclusion criteria were applied: “follow-up time <6 months”, “does not report complications” and “does not report immunosuppression regimen (double vs triple)”. Demographic data, clinical characteristics at the time of surgery and postoperative results were analyzed.ResultsA total of 14 references (including 45 patients) were selected, including 3 case series (6–20 patients) and 11 case reports.Of the 45 subjects, 33 (73.3%) were male and 12 (26.7%) female. In most cases (n = 30; 66.7%), the cause of PALF was undetermined. All patients underwent APOLT. Their median age was 9 (range 0.6–17) years. In the postoperative period, the immunosuppression regimen was double in 34 (75.6%) and triple in 11 (24.4%) individuals. The main postoperative complications were rejection and infection. Over a follow-up period of 6 months to 14 years, 10 (22.2%) patients died. The main cause of death was sepsis (70%). Six (13.3%) patients were retransplanted. Of the survivors (n = 35), 68.6% achieved complete withdrawal from the immunosuppression regimen.ConclusionBased on current published evidence, APOLT for the treatment of PALF is a safe option, with an acceptable rate of complications and mortality. It has the great advantage of providing an immunosuppression-free life in the majority (68.6%) of survivors.     

Do patients with acute liver failure have a better chance to receive liver grafting?

OBJECTIVE: Patients with acute hepatic failure (AHF) were always given first priority on the transplant waiting list. We investigated whether AHF patients will deprive other patients on the waiting list of the chance of liver transplantation (LTx). METHODS AND RESULTS: From January 1999 to March 2003, a total of 423 patients were on the transplant waiting list at the National Taiwan University Hospital. Sixty-five of the patients had AHF caused by hepatitis-B-related disease (HBV, n = 52, 80%), Wilson disease (n = 3, 4.6%), drug-induced AHF (n = 3, 4.6%), and other causes (n = 7, 10.8%).Thirty-three patients died and 16 survived by medical treatment. Two received LTx abroad and 14 underwent LTx at our hospital (7 living-related; 7 cadaver). A total of 140 patients died while waiting for a transplant during the period studied. Of them, 107 were among 358 non-AHF patients (30%), and time-to-death interval was 133 +/- 175 days (median: 62); 33 were among 65 AHF patients (51%); time to death was 19 +/- 28 days (median: 8). There were 35 cadaver donor livers available during the period; 28 of 358 non-AHF patients (7.8%), and 7 of 65 AHF patients (10.7%) received cadaveric LTx. Their waiting time totaled 342 +/- 316 and 12 +/- 9 days, respectively (P < .0001). CONCLUSION: Most AHF patients died unless they received liver grafts. Even with a higher priority assigned to them, AHF patients still have little chance to get a cadaver donor liver in Taiwan, and non-AHF patients have an even slimmer chance. Therefore, we need to encourage liver donation from living-related donors.     

Treatment of 209 cases of liver injury

Objective: To summarize the experience of the treatment of traumatic hepatorrhexis. Methods: The clinical data of 209 cases of liver trauma treated in the three affiliated hospitals of the Third Military Medical University from 1989 to 1999 were retrospectively analyzed. Among the 209 patients, 108 (51.7%) had Grade Ⅲ or more severe liver injury. Operative treatment was performed in 186 cases and preservative treatment in 23. Results: In the operated group, 169 patients were cured. The eomplications occurred in 18 patients and 17 of them died. In the non-operated group, the complications occurred in 22 patients and only 1 of them died. Conclusions： Severe injury and delayed treatment are two major factors leading to death from liver injuries.Surgical intervention is still the principal measure to treat traumatic hepatorrhexis. The indications for non-operative treatment should be carefully selected.     

Adult living‐related liver donation for acute liver failure: is it ethically appropriate?

Carlisle EM, Angelos P, Siegler M, Testa G. Adult living‐related liver donation for acute liver failure: is it ethically appropriate?
Clin Transplant 2011: 25: 813–820.
© 2011 John Wiley & Sons A/S. Abstract: Acute liver failure (ALF) results in the annual death of approximately 3.5 per million people in the United States. Unfortunately, given the marked shortage of cadaveric liver donations and the ethical questions that plague utilization of living donor liver transplantation (LDLT) for ALF, many patients with ALF die before a liver is allocated to them. In this review, we discuss how the consistent utilization of LDLT for ALF could decrease the mortality rate of ALF. Additionally, we examine a key underlying issue: is LDLT for ALF ethically appropriate?     

Does model for end-stage liver disease score predict the short-term outcome of living donor liver transplantation?

Objective

The objective of this study was to evaluate the predictive ability of the Model for End-Stage Liver Disease (MELD) score for short-term outcomes after living donor liver transplantation (LDLT).

Patients and Methods

The 135 consecutive patients who underwent LDLT did not include prisoners or their organs. Patients were divided into a low (group A; MELD score <15), a moderate (group B; MELD score ≥15 but <25), and a high MELD score (group C; MELD score ≥25) group according to their preoperative score. We retrospectively analyzed the data concerning complications, biochemical parameters, and survival over 90 postoperative days.

Results

Complications were similar among patients with a low, moderate, or high MELD score. The 90-day survival rates of group A, B, and C were 88%, 90%, and 90%, respectively (P = .960). Compared with groups A and B, group C showed a longer mean intensive care unit (ICU) stay.

Conclusion

Preoperative MELD score may not help to predict short-term outcomes of LDLT. However, a high MELD score may be related to a prolonged ICU stay.